When Is the Right Time to Settle My Workers’ Compensation Case?

It starts out with you unfortunately suffering an injury at work, whether it is a physical or mental injury, or an occupational disease. Either you are fortunate enough to have your claim accepted from the beginning, or you fight and win your claim, and then you begin receiving workers’ compensation benefits, wage loss and medical. As time goes by, you are treating and hopefully healing well enough to return to some type of work. Depending on your injury, you may be on workers’ compensation for a period of months or even years. While you are receiving benefits, the workers’ compensation carrier, and specifically your Claims Adjustor, will be trying to figure out a way to stop or reduce your benefits. It is not a matter of “if” but a matter of “when” this will happen.

The initial step to undermine your benefits comes with you receiving a letter advising that you are to attend an Independent Medical Evaluation. The workers’ compensation carrier is permitted by law to have you attend one of these exams every six (6) months, so two (2) times a year. An Independent Medical Evaluation is when the workers’ compensation carrier hires a physician to perform a one (1) time examination of you regarding your work injury. The chosen doctor will receive all of your medical records pertaining to your work injury, and you will be expected to bring all of your diagnostic studies — such as x-rays taken after the work injury, MRIs, CT scans, etc. The doctor will review everything provided, then take a history from you at the time of the examination. After the exam, the doctor will provide a written report to the carrier with his or her opinion as to your condition, relating to the work injury, as well as their opinion as to your work capabilities. Based on the Independent Medical Evaluation (IME) report, the workers’ compensation carrier will then decide whether to take steps to reduce or stop your wage loss and/or medical benefits.

Let’s say that steps are taken through the workers’ compensation legal system to try to alter your benefits. This process will involve a Workers’ Compensation Judge and lawyers. This process could take up to a year in litigation and can be very stressful. The good news is that there is a mediation process to allow the parties to try to settle. In these circumstances, depending on the evidence on either side, it may be the best outcome for you as the individual to settle for a lump sum amount and move on with your life.

Let’s look at the flip side. If the IME doctor found that you are still disabled to some degree, but your employer does not have any work available for you to return to in any capacity, and the workers’ compensation carrier simply wants to be done with your situation, you may be approached about settling. You must ask yourself whether you are done, or almost done, with your treatment for the work injury. The reason for this is that most carriers want to resolve the entire matter — both wage loss and medical — through a full “Compromise and Release Agreement.” This is the name of the settlement document. If you settle too soon, you will not be able to continue having your medical treatment paid for by the carrier after the Agreement is approved by a Workers’ Compensation Judge.

The best way to ensure that you are settling at the right time for your particular situation is to consult with an experienced workers’ compensation lawyer.