Four Things to Remember When Settling a Workers Compensation Claim: Future Employment, Future Medical, Voluntary Resignations, Strategy Considerations

Four Things to Coonsider When Settling a Workers Compensation Claim: Future Employment, Future Medical, Voluntary Resignations, Strategy Considerations

1-Availability of Future Employment in the Marketplace

In the industries where employees perform physical labor, one of the obstacles to the successful settlement of the work comp claim is the ability of the employee to return to work with their disability. For instance, the employee’s prior job required the employee to lift 50 pounds, and now the treating physician has given the employee a permanent 25 pounds lifting restriction.

The adjuster needs to work with your workers’ compensation coordinator to determine if there are other positions within your company to which the employee with permanent disability restrictions can transfer. This option is usually much lower in cost than having to retrain the employee to perform another type of work for another employer. Rehabilitation cost can add up quickly with no benefit to your company if you are required to re-train the employee who will then go elsewhere for employment.

2-Voluntary Resignations

If the consensus is the employee will be a continuing problem (either from a work comp standpoint or for other reasons) if the employee returns to your workplace, a voluntary resignation in conjunction with the work comp settlement might be the best approach in those states allowing it. If the employee’s resignation will require additional financial consideration, then the cost and benefits of the employee not returning should be weighted and evaluated.

Some states prohibit the discharge of an employee or the voluntary resignation of an employee in conjunction with the settlement of the work comp claim. Such actions are viewed as a retaliatory discharge and can result in large fines and/or litigation. Therefore, it is essential to know the work comp statutes in the state where you have an employee who you don’t want to return to work. Resource: http://reduceyourworkerscomp.com//laws_and_regulations.php

If voluntary resignation from employment is desired, have your legal department prepare a release of all future claims. Execution of a release should be mandatory; otherwise the employee can take the settlement, then turn around and reapply for a position at your workplace. Make sure to include the provision for releases in your account handling instructions.

3-Value of Future Medical

A tactic commonly used by plaintiff attorneys is to overstate the value of future medical. Your medical director should review any estimate of future medicals over a predetermined limit set by your Risk Management Department. Often it will be necessary for the medical director to consult with both the treating physician and the IME doctor to pinpoint what is necessary and what is fluff in the future medical estimate provided by the plaintiff’s attorney.

Once the medical director establishes what is needed for future medical care, the adjuster and/or defense attorney should resist budging from the amount, even if it necessitates adjudicating that aspect of the claim with the workers’ compensation board.

4-Strengths and Weaknesses of Both Sides

When it comes to settling your workers’ compensation claims, an experienced adjuster who can properly evaluate the pros and cons of the claim is your best asset in obtaining a fair and appropriate financial resolution of the claim. You want an adjuster who will fight the good fight when there are reasons to either deny or mitigate the claim.

You do not want the adjuster who takes an unsustainable position on a claim. On average, this creates more in legal expenses then you save in reduced cost of the claim.

Author: Robert Elliott, Esq., [email protected]

By: private investigator with 25 years experience.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.

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