Learn how Georgia insurers calculate the value of your
work injury claim
When a person has been injured on the job, one of the many issues they may have to confront is whether to seek ongoing workers’ compensation benefits or to settle their case. Your employer’s insurance carrier isn’t obligated to make a settlement, so you may wonder:
Will the insurance company offer me a workers’ compensation settlement?
Let’s take a look at why they might make an offer and how you should address it.
What drives an insurance offer?
The main motivation for an insurance carrier to make a settlement offer is if the adjuster believes that paying out the case could lead to long-term financial exposure. On their end, it’s often better to get the matter settled and pay one lump sum or set up an annuity. This judgment will usually be made by an insurance adjuster, who is a professional appointed by the insurance company to assess the validity of the claim and decide how to pay it out.
Presuming the claim is valid, a handful of factors will influence the final settlement amounts. These factors include:
- The total cost of your medical bills to date
- Any disabilities benefits you might be entitled to (especially if there’s a permanent disability)
- The projected future expenses
- Whether you were reassigned to a lower-paying job or can’t work at all
Learn the advantages and disadvantages of accepting a settlement offer from your employer’s workers’ comp insurance company.
Considering future medical expenses in your claim before accepting an insurance settlement is crucial. While it is fairly straightforward to add up past medical bills, it’s the unknown future costs that lead to problems. Accepting your settlement early can be costly in in the long run.
How do insurers calculate a workers’ compensation claim?
Every offer should include full coverage of your medical expenses to date. This will include compensation for things like doctor visits, drug costs, surgeries, consultations and therapy.
When thinking about projecting future medical expenses, you should seek what’s sometimes referred to as “maximum medical improvement” or MMI. This means you should seek compensation that’s sufficient to pay for physical and occupational therapy that will maximize your future mobility, employability and enjoyment of life.
It’s also worth discussing whether you can settle other parts of your case while maintaining your right to have the insurance company cover ongoing medical expenses.
Calculations for lost wages and future earnings are usually based on a percentage of your wages at the last position you held. If you are still employed and were assigned to a lower-paying position, you may still be able to recover some of the difference between your previous pay and your current wages.
Permanent disability benefit calculations
One of the main motivators for an insurance company to make a big settlement offer is a permanent or very lengthy temporary disability. If you have a permanent disability, it’s critical that you not jump at whatever first settlement offer might come your way.
Review the offer with an attorney and think about your future. It’s important to consider how much value will be attached to the loss of your:
- Physical and mental capacities
- Ability to enjoy life
- Capacity to parent any children you might have
- Right to be gainfully employed in your trade
- Consortium with your spouse (if you have one)
You should also think about just how expensive something like long-term care might be. It’s important that the settlement amount is sufficient to cover your current medical bills, future care and legal expenses. Also, assume a low rate of return on any money you might put into a financial account.
What factors push a workers’ compensation settlement even higher?
When it comes to workers’ comp settlements, there is no substitute for a well-prepared initial claim. The adjuster simply needs to get a lot of information and be able to process it. Working with an expert attorney who is skilled in your case area is a good way to see that all the paperwork will be well-organized. That means making sure the adjuster has ready access to medical and incident reports, tables of expenses and details about your wages prior to being hurt.
It’s also normal for a lawyer to have their client document their situation. For example, an attorney may ask you to keep a journal outlining your pain and suffering. This will help the adjuster get a sense of what your situation is really like and what your long-term recovery prospects might be.
Negotiating your insurance offer
A well-organized claim also makes it easier for you to process the potential settlement offer. You’ll have a clear idea of what your target settlement is, and that will help you to understand just how far off the negotiation might be.
Note that the first settlement offer doesn’t have to be rejected out of hand. While it’s smart to play hardball and not bite on the first offer if it’s weak, there’s no reason to delay compensation if the insurance company is offering everything you want in the first round. Just be careful that you aren’t being taken advantage of by miscalculating the actual value of your work injury claim.
When to contact a Georgia workers’ compensation attorney
Working with qualified legal counsel is the best way to reduce some of the potential challenges in your case. A properly organized and articulated workers’ compensation claim will often encourage an adjuster to consider settling. The important thing is to focus on the details and make it clear that you know what your case is worth. In this regard, Gerber & Holder Law is here to help you.