Settling workers’ compensation claims for injured workers
The workers’ compensation law in Georgia encourages settlement whenever possible. Cases can even be settled before you physically recover from your injuries. But in most cases, we believe that injured workers should settle after their medical conditions have stabilized. This is a practical consideration so that workers shift the majority of responsibility to the workers' compensation carrier. However, "living" on workers' compensation benefits is very difficult, and injured workers have to consider very factors when closing or settling their claim
The settlement procedure
In Georgia, the law cannot force either of the parties to settle a claim. In fact, all workers' compensation settlements must be approved by the State Board of Workers' Compensation. Therefore, the idea of "settlement" or "resolving" a claim must come up organically from one or both parties.
If there is sufficient interest from both parties, the injured worker submits a settlement demand to the insurance company. This demand is a starting point for the parties to negotiate a settlement figure and terms necessary to close the case. The insurance company may reject or accept the demand or counter with a new offer. Negotiations will ensue until both parties have agreed on a settlement amount.
Again, a workers’ compensation settlement in Georgia is purely voluntary. The judge or State Board official cannot force you or the insurance company to settle the claim. Both parties must agree to the settlement terms and conditions.
Georgia workers’ compensation cases where income benefits were paid generally settle on a compromise liability basis, where the parties agree to foreclose on future liability and risk. Alternatively, in matters where no income benefits are paid, the employer/insurer will generally insist on settling on a "no-liability" basis disputing its responsibilities under the Georgia Workers’ Compensation Act in exchange for a lump sum of money.
Workers’ compensation settlements generally release the employer from all liability related to the occupational injury, including wage loss benefits, vocational rehabilitation services, and the right to medical treatment. Most insurance companies also require a complete separation of employment and waiver of all other potential claims related to the employment relationship between the parties.
As informed consent is paramount in the closure of the claim, legal consultation is highly recommended when the injured worker is dealing with head or neurological trauma. Contacting a head and brain injuries lawyer can provide essential guidance in these specialized matters.
While rare, the parties may also cancel the settlement at any time before the Workers’ Compensation Board approves the settlement agreement. However, once a judge approves the settlement, it cannot be canceled generally. As the injured worker, you are entitled to payment after 20 days once a judge approves the agreement.
Terms of agreement for the settlement
The terms of the agreement will determine the distribution of settlement money. Several items may be subtracted from your settlement such as:
- Unpaid and unauthorized medical bills;
- Attorney’s fees;
- Unpaid child support;
- Litigation costs and expenses;
- Overpayments; and
A portion of the settlement money may also be set aside for future medical treatment related to the work injury.
Should You Settle a Workers' Comp Claim?
Settling a workers' compensation case is a decision that requires careful thought and shouldn’t be rushed. There are many factors to weigh before agreeing to a settlement offer. For instance, you should consider (1) your future healthcare needs, (2) the availability of suitable employment after the claim is resolved; and (3) pursuing additional education or training.
In many cases, the authorized treating physician may help you determine what future medical treatment will be necessary, what the cost of it will be, and whether you will be able to return to gainful employment. However, it may be prudent to secure a second opinion to ensure your health is protected.
What Are the Benefits of Settling a Claim?
While settling your workers' compensation claim isn't always the best option, it can offer several advantages. One major benefit to settlement is the power and freedom to see any physician you choose, unlike the restrictions you face during the claims process. No one is going to care more for you than yourself and having the discretion to treat with your own physician is powerful. Furthermore, the sense of closure that comes with finalizing your case leads to greater peace of mind. If your settlement provides you with a lump sum of tax-free money, it can grant you greater flexibility in how you move forward with your life, whether you choose to pursue further education or explore new career opportunities. This lump sum also means no more waiting for regular weekly or bi-monthly checks.
Is a Judge Involved in the Settlement Process?
The workers' compensation settlement process typically happens outside of the courtroom. Most of the time, your attorney and the employer or insurer’s attorney will communicate via phone or written correspondence. An administrative law judge won’t be involved in these talks, and you won't need to present your case to them. However, if you’re attending a settlement mediation conference at the State Board of Workers' Compensation, a judge may serve as a neutral mediator to help facilitate the settlement. Keep in mind, though, that this mediator will not be the judge handling your case if the settlement talks break down.
What Happens to My Health Insurance After I Settle a Claim?
In nearly all workers' compensation settlements, the employee is required to resign from their position with the employer as a condition precedent. For many individuals, this means giving up any benefits he or she previously received, such as health insurance and other fringe benefits. Hence, it is incumbent upon the injured worker to secure alternative health insurance outside of his or her employment or workers' compensation.
Settling a workers’ compensation claim: FAQs
Can I Still Receive a Workers' Compensation Settlement if I Was Fired?
In Georgia, you may be fired by your employer at any time; however, this does not bar you from receiving a settlement or continued workers' compensation benefits. If you are considered to have a disability arising out of and in the course of employment, your entitlement to workers' compensation benefits continues until formally closed by the State Board of Workers' Compensation. Interestingly, if you are fired while having documented impairments, you may also have rights under the Americans with Disabilities Act that may be worth exploring.
What if My Company Closes?
