October 30, 2019 | Workers' compensation

If you have been hurt at work and you have had your treatment and you’re at maximum medical improvement (MMI), which is a way of saying your condition is stable and not likely to improve, the insurance company may ask if you want to settle. It’s your decision whether or not you settle the case if the insurance company is interested, but you should know about the process and your rights fully before making this big decision. Insurance companies want to close claims for as little as possible, and here are some things you should know before agreeing to settle:

Work comp settlements in Nebraska have to go through a court process, whether you are represented or not. If you receive a check but did not agree to a full and final settlement of your case that was reviewed and approved by the compensation court, you have not settled your case. That means the insurance company still must pay reasonable and necessary medical expenses related to your work injury.

A common situation happens when you’re at MMI and you have an impairment rating and you receive a check, usually it is higher than your checks while you missed work. We get many calls about whether or not employees should accept the check and if they have accepted it, is their case closed. First, the adjuster has to give you an explanation for what the check is for. In most cases it is for accrued permanent partial disability benefits and you may be entitled to weekly benefits for a period after as well.

Don’t hesitate to ask questions; that adjuster is required by Nebraska work comp claims handling standards to tell you what the check is for. Again, your case is not closed until you sign a settlement application (if you aren’t represented by an attorney) and that application is approved by the Court. So if someone suggests you cannot receive treatment that your doctor thinks you need because of a work injury after you cash the permanent disability check, that is not likely true and you should consult an attorney.

How do you tell if what the insurance company has offered is a fair amount? Work comp settlements are based on consideration of a few things. First, if your claim is accepted, did the insurance company pay all of the medical bills and reimburse you for out of pocket expenses and mileage? If not, settlement should include that reimbursement and mileage and the insurance company should pay the bills related to the injury. Second, were you paid for time off (temporary total or partial disability)? If not, the amount owed for that should be included.

Third, if you injured a scheduled member (this is the legal term for parts of the body that fit the compensation schedule; the most common members are shoulders and knees, for example), did the doctor give an impairment rating and, if so, does the settlement include the value of the scheduled member impairment (this is a mathematical calculation based on your wages before you were hurt and the % of impairment)? Did your doctor say it was more likely than not that you would require some kind of medical treatment after MMI? If so, the settlement should include some estimated value of future medical treatment.

With body as a whole injuries, permanent disability is determined based on lost earning capacity, which is different than physical impairment. Body as a whole injuries are generally, head, neck, and back injuries; they are injuries that do not fit the listed members in the statutory schedule. Lost earning capacity is determined first by restrictions. So if you receive a settlement offer based on impairment (like 5% to your back) but you are restricted and cannot return to work doing what you did before, you should consult an attorney for advice on what to do or whether what they have offered is fair under the circumstances.

Many work comp attorneys, including those at our firm, offer a free consultation to help you understand the settlement process and see if what is being offered is fair. If so, you don’t have to retain an attorney and pay a fee. Even if the initial amount offered is not enough and you do need an attorney to help, we only calculate our contingent fee based on any amount over what you were offered. So the fee applies only on what extra recovery the attorney gets for you. It is a good idea to meet with someone if you’ve been offered a settlement.

Finally, there are some reasons that you might not want to settle or might want to wait awhile before settling even if you’re offered money from the insurance company. First, if your work injury is going to require ongoing treatment or a likely surgery, it might be more to your benefit to have the insurance company continue to pay the medical benefits as you go rather than estimating future medical cost and paying it yourself. Also, if you lost your job because your employer couldn’t accommodate your permanent restrictions, you might be entitled to a benefit called vocational rehabilitation that would help you get a new job with job placement help or go back to school to be trained in a different type of career. If you settle your case, you would not get that benefit, which is one that can help you for the rest of your life, and you should really strongly consider the pros and cons of giving it up or participating.

Whether it’s in your interests to settle your workers’ compensation case is extremely dependent on the facts of each unique case, and a lot of things can determine what is a fair amount. There are risks and benefits of settling and not settling. It is often a good idea to talk it through with an experienced work comp attorney to see what is best for you under all of the circumstances.

If you have questions about whether to settle your workers’ compensation case generally or because you received an offer from the insurance company, contact our office to set up a free consultation. We can go through any questions you have so that you’re empowered to make the best decision under all of the circumstances. Give us a call 402.933.3345.

Workers’ Compensation Claims