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How to Maximize Your Workers’ Comp Settlement


Without money from a workers’ comp settlement, it can be hard to pay medical bills that come from a work injury. In order to build a strong work injury claim, get fair compensation, and get the best settlement possible, there are some steps you need to take. There can be problems that come from the workers’ comp insurance carrier. Insurance carriers are for-profit businesses that want to avoid large payments.

Get Immediate Medical Care

If you get injured on the job then you need to make sure you get immediate medical attention and not wait to see if you will feel better in a few days. If your supervisor wants to call an ambulance for your injuries or take you to the company nurse then be sure you let them. Any delay in medical care for a work-related injury will give the insurance company a reason to deny your claim and you definitely won’t get the maximum settlement you could be entitled to. If you don’t get immediate care then the insurance company could say that the injury didn’t even happen at work, or that you couldn’t be hurt that badly if you waited to seek medical care.

Notify Your Employer of the Injury as Soon as Possible

There isn’t a good reason to put off telling your employer you were hurt on the job. The longer you wait, the harder it’s going to be for your employer or the insurance company to believe that your claim is legitimate. You need to report the injury to your employer, even if you think there will be consequences, such as getting in trouble or losing your job. Keep in mind it’s illegal for your employer to fire you or harass you for reporting your injury and filing a claim.

File Your Claim in a Timely Manner

Just because you told your employer doesn’t mean you have filed a claim. You will need to do both in order to qualify for benefits. You are entitled to compensation for lost wages and medical expenses. There can be certain deadlines for filing a claim depending on your location. Missing the deadline will cause you to lose out on rights to your claim. After you have notified your employer, you will be given a claim form for workers’ comp insurance. Be sure to fill out the form accurately and completely. If your injury has caused you to be groggy or in too much pain then ask a family member or trusted friend for some help. The form is going to be the official notification you give to the insurance company. A messy or incomplete form can slow down the process and can cause issues with your claim. Be sure the form is sent to the correct person on time.

Select Your Doctor

Each location has its own regulations and rules regarding the choice for doctors for workers’ compensation injuries and you will most likely have to pick a physician authorized by the employer’s insurance company. However, you may only have to stay with the doctor for a limited time. If you aren’t comfortable with the treatment or care you get then you are allowed to change doctors. You just want to make sure that you let the insurance adjuster know before you change doctors and start treatment. Unfortunately, the insurance company doctors could have a conflict of interest. The doctor may have a desire to keep getting money from the insurer and this could affect the way the injury is treated. For example, the doctor could clear you to go back to work before you are healed or deny a more expensive test, such as an MRI. You will need a doctor to give you an honest disability rating for your injuries, even if it does cost the insurance company money.

Understand the Worker’s Comp Disability Rating

Work injuries often mean there is some form of lasting disability that may prevent you from working for a certain time. There are four different categories you should be aware of. Temporary total disability is a disability that prevents you from being able to work for just a certain time period. Temporary partial disability is one that prevents you from performing just some of the work-related duties for a certain time period. Permanent partial disability is a disability that will permanently prevent you from performing some work-related tasks. Permanent total disability is one that will prevent you from ever being able to work again, regardless of your job or employer. If you are left with any sort of permanent disability then your doctor will assign a score based on the severity. The severity score will range from 5% to 100%. Any permanently injured worker may also be eligible for lifetime wages in order to replace wages lost from the injury.

Always be Consistent and Specific with Your Report

You will need to be ready to describe in detail just how the accident happened. You will need to tell every medical provider you speak with exactly how you were injured on the job and you want to be specific and consistent with your account. You shouldn’t make excuses for your symptoms or injuries. The insurance company has experts on staff who will go over every single aspect in your report and medical record to find a reason to limit compensation or deny your claim entirely. The insurance company is also going to be on the lookout for any pre-existing conditions in order to have a reason to deny your claim. This doesn’t mean you should hide any previous condition or injury, but make it clear you didn’t have any symptoms before the accident. The more details you can include, the better.

Give Limited Medical Authorizations

You shouldn’t give the insurance company just a general release for your medical records. Your mental health history and medical history aren’t any of their business. Be careful before you sign any authorizations from someone hired to represent the insurance company. They may try to have you sign one through a worker’s comp doctor or a vocational counselor. The authorization you do sign should state it’s only for the records related to the work-related injury and dated after your accident. The insurance adjuster may try to scare you and say that you have to sign the authorization or you lose your benefits. If you are having problems then you can work with a worker’s comp attorney in order to help advocate for yourself.

Keep in Mind You Are Being Watched

The insurance company is going to be watching your every move. This may actually even include hiring private detectives to follow you around. These private investigators could catch a video of you walking to the mailbox, picking up a crying child, or unloading your own groceries from the car. The insurance company can then use these videos to end your benefits and say that you aren’t as injured as you claim. Other ways the insurance company can watch you is with social media, your medical records, and appointments. Any images and comments about you on social media can be fair game. Your therapy and medical records will also be looked at. Medical staff will note if you don’t take medications or follow instructions. Your benefits may end if you miss appointments.

Be Prepared for an Independent Medical Exam (IME) 

You may be asked by the insurance company to undergo an IME. Most of these exams are requested after a worker has reached Maximum Medical Improvement. This means that you won’t get better even with further treatment. After reaching this point, the doctor can give you an impairment rating that qualifies you for permanent benefits. Before you get these benefits, you will get this exam done as a second opinion. You may want to consult with a lawyer if you are being asked to undergo this exam. The doctor for this exam works for the insurance company so you don’t get any medical treatment, and the purpose of the exam is to get an opinion on whether you are able to go back to work.

Keep Detailed Records of Everything 

A successful claim that maximizes your benefits starts with excellent recordkeeping. Keep copies of everything you have filled out. You should have detailed notes of every message, phone call, or just attempts to speak with the insurance company. Out-of-pocket expenses are usually reimbursable so you need to keep receipts of over-the-counter meds, parking lot fees, and driving you do to appointments. Keeping records of everything can help maximize your settlement.

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