Even if your employer closes its doors, you may still receive workers' comp benefits (and a settlement) as the insurance company's liability continues to remain responsible. In other words, the insurance provider is typically responsible for handling any workers' compensation claims, even if the business is no longer operational.
Can Surviving Family Members of a Worker Who Died on the Job Receive Benefits or Even a Settlement?
Yes, surviving dependents may receive Georgia workers' compensation benefits if the injured worker was killed due to a work-related injury or illness. In Georgia, the workers' compensation system provides death benefits to surviving spouses, children, or other dependents in most cases including reimbursement for funeral and burial expenses up to a certain extent.
Work with injury lawyers who care
Filing for workers' compensation benefits and negotiating a workers’ compensation settlement demands legal skills and knowledge. A lawyer and trained professionals will always represent the insurance company, and you will be disadvantaged if you do not have an experienced and dedicated attorney at your side.
We are committed to maximizing your claim and securing the best possible results. Ramos & Law will care for you and your family through the process. Schedule a consultation today with one of our trusted lawyers.
Client-Focused Representation
Unlike many workers' compensation law firms, our Firm’s focus is on the injured worker’s current well-being, best possible recovery, and life after the claim. If Ramos & Law accepts your case, we will put your interests before ours. As a client, you will have a dedicated legal team working to provide you with the best possible options for you and your family. You will not be “just another client." We will understand your medical care plan and create options for having the best quality of life during and after the claim.
Driven By Honesty
At Ramos & Law, we pride ourselves on making a genuine connection with our clients. We will not promise you miracles or provide you with a “sales pitch.” We believe that if you have been injured at work, the last thing you need is someone who will be dishonest with you. If we accept your case, that means we believe in you, and we believe we can help you maximize your claim. It means we will care about you and your family, and we will stand up in court for you. If we do not recover for you, we do not get paid.
Client Reviews & Testimonials
REPRESENTATIVE CASES
These case studies are not meant to promise or guarantee a certain or similar result, but rather to demonstrate the legal attention and work ethic our attorneys assert in our cases. Every case is different and is fact sensitive. Certain facts can greatly influence and determine a client’s award, outcome, and recovery. Injuries to the back and neck are common, but trauma to the head may require assistance from a head and brain injuries attorney for specialized claims.
Back Strain
An employee worked for a manufacturer of outdoor power products in Middle Georgia. His job required him to pull pallets of material across the work area. As a result, he experienced a back strain. The manufacturer denied the claim and contested his need for medical care. Ramos & Law was able to secure helpful diagnostic scans and meaningful medical care for the injured worker. After a few months of litigation, the parties reached a settlement of $65,000 with a complete resolution of all outstanding medical bills.
Foot Injury
An employee was stocking heavy merchandise for a large retailer in Columbus, Georgia. During the course of her job duties, a stocking cart of the merchandise fell on her right foot and great toe. The national retailer directed her to its company doctors but she received very little relief. The attorneys at Ramos & Law were able to navigate her medical care to more qualified doctors where she received a better overall results. As she reached maximum medical improvement, the large retailer settled the claim for over $100,000 and paid for all of her past medical treatment.
Failed Back Syndrome
An employee was working part-time for a large automotive parts store. The employee fell off a ladder injuring his teeth, neck, ribs, and low back. After exhausting conservative medical care, physical therapy, injection regimens, and medication, it became clear that this injured employee required the need for spinal surgery. While the insurance company fought the surgery, Ramos & Law was able to force the insurance company into paying for the surgery and associated therapies including the implant of a spinal cord stimulator. Given the severity of the injury, Ramos & Law was able to refer the client to a federal disability benefit specialist who assisted him in securing Social Security. This part-time employee settled his case for $185,000 plus almost $300,000 in future medical care.
Low Back Herniations
A pediatric physician injured his back while assisting a child off an examining room table. As a result, the physician herniated several discs in his spine which also triggered depressive mental episodes. While the insurance company denied medical coverage for his numerous symptoms, Ramos & Law was able to secure quality medical care for the employee including orthopedic care, psychiatric treatment, a spinal cord stimulator, and physical therapy. Additionally, the employee received on-going income benefits at the maximum workers' compensation rate. At the end of the case, the matter settled for a figure close to $250,000 in addition to payment of previous medical bills.
Shoulder Injury
An employee at a beverage maker in Atlanta was stocking heavy cases of merchandise when she felt severe neck and shoulder pain. It was revealed that she suffered a torn rotator cuff. While the beverage maker initially denied her medical care, Ramos & Law was able to convince the employer to approve her treatment plan and accept the case. After months attempting to return to work, it was clear that the employer was not able to accommodate her medical limitations. As a result, the case settled for $115,000, along with all her medical bills being paid.
Severe Burn
A part-time grocery employee fell into a tub of “degreaser” that caused severe third degree burns over his torso and buttocks region. The employee required immediate medical care and several weeks in the intensive care unit within the local burn center. The costs of the care reached in the millions of dollars. While the grocery store denied liability for the accident, the attorneys at Ramos & Law were able to secure a settlement of $250,000 in addition to the employer’s acknowledgment to pay for all past medical bills.