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15 Tips for Calculating a Workers Comp Settlement Amount and Negotiating with the Insurance Company

Posted by James Aspell | Mar 08, 2024 | 0 Comments

Every workers' compensation claim in Connecticut is unique.

However, the elements to consider for a just compensation amount for workers comp remain consistent across different cases.

Consider the following factors when determining a fair settlement for the injuries you've sustained:

Acceptance of Liability

A fair settlement is more probable if the insurance provider acknowledges that your injury or occupational illness qualifies for compensation under the Workers Compensation Act, especially if this acceptance is documented in a Workers Compensation Award Letter. This acceptance provides leverage for negotiating a higher settlement since the insurance company faces procedural challenges to terminate your benefits.

Probability of Success at Trial

Should your claim be rejected, assess the strength of your evidence to gauge your chances of winning at a workers comp hearing. The insurer's settlement offers may mirror the strength or weakness of its case.

Pre-Injury Earnings

Your settlement could be influenced by your average weekly wage before the injury. A higher pre-injury wage could increase the insurer's liability for compensation, impacting the settlement figure.

Responsibility for Medical Expenses

The settlement should reflect who will bear the costs for medical treatments already received. Typically, you can negotiate for a higher settlement if the claim is settled with medical bills unpaid. However, this is only advisable if you have alternative means to cover these costs, like private insurance or Medicaid.

Future Medical Costs

Consider including funds for future medical needs related to the injury in your settlement, as settling usually means forfeiting ongoing medical benefits. Future medical costs could include treatments like chiropractic care, diagnostics, doctor visits, emergency room visits, home healthcare, home modifications, medical devices, mental health counseling, palliative care, physical therapy, prescriptions, and surgeries.

Calculating future medical expenses is complex. It's wise to consult with a life care planner to determine a suitable amount.

Coverage for Future Medical Needs

Private health insurance can make settling more appealing. Your lawyer can negotiate terms in the settlement to leverage anti-subrogation laws, protecting you from reimbursing your health insurer and allowing the continued use of your private insurance for medical care post-settlement.

Permanent Work Restrictions

If you're given permanent work restrictions post-recovery, this could affect your ability to return to your previous job and impact the settlement amount, especially if you cannot return to your pre-injury employment.

Employability with Restrictions

Consider how your permanent restrictions, along with factors like age, education, and geographic location, affect your job search and potential wage loss benefits, which in turn affect your settlement amount.

Eligibility for Other Benefits

If you're eligible for other disability benefits, this interplay can affect your settlement amount, as closing your workers comp case could impact your ability to secure other forms of benefits.

Injury to Scheduled Body Parts

The specific body part injured can determine eligibility for compensation for permanent loss, affecting the settlement amount.

Fairness of Permanent Impairment Rating

Ensure your permanent impairment rating accurately reflects your condition, as this rating significantly influences your compensation for permanent loss or loss of use of a body part.

Secondary Injuries

Consider compensation for additional injuries or conditions caused by overuse of a non-injured part due to your work-related injury, known as the compensable consequence doctrine.

Insurance Payments to Date

In places like Connecticut, some workers comp benefits are capped , so the amount already paid by the insurer reduces its liability and affects the settlement amount.

Third-Party Negligence Lawsuits

If you have a third-party negligence claim, your settlement could adjust to account for any liens the workers comp insurer has against the third-party action proceeds.

Settlement Policies of Insurers and Employers

The approach of insurers and employers towards settlement negotiations can vary, influencing the settlement offers you receive.

Financial Value Over Time

Consider the argument of "present value" versus the potential for cost-of-living adjustments to counter lower settlement offers based on the value of immediate lump-sum payments versus periodic benefits.

Understanding these factors can help guide you to a fair settlement for your workers' compensation claim in Connecticut.


About the Author

James Aspell

Principal since August 1, 2006 James F. Aspell is the principal and managing attorney of the firm which he started in 2006 following 20 years of litigation practice in a mid -size firm in Hartford, Connecticut. Jim focuses his practice in the areas of worker's compensation and personal injury l...


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