Settlement amounts in Pennsylvania Workers' Compensation claims are influenced by many factors, but the main factors can be simplified into two main points: (1) how strong is the evidence, especially medical evidence, supporting your claim for benefits (2) how strong is your procedural position within the workers compensation system. More on the specifics, a bit below.
To make any reasonable settlement, your case must be strong on both points. To make a truly "full value" settlement and get what you deserve, you will also need a skilled attorney with specialized knowledge of Pennsylvania workers compensation. The simple truth is that if you attempt to negotiate without an attorney specializing in the highly nuanced field of Pennsylvania Workers' Compensation Law, the adjuster on the other side will certainly discount the value of your claim, far beyond the cost of an attorneys contingent fee.
The insurance company does not want to settle with you, even if they are inviting you to make a demand. Certainly, they may want to be done with your case. But they will consider the cost of any settlement offer only in comparison to what it would cost them to instead block, stop or cut down your compensation by using the system against you. An insurance adjuster would be crazy not to downgrade the value of your case if you have no attorney. It is their career work to know the workers compensation system far better than you do. If they think they can stop your benefits within a matter of months by using the system against you, they aren't going to afford you a lump sum settlement valued at years of future compensation. If you don't have an attorney, they don't take seriously the risk that you may be the one to more effectively use the system against them. They act like they are doing you a favor, and they dramatically undervalue your claim. Do yourself a favor: Call us to see how we can help, or take all steps needed to get a good attorney who is certified as a specialist in Pennsylvania Workers Compensation law before you have any serious discussion with an insurance adjuster about settlement of your claim, or just as early as possible in the life of your claim, to set yourself for a maximum full value settlement when the time is right.
Other than the basic advice that you need the most competent and experienced workers' compensation attorney you can find, there are a great number of factors that play into the potential value of your claim. Many of these factors can be influenced by the advice of a good attorney, but all will vary from one case to the next.
Some of the things that will influence when and how much an insurance carrier or self-insured employer will pay as a lump sum settlement include the following:
1. Are you currently receiving compensation, or are you still in a position where you need to fight to get benefits. Insurers may offer very little until they become convinced they will lose in court, if your right to benefits has not already been established.
2. If you are on compensation, how long have you been getting benefits? Has your claim gone beyond the first ninety days, shifting the burden to the employer to stop your benefits?
3. What treatment have you had and what treatment are you getting now? Gaps in medical support hurt your settlement value.
4. What diagnosis or diagnoses have been documented by your doctors? Company or "panel" doctors notoriously understate the diagnoses they give to patients for work-related injuries, which can impact your leverage for settlement.
5. Have you had a proper medical work-up by a sympathetic doctor not under the insurance adjuster's thumb? If not, you need to talk to us about a proper medical referral before seriously considering giving up your rights for any lump sum.
6. Is your diagnosis one that carries the threat of long term disability? For back and neck injuries, disc pathology carries greater long-term concern than a mere "strain and sprain" injury -- which is why insurance company documents (and many insurance oriented doctors) always refer to back injuries as mere strains or sprains. We are more concerned what what has really been diagnosed.
7. Have you had objective diagnostic tests or studies, such as MRI testing, EMG testing, Nerve Conduction studies, diagnostic ultrasounds, CT scans or the like? If so, how have the results been documented? Do they strongly support your diagnosis and injury, or are they being read as "normal" or passed off by insurance-oriented doctors as only "degenerative" findings? Having the right test reviewed by a sympathetic medical expert with the right credentials can hugely impact the value of your claim.
8. What "description of injury" has been acknowledged by the employer/insurer, in the formal documents controlling the claim? Insurance companies and their "occupational health" doctors literally almost always understate your injury in early records, such as by calling a disc herniation a "back strain" or by calling a rotator cuff tear a "shoulder strain". This often becomes the legally controlling description of your injury, which can rob you of your rights, if you are not able to show that you are prepared to fight back and/or even turn such points to your advantage.
9. Do you have any related past medical history of injuries or problems affecting the same parts of your body involved in your work injury?
10. Have you admitted and discussed your past medical history consistently with all doctors? If not, can this be fixed before the insurance company uses any failure to report past medical history as a way to attack your credibility?
