Every state requires employers who hire employees to carry workers’ compensation insurance. This coverage pays employees for both medical bills and a percentage of income lost due to their inability to work. It’s a proven useful method for helping employees recover and get back to work faster.
Situations Covered by Workers’ Comp
Workers’ comp is a great solution for speeding up recoveries post workplace injuries and illnesses. It’s also helpful in paying living expenses to the patient for lost wages. Nonetheless, it usually only pays up to 75 percent, which can add strain to a low-paying job. Overall, it helps a company retain workers because it treats them like people rather than statistics.
Most reported claims are accepted by workers’ comp insurers, but there are situations where claims can be rejected. For example, if the insurer believes the injury was not work-related, they will likely not cover it.
When an employee sues the workers’ comp provider, a judge first reviews the claim to determine its validity. For valid cases, the judge will propose a settlement they believe to be fair. The parties can then agree on the amount or appeal the entire decision or certain parts. An appeal is usually settled in about 30 days.
Workers’ Comp Settlement
The employee files a claim in accordance with the insurance requirements and then waits for a settlement offer. The insurer’s offer may be lower than expected, in which case the employee can refuse the offer and take the case to court. It’s possible for an attorney to then negotiate for a higher workers’ compensation settlement.
To receive a workers’ comp settlement, the employee must agree not to sue the employer. Nonetheless, an employee can sue their employer if they bypass workers’ comp and can prove in court the employer was negligent and responsible for the accident.
The employer doesn’t need to get involved if the employee sues the workers’ comp provider. However, the employer should maintain open communications with the insurer and provide the necessary information.
Be aware that each state sets its own rules about handling and settling workers’ comp claims. Many states require a court to review a proposed settlement to ensure compliance with regulations.
Either the insurance company will approve the claim by its own deadline or reject it, in which case a legal battle becomes an option. If the provider approves the claim, it will send a check right away to the employee.
The two main workers’ comp payout methods are a lump-sum or a structured settlement. A large one-time payment requires the employee to close the case by signing a settlement agreement. By contrast, a structured settlement involves a series of payments over an agreed-upon term.
The easiest way for an injured employee to get a workers’ compensation settlement is to file the claim honestly and accurately in a timely manner. Call our experts at John E. Peakes Insurance Agency if you have workers’ comp questions. We can help you determine the most appropriate coverage for your business needs. Contact us today to learn more.