How Do Workers’ Compensation Claims Get Settled?

How Do Workers’ Compensation Claims Get Settled?

Having an accepted workers’ compensation claim is a long and often physically and mentally demanding process.  Not only are you getting paid only 2/3 of your average weekly wage, but you also do not have a say so in selecting which doctor is coordinating your medical care, or doing surgery on you.  Quite often family relationships get strained due to money issues, and because the injured worker feels he, or she, is no longer a contributing member of the household.  Some workers’ compensation cases go on for years through multiple surgeries, rehabilitation, and vocational rehabilitation.  But, what happens when the authorized treating workers’ compensation physician reaches the point where you are as good as you are ever going to be?

Generally, a workers’ compensation case can settle one of two ways.  You can settle on what is called an open agreement, referring to you not closing out your right to future medical care paid for by the workers’ compensation insurance carrier, or your employer.  You can also settle on what is called a clincher, or compromise settlement agreement.  These full and final agreements will typically compensate you for a higher sum than an open agreement because you are “clinchering,” or waiving your right to future medical care, and sometimes weekly indemnity payments. Often, as part of a compromise settlement agreement, you are required to sign an employment release and resignation from your employer.  Sometimes this is not a big deal as you either voluntarily quit, or took a new job.  It becomes more complicated if you are nearing a year in which your retirement becomes vested, or are so close to retirement age that any likelihood of working elsewhere is slim to none.

So, which way of settling your workers’ compensation case is best?  There is not an easy quick answer to this question as no workers’ compensation case is exactly the same.  If you had the type of injury where you returned to work with your employer relatively quickly, then an open agreement is usually done.  The exception to this is if your company has switched workers’ compensation carriers since you were injured.  Then, the old workers’ compensation company that is still responsible for your claim often wants to have you close out your workers’ compensation claim so that they can close their file.  Of course, you do not have to do this if you do not want to.  If you do an open agreement, different states have different options for giving you a chance to have someone else opine on the disability rating that your settlement is calculated on.  In North Carolina, you have a statutory right to a second opinion on the disability rating with a physician of your own choosing.  The workers’ compensation carrier has to pay for this visit, and the North Carolina Industrial Commission, the state agency that regulates North Carolina workers’ compensation, will typically average the rating of the workers’ compensation physician, and the physician you chose, to come to the amount of your compensation.  In South Carolina, while there is no right to a statutory second opinion on the rating, you are able to go in front of a hearing commissioner of the South Carolina Workers’ Compensation Commission, and they get to decide your percentage of disability, or impairment.

The decision to clincher, or fully and finally settle your workers’ compensation case is often a complicated one.  You may not know what future medical treatment you are going to need.  You can, of course, clarify this with the workers’ compensation physician, but some people don’t want to make a decision without an unbiased second opinion.  Some folks will see a physician entirely outside of workers’ compensation to get this type of confidential opinion.  But, if you don’t have the means to see a physician outside of workers’ compensation, you are not going to have this option.  So, you are going to ultimately have to bet on yourself in terms of when you will be able to return to work, if at all, and what kind of medical treatment you may need in the future.  Also, though it may be possible for you to return to work, your employer may not want to bring you back for fear that you will get injured again, or they have simply filled your job in the interim.  Nothing requires them to bring you back to the job, or provide another that meets with your permanent restrictions.  If they don’t have a job that meets your permanent restrictions, that is just one factor that determines what the workers’ compensation insurance company looks at in terms of evaluating your case for a full and final settlement.  They will also look at the doctor’s final note, and see what future medical treatment he, or she, is recommending.  Many workers’ compensation insurance companies would rather offer a lump sum than stay on the hook for your medical care in the future.   As you may have guessed, figuring out what to do when you are trying to close out your workers’ compensation case can be quite confusing.  Making a decision that literally may affect the rest of your life should not be made without consulting an attorney that practices in the field of workers’ compensation.

If you have a workers’ compensation case, and you have reached the point in your case where it is time to resolve it one way, or the other, please pick up the phone and call Tippens & Zurosky.  Trying to settle a workers’ compensation case on your own can be difficult, especially when the workers’ compensation insurance company is in business of settling claims, and you are not!  You need someone to look out for you, so call Tippens & Zurosky, so we can be your voice, answer all of your questions, and help you resolve your claim!  Tippens & Zurosky has knowledgeable, experienced attorneys certified in North Carolina and South Carolina, who can fight for your rights during this often long and difficult workers’ compensation process.  Call us toll-free at 877-872-3580, or at 704-343-0018, for a free consultation. Let us help you!


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Why Should I Call Tippens & Zurosky? 704-343-0018

Our legal fee is a percentage of your case settlement.  Unlike domestic, or criminal, lawyers, who work on a nonrefundable retainer, there is only a legal fee if we are able to negotiate a settlement on your behalf.

Insurance companies set what is called a reserve for every claim. A reserve is simply the amount of money they think they are going to have to pay to settle your claim. Naturally, if an attorney is involved the reserve is generally set higher to account for the fact that the attorney can file a lawsuit on your behalf, and litigate the claim.

We are in the business of dealing with insurance companies, so let us talk to them on your behalf. Insurance adjusters are trained to help save their companies money, and sometimes this is at your expense. Let’s face it if an insurance company can find a way to not pay on a claim, they are going to do so. It’s good business for them and bad news for you.

Many people injured in automobile accidents or injured at work are afraid to get medical treatment because they are afraid that they are going to get stuck with the bill.  We can analyze your case for any risk of denial, and also refer you to chiropractic physicians that will not charge you upfront for their services, and will wait to get paid at the end of the case.

Whether you were on a motorcycle, were a pedestrian, or in a car, we can help you.  We handle rear-end collisions, head-on collisions, intersection, or right-of-way cases, drunk driving, or reckless driving cases, and every other type of automobile accident.  Also, if you were in an auto accident while on the job, we can take care of this for you.

Though our main office is in Charlotte, North Carolina, we represent people injured in automobile accidents that occur all over North Carolina, and South Carolina.

Calling Tippens & Zurosky as quickly as you can after you have been involved in an automobile accident, lets us file your claim with the insurance company, so you don’t have to speak with them.  The sooner we can get involved, the sooner we are able to protect your rights, preserve the evidence, and get you the medical treatment you need.

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