How Workers Compensation Settlements Work

In 2019, there were at least 2.8 million nonfatal workplace injuries and illnesses by private employers in the United States. Employers also spend at least $62 billion on lost time due to workplace injuries. Workplace injuries do not only cost employers money, but they also cause employees several other losses. This is why employees have a right to claim compensation if they have been injured while at work.

To protect both the employers and employees from the damaging effects of workplace injuries, the federal and state government requires all employers to have workers compensation insurance. This coverage protects employers from lawsuits and ensures employees get fair compensation. Therefore, if you are injured at work, you can talk to an Austin law firm to help you with the claim. 

The Workers Compensation Process

When an employee sustains an injury while at work, they first have to report to their supervisor, manager, or employer. States have a deadline for reporting an injury. This can be anywhere between 72 hours to 2 years. If a worker fails to report the case within the set deadline, they risk losing their compensation.

Once the employee has reported the accident, they should seek medical attention immediately. The employer should then investigate the accident, provide the employee with the right forms that they need to use to file the claim. It is the employer’s responsibility to file the claim with their insurance provider. The insurance company will then review the accident reports and medical files. They can also choose to approve or deny the claim.

What Happens if a Claim Is Approved?

When the claim is approved, the insurance company will proceed to pay or compensate the employee for medical expenses related to the injury. If the employee cannot work, they will receive a part of their wages as a benefit. The workers’ compensation also compensates for temporary or total disability. Temporary disability ceases when the employee returns to work. However, they can still pay for hospital bills such as physical therapy as per the doctor’s recommendations.

Employers can also help employees get back to work through a return to work program, such as offering them light duties. Such programs have additional benefits and encourage employees to return to work. In some states, if an employee refuses an offer to get back to work and handle light duties, they may lose some benefits.

Why a Claim Can Be Denied

Insurance companies give several reasons for failing to approve a claim:

  • The injuries were caused by horseplay or a fight
  • The injuries are self-inflicted
  • The accident did not occur at the workplace or while in the line of duty
  • The employer was violating company rules, under the influence of drugs or alcohol, or was committing a crime at the time of the accident

If a claim is denied, an employee can obtain legal help to appeal and prove their claim.

How the Settlements Are Reached

A settlement can be paid either as a lump sum or structure payment. The payment will depend on each state’s statutes. In a lump-sum payment, the employee will receive a one-off payment for all benefits and medical costs. 

In a structured payment plan, they will receive payments for a specific period of time. The settlements include disability payment, lost wages, attorney fees, future treatments, future wage loss, and more. The employee’s attorney can negotiate the settlement with the insurer to ensure that the employee gets fair compensation. 

The settlement can take weeks or months to get paid. If the settlement is in dispute, the employee can talk to their attorney about other options, such as filing a lawsuit against them. 

Know More About Workers Compensation Claims

If you are injured while at work or in the line of duty, you have a right to claim compensation through the workers compensation act. The laws that regulate this compensation vary from state to state. It may be ideal to talk to a workplace injury attorney in your state to know more about what to do to claim compensation.