Workers’ compensation insurance can help employees maintain financial stability while recovering from a work-related injury, and it’s important for both employers and employees to understand how the workers’ comp settlement process works. So when will workers’ comp offer a settlement?
Workers’ compensation insurance offers settlements to employees to help them pay for a variety of expenses after they are injured or become ill while at work. Filing a workers’ comp claim can be fairly simple, but settling one is often more complicated, depending on the circumstances.
Here’s everything you need to know about the question of how and when will workers’ comp will offer a settlement?
What is Workers’ Compensation?
Workers’ compensation insurance is designed to protect employees that suffer an injury or illness while at work.
If an employee is approved for workers’ compensation, they can use the funds to pay for a variety of expenses, including medical bills, rehabilitation expenses, lost wages, and more. If an employee loses their life due to a work-related accident, workers’ compensation may also cover death benefits for the families of the deceased.
To be approved for workers’ compensation insurance, employees must have been injured or become ill while acting within the scope of their normal job duties. If an employee is injured while not at work, workers’ compensation will not cover them while they recover.
What Does it Cover?
Workers’ compensation is meant to help employees maintain financial stability while they recover from an injury or illness and await their return to work.
If approved for workers’ comp, you may use the funds to cover a wide range of expenses, including:
- Lost wages
- Short-term medical expenses
- Ongoing medical care
- Disability benefits
- Funeral costs
When an employee is forced to take time off of work due to a work-related injury or illness, workers’ compensation can help them avoid financial hardship and focus on their recovery.
How the Workers’ Comp Claim Process Works
Both employers and employees need to understand how the workers’ comp claim process works to ensure workers are able to get the funds they deserve after suffering a work-related injury or illness.
When an employee experiences a work-related injury, they need to report it as soon as possible after receiving medical care to start the workers’ claim process. Each state has different deadlines for reporting work-related injuries, ranging from three days to two years.
Employers should follow these steps after learning of a work-related injury:
- Help the employee seek medical care after learning of their injury.
- Investigate the accident to document what happened and identify potential safety issues.
- Provide the employee with an injury report form.
- File a claim with your insurance company, and if necessary, submit the appropriate documentation to the state workers’ comp board to support the claim.
While waiting for the claim to be approved or denied, employees should continue medical care and focus on their recovery. Employees should also follow up on their claims with their employer to ensure they receive their benefits in a timely manner.
What happens if my claim is denied?
In some cases, your workers’ comp claim may be denied.
This usually occurs when the injury:
- Occurred away from work
- Is self-inflicted
- Occurred while under the influence of alcohol or drugs
- Occurred while committing a crime or violating company rules
If your claim is denied for any reason, you can appeal the denial and hire an attorney to represent you. The appeal process typically requires you to attend a workers’ comp hearing, where a judge will evaluate the case and determine whether you deserve a settlement. The question of when will workers’ comp offer a settlement, will be determined at this juncture.
What happens if my claim is approved?
If your workers’ comp claim is approved, then the insurance company will pay for the medical expenses that you incurred as a result of your injury.
While you continue to recover from your injury, you will also receive a portion of your normal wages as a weekly benefit. This typically amounts to two-thirds of your normal pay.
Your weekly benefits will end as soon as you return to work, even if the claim is still open. However, the insurance company will continue to pay for any medical bills related to the injury.
Some employers also offer return-to-work programs that are designed to get employees back to work as soon as possible. These programs typically involve employees performing light or modified work that is less physically demanding than their normal job duties. Workers may prefer participating in return-to-work programs as they will likely earn more than their weekly workers’ comp benefits.
How Workers’ Comp Settlements Work
Once the injured employee completes their recovery and returns to work with no outstanding medical bills or unpaid workers’ comp benefits, the claim can be closed.
Closing a claim often involves negotiating a settlement between the insurance company and the injured employee. If these parties can’t reach an agreement, a judge will decide the settlement in a workers’ comp hearing, including the question of when will workers’ comp offer a settlement.
The settlement process usually starts with the insurance company offering a settlement that includes payment for unpaid benefits, medical bills, and future medical care. If the employee’s injury leaves them permanently impaired, they may also receive a disability award as part of the settlement.
Workers’ comp settlements are distributed as structured payments or lump sum payments:
- Structured payments: With structured payments, the employee will receive several payments over a specified period of time.
- Lump sum payments: In some cases, employees may receive their settlement as a one-time lump sum payment that covers all medical bills and benefits. Depending on the state, employees may have to agree to not seek future compensation in order to receive a lump sum payment.
Employees should work with their attorney before agreeing to a settlement to determine how much their payout should be.
Workers’ comp settlements should take several expenses into account, including:
- Outstanding medical bills
- Future medical care, including physical therapy, rehabilitation, and surgery
- Lost wages
- Future wage loss
- Disability payments (temporary or permanent)
- Attorney fees
- Workers’ comp rules and regulations in the state where the injury occurred
After calculating how much the payout should be, the employee and their attorney will negotiate a settlement with the insurance company. Depending on the state, a judge may need to review the settlement before finalizing it.
If the insurance company and the employee can’t come to an agreement, then they will likely need to go to court to resolve the claim.
How long does it take to reach a settlement?
The length of the settlement process mostly depends on how long it takes for the employee and the insurance company to come to an agreement. This process may be extended if the injury occurred in a state that requires a judge to review the settlement before it’s finalized.
Settlement negotiations can often take months as the employee’s attorney works to ensure they receive a fair settlement. In general, this process can take anywhere from a few weeks to 12+ months.
During this time, employees should continue to focus on their recovery and stay in contact with their attorney to ensure they are up-to-date with the status of their claim.
What is a Workers’ Comp Hearing?
Workers’ comp hearings are necessary when:
- An injured employee’s claim is denied and they request an appeal hearing so that a judge can review their case.
- An injured employee’s claim is approved, but they are unable to come to and reach a settlement agreement with the insurance company.
In either of these cases, the employee and insurance company may need to go to court to let a judge review the case and determine a fair settlement.
At a workers’ comp hearing, both sides can present their arguments. A judge will then evaluate the case and decide on a settlement. The insurance company will then be required to pay this amount to the employee.
Taking a workers’ comp claim to court can be fairly risky for both employees and insurance companies, as the judge may determine a settlement that is much lower or higher than what either party expects. As such, employees and insurance companies should work together to come to a fair settlement agreement before sending the claim to court.
During a hearing, the employee’s responsibility is to provide their attorney with the necessary information and evidence they need to argue on the employee’s behalf.
Once the hearing is complete and the settlement is paid, the claim will be closed, and both sides can move on.
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Workers’ compensation insurance offers essential coverage for employees. If an employee is injured or becomes ill while on the job, workers’ comp benefits can help them cover their medical bills, maintain financial stability, and focus on their recovery so that they can get back to work as quickly as possible. Understanding how the workers’ comp settlement process, including “when will workers’ comp offer a settlement”, can help employees and employers be prepared to handle workers’ comp claims quickly and efficiently.
At KSA Insurance, we work with businesses in South Carolina and across the southeastern United States to help them find affordable workers’ compensation insurance policies that meet their state’s requirements and protect their employees.
Contact us today to get a quote and learn more about when workers’ comp will offer a settlement.