11. Do your medical records suggest any credibility issues? For example, are there notes claiming "symptom magnification" or notes expressing concerns regarding improper medication use, new injuries outside of work, or other problem issues?
12. If there are elements in your records which the Judge may regard as negative, will there be time or opportunity to correct these concerns by further communication with the doctor or doctors, to explain away any problem issues or misunderstandings? It is important that you have an attorney with the skills necessary to spot and to diffuse these kinds of "bombs" in your medical records.
13. Have you made any past attempts to return to work? If so, what did the employer have you do, how did it affect your injury, and how did the employer treat you? One way insurance companies threaten to limit your rights is to raise the fear of a "light duty" job offer -- which can kill your workers' compensation rights with just a temporary release to work, even when the injury itself may be chronic or long-term. Can your attorney help guide you through such traps, to make your case, and its settlement value, stronger, not weaker?
14. Is the employer disputing the circumstances of your injury or the circumstances of a return to work attempt or offer? Where there witnesses? Can these witnesses be expected to tell the truth or will they lie or distort their testimony to please the employer?
15. Is the employer in a position to offer further light duty? Has it been offered to date?
16. Were you "fired" from the job? If so, what reason was given? This can sometimes be turned to your benefit, in more ways than one, by a skilled workers compensation attorney.
17. Have you been scheduled for or attended an IME? Did you have the opportunity to discuss this in advance with a skilled attorney, to give you the best chance to emerge with a favorable result? Has the adjuster shared all IME reports?
18. How much difference is there between what the insurance medical expert says you can do and what your own doctor would allow?
19. Have you testified in the claim? If so, how well did you explain your status? What points were made against you in cross examination? Was your testimony fully consistent with the medical records, early reports of injury and other available evidence?
20. Which Workers' Compensation Judge will be deciding your case? Even if your case is not in litigation, a workers compensation specialist will know to what office it would be assigned in the event of a litigated dispute. Some judges are more claimant-friendly, while others are more insurance oriented.
21. Do you have an attorney who is respected by the defendant attorney and the insurance carrier as someone who will fight hard and effectively if they try to "low-ball" you on settlement? If you already have an attorney, ask him or her how each of the above points will impact your settlement and how you can make your claim stronger and increase its value. If you do not have an attorney, call us immediately for help, or look for another well-respected attorney who is a certified specialist in Pennsylvania workers compensation law and who has a very high "Avvo" rating (8.0 or above) and good reviews from past claimants.
A good workers' compensation attorney will carefully review every element of the available medical evidence with an awareness of what favorable points can be used to help your case and what problem points must be played down or converted to your benefit. An experienced and competent workmans' comp lawyer will orchestrate the medical witness testimony in such a way that the formal record, reviewed by the Judge, favors your position as strongly as possible.
This is how workers' compensation cases are won in litigation. It is also how I make clear to insurance carriers the extent of their exposure, driving home the point that the settlement of your claim must be for full, maximum value.
The listed factors appearing above are not the only considerations in your claim. One big factor is often this: Just how good is the insurance company's attorney. Note that while most are experienced and at least competent, some are far better and far more dangerous to your claim than others. Fortunately, we can stack up against the toughest and most effective insurance company attorneys, so that we consistently get the results our clients expect. Because adjusters know this, we can often acheive great things in negotiation without the need for active litigation.
Understand that nearly all of the factors affecting the settlement value of your claim can be influenced by the competence, experience and aggressiveness of the workers' compensation attorneys you choose to represent you. The attorneys who represent the insurance carriers know this very well, as do the insurance company adjusters, who often control the purse strings. These people know me. They have seen, in case after case, the significant influence that strong, competent and unrelenting legal advocacy has on the settlement values they must approve. I am proud to enjoy the reputation, acknowledged even by Workers' Compensation Judges, of an attorney who fights to obtain the maximum value for every case I settle.
I am very selective in the cases I take. My firm maintains a case volume sufficient to allow me to remain intimately, aggressively and actively engaged in every case. We litigate circles around even the toughest and smartest adversaries.
Call my office today, whether simply to discuss the potential settlement value of your specific claim or to set an appointment to retain us to move forward with your case and with negotiations for settlement: 484-453-8144.