Health Care

The Benefits Available In Your Workers’ Compensation Claims

When we talk about the benefits that you can receive as part of a Workers’ Compensation case, they can be broken down into two different categories: medical compensation and disability compensation.

Medical compensation involves payment to doctors for treatment as it is provided.

In cases where an employer and insurance company have accepted liability for your injury…

They will pay your doctors as medical treatment is needed.

In cases where an employer and insurance company have denied liability for your injury…

You would submit a record of past and current medical treatment as part of the trial for benefits. During trial, you would request that the unpaid medical bills be paid, any out-of-pocket expenses for medical treatment be reimbursed, and that the employer and their insurance company be responsible for payment for any future medical treatment as it occurs.

Disability compensation, the other category of benefits, can be broken down into three forms…

1.) Temporary Total Disability

This comes into play when a doctor indicates that due to your work injury, you are unable to return to work in any capacity. Or, when a doctor assigns work restrictions that make it impossible for an employer to bring you back on, and you can’t find new employment despite making reasonable efforts to do so.

Temporary total disability benefits are generally paid on a weekly basis. The amount you are paid is determined by your pre-injury average weekly wage. This is found by averaging all wages, overtime, bonuses, and compensation paid to you each week (before taxes) in the year prior to the date of your injury.

The amount of your temporary total disability will be two-thirds of your pre-injury average weekly wage. This is paid to you tax-free, and will likely come out to slightly less than what your take-home pay was prior to your injury.

2.) Temporary Partial Disability

These benefits are possibly available if your doctor is not preventing you from going back to work, but is imposing certain work restrictions. To qualify, you must only be able to find work that accommodates these restrictions and pays less than your pre-injury average weekly wage.

Temporary partial disability may entitle you to weekly or bi-weekly payments. These payments will be calculated using your pre-injury average weekly wage and your current wage. To the extent that there is a difference, you could receive two-thirds of the remaining balance tax-free.

3.) Permanent Partial Impairment Rating

This is possibly available when your doctor determines that you have sustained a permanent injury to a particular body part, but the damage hasn’t caused you to be completely disabled.

In these cases, you will be assigned a permanent partial impairment rating. This is done in two parts.

First, your physician will address your impairment by assigning a percentage of disability. Second, North Carolina Workers’ Compensation law describes a set number of weeks during which you can receive benefits based on the body part that was injured.

Therefore, to determine the amount you are eligible to receive, you will multiply the number of weeks’ worth of benefits allowed for the injured body part by your percentage of disability. The resulting figure will equal the number of weeks of benefits you may receive due to the permanent injury.

It’s important to keep in mind that your permanent partial impairment payment is not meant to replace wages or compensate you for reduced wages. Instead, this payment is made to compensate you for the permanent injury you sustained as a result of an accident at work.

Settlements

One option to resolve your Workers’ Compensation case is the pursuit of a settlement. But there are a few things to keep in mind when considering this option…

There is no requirement for a Workers’ Compensation case to settle. Additionally, the North Carolina Industrial Commission cannot order a settlement. This means that settlement only occurs if both parties want to settle the case and can agree on the settlement amount.

Because neither party can force the other into a settlement agreement, a settlement often involves negotiations. This process often starts with the employer and their insurance company coming in with their lowest offer, while you and your attorney start at your highest offer.

It’s only through negotiation between the parties that a conclusion can occur. Through this conclusion, the parties either:

1.) Agree to terms of settlement.

This involves a lump sum payment in exchange for the employer being released from any further obligation to pay Workers’ Compensation benefits.

2.) Are not able to reach a settlement agreement.

In this case, both sides walk away from the negotiations as if they never occurred.

So anytime this issue of settlement comes up, you need to confirm that both parties are interested and that they may be able to reach the terms of a settlement.

Why? Just because the parties are talking does not mean that case is going to settle. It only means that they are trying to explore whether they can potentially agree to terms of a settlement.

In Workers’ Compensation cases, settlement generally comes up in situations where the employer and insurance company are concerned that if they don’t settle the case, there may be further benefits to pay in the future.

For example, you often see settlements come up in cases that are initially denied, and benefits are yet to be paid. In these situations, the parties will discuss the potentiality of reaching a settlement during pre-trial mediation.

In other instances, settlement may come up when an employer and insurance company have paid benefits, but the doctor then assigns a permanent restriction to the injured party which do not allow a return to work for the employer or any other employer. In these cases, a settlement may be discussed to offer a lump sum in lieu of paying benefits into the future.

Now, there’s nothing wrong with settling Workers’ Compensation cases.  In many instances, it may be in someone’s best interest to settle their Workers’ Compensation case.  The one critical fact is making sure that that settlement adequately covers any additional benefits that are owed. And that’s where the attorney gets involved.

Anytime an attorney is involved in a case and the issue of settlement comes up, they’ll need to perform a settlement evaluation.  This evaluation allows your attorney to provide a good estimate of what benefits would be owed if the case didn’t settle — whether that’s through medical or disability compensation.

A settlement evaluation is particularly important because it provides you with the information required to determine whether a settlement will sufficiently meet your needs.

In reality, any case can settle.  An insurance company would likely settle every case in the world if they could. The critical factor is: How much are they willing to settle for?

The answer to this question ultimately decides whether or not a settlement is possible. Will it adequately compensate you for the benefits you are entitled to? Or will it confirm that you are better off continuing to receive or fighting for ongoing benefits that will provide you with financial support into the future? The choice, when given to you, is ultimately yours to make.

For more information Benefits Available In Workers’ Compensation Claims, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (833)444-4127 today.

Skip to content