BAY AREA WORKERS’ COMP ATTORNEY
what you need to know to close your workers’ comp case
CALL TO WORK WITH A WORKERS' COMP ATTORNEY
When we first take on a client in a workers’ compensation matter, one of the first things we try to find out is what they seek to accomplish by filing a Worker's Compensation claim. Every injured worker has a different set of goals as it pertains to their case. However, in order to understand what the potential goals are, an injured worker should be aware of the different methods that Worker's Compensation claims are resolved.
In most Worker's Compensation claims, we as applicant attorneys typically seek to maximize 3 types of benefits:
- Medical Treatment
- Temporary Benefits
- Permanent Disability
Typically, Worker's Compensation claims resolve under one of three scenarios:
In a Stipulated Award, an injured worker has been deemed "Permanent and Stationary" and a doctor has determined that there is a specific level of Whole Person Impairment which would convert to Permanent Disability. The California Labor Code provides a table that corresponds to the different levels of Permanent Disability. Depending on the level of Permanent Disability found after rating out a doctor's report, a certain level of monetary value will be assigned to the percentage of Permanent Disability as it corresponds to the table in the California Labor Code.
The California Labor Code will then calculate the number of total weeks paid in Permanent Disability usually paid on a biweekly basis.
If an injured worker elects to settle their case by stipulated award, the parties are agreeing to the percentage of Permanent Disability that should be assigned to that particular injured worker. The defense would agree to pay out the permanent disability over an extended period of time until all of the permanent disability benefits are exhausted.
The benefit to this method of settling this claim is that an injured worker would still be entitled to medical treatment for the injured body parts accepted by the insurance company for the rest of that worker's life.
The downside to this type of settlement is that an injured worker would still have to treat within the Worker's Compensation system and would still have to deal with the rigorous authorization process known as utilization review. In addition, the injured worker would still have to treat within the medical provider network assigned by the insurance company. This often limits doctor choice for injured workers which is not ideal.
Further, an injured worker will be paid over time instead of all at once. For clients that want to move on with her life, settling a case by stipulated award is not necessarily the best method.
However, if an injured worker wants to at least have the option of having medical treatment that they will never be responsible for in the future, this method would make sense for that injured worker.
Compromise and Release
In a Compromise and Release, the case resolves in a method that is extremely final. Using this method to settle a case is beneficial to a client that does not want anything to do with the Worker's Compensation system any longer.
Using this method to settle a case means that you will receive a lump sum payment and the insurance company would no longer be responsible for any further benefits whatsoever. In this particular case, the insurance company would pay out the permanent disability in one payment and would also buy out a negotiated cost of future medical care on top of the permanent disability provided by a doctor.
Many clients prefer this method because they are paid out all at once. In addition, the benefit of settling a claim in this method allows an injured worker to decide which doctors they want to choose rather than working within the framework of the Worker's Compensation system.
The downside, is that if further medical treatment is warranted in the future, an injured worker cannot turn around and request that the insurance company pay additional money. The settlement is final and extinguishes any further rights to worker's compensation benefits upon the approval of the compromise and release by a Worker's Compensation judge.
However, many clients appreciate the freedom of controlling their own destiny as it pertains to their health and not having to jump through the hoops currently set within the Worker's Compensation system. In addition, it acts finality to a client's usually difficult path to recovery.
The vast majority of our clients opt for this method when resolving a claim.
Findings and Award
Finally, if the parties cannot agree to a resolution in a Worker's Compensation case, this matter has to go forward to trial. At that point, a judge will make the decision as to the dispute between the parties and render a decision called a "Findings and Award". In this scenario, the judge will make the decision as to the level of permanent disability and also make a findings of fact as to the injured body parts that would apply to an injured worker's particular case.
After a judge issues a findings and award in favor of an injured worker, the case would be paid out in the same manner as a stipulated award.
In order to determine which option is best for the injured worker, it is essential that our clients communicate with us their goals so that we may steer their case in the right direction.