Worker’s compensation benefits can last for years, depending on your medical needs and the type of disability (partial, total, temporary, permanent). Rather than continue paying benefits for an unknown period, your employer’s insurance carrier may try to settle or buyout your claim for a set amount. Usually, this amount is paid in one lump sum, although it may be paid over a lifetime through a structured settlement including a partial lump sum payment plus periodic payments.
A workers’ compensation buyout or settlement is known in Pennsylvania as a compromise and release, and it puts an end to your ability to seek further workers’ comp benefits for your injury. When should you accept a settlement/buyout, and when should you pass on this opportunity? An experienced workers’ compensation lawyer at the Figured Law Firm can take the time to thoroughly understand your situation and fully explain your options. We can help you get the best long-term results after a workplace injury in eastern Pennsylvania.
Why would an insurer buy out your workers’ compensation claim?
Under Pennsylvania workers’ compensation law, there is no limit on how long medical care is covered. You receive benefits for as long as you need them, so long as expenses are reasonable, necessary and related to the treatment of your work injury. Insurance companies often use tools such as an IME to try and terminate or suspend your benefits. When these tactics fail, however, the carrier may prefer to buy out your claim to get it off the books. The settlement may include wage loss replacement (sometimes called commutation), medical bills or both, for a full release of your claim.
The insurance company is not required to offer you a buyout, and you are not required to accept one. If a reasonable settlement can be reached that provides you with what you need, a buyout may be preferable to both employee and employer. Keep in mind, though, that the carrier is only offering a settlement it thinks is financially advantageous to them, which means it might not be in your best interests. It’s important to have an experienced workers’ compensation attorney who is familiar with your case review any proposed settlement offer and negotiate on your behalf to ensure you get the best deal available.
What are the pros and cons of accepting a settlement or buyout of your workers’ comp claim?
On the plus side is the fact that stepping outside of the workers’ compensation system enables you to control your medical care without worrying about periodic IMEs and Utilization Reviews and attempts to cut off your benefits, or wondering whether the insurance company will accept or deny the doctor’s medical bills at any point, forcing you into bureaucratic nightmares, hearings and appeals just to hang on to your benefits for as long as you need them. Once freed of workers’ comp rules, you can see your doctor when you want for as long as you need without the employer’s workers’ comp carrier constantly looking over your shoulder or conducting surveillance of your leisure activities.
On the other hand, while taking charge of your health care may be liberating in one way, it may also be burdensome in another way. If you are still under a doctor’s care, the burden of paying for your health care now falls on you. You can set aside that lump sum in a special account designated for medical expenses, but you’ll need to be disciplined and not spend that money on other needs. Also, if medical costs end up exceeding your settlement amount, you can’t go back to workers’ comp and ask for more help.
If you have good health insurance on your own or through your employer, your health insurance will pick up much of the cost of your health care, after you meet deductibles and co-pays. But the health insurance carrier may try to limit or control your treatment similar to how the workers’ comp insurer was operating. It’s possible you could end up trading one insurance headache for another.
How do you decide on a workers’ compensation settlement/buyout?
Talk with your treating physician and evaluate as best you can what your future medical needs and costs will be. Future costs depend on the nature and extent of your injury and the type of future treatment and care required. Will there be future surgeries with risks of complications? Are degenerative conditions such as arthritis likely to arise from your injury, requiring a lifetime of ongoing care?
Once you’ve got a handle on your needs, talk to an experienced workers’ compensation lawyer about representing you in negotiations with the insurance company. Odds are that whatever amount they are offering you is less than the full amount owed to you. If they weren’t saving money through a settlement/buyout, they wouldn’t be offering it. Your lawyer can evaluate the entire circumstances surrounding your case and counsel you on whether a settlement/buyout is desirable, providing further assistance in negotiating a settlement/buyout that truly reflects your needs and what you are owed under Pennsylvania workers’ compensation.
Talk to Attorney Keith Figured about Your Workers’ Compensation Settlement/Buyout
The insurance company may offer a settlement/buyout as soon as you have been out of work for more than four months. Don’t accept any offers or engage in negotiations until you have talked with an experienced and successful workers’ compensation lawyer for the best result. In eastern Pennsylvania, call attorney Keith Figured of the Figured Law Firm at 570-954-9299 for a no-cost, confidential consultation.