Many people considering a workers’ compensation claim want to know “How much is my case worth?”
It’s a complex question, and can sometimes depend on who’s holding the calculator. Here are three primary factors that will affect how much you’re paid.
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3 Factors That Can Determine Your Workers’ Comp Benefits
Three key elements go into determining the value of a workers’ comp case:
Once you have reached what is known as Maximum Medical Improvement (when you’ve healed as much as possible) but you’re still not the same as you were before your injury, your doctor should assign an impairment rating to the part of the body that was injured.
An impairment rating is worth a certain amount depending on your compensation rate at your job and the part of the body that was injured. Your compensation rate is 2/3 of your average weekly wage for the 52 weeks prior to your injury. The part of the body that was injured and the rating is significant in this formula because the North Carolina Industrial Commission has determined that specific body parts are worth a certain number of weeks of your compensation rate.
Spine = 300 weeks
Leg = 200 weeks
Arm = 240 weeks
Let’s say you injured your left arm at work and your authorized treating physician has assigned a 10% impairment rating to that left arm. Your compensation rate is $350, based on the following formula:
10% of 240 weeks = 24 weeks
24 weeks x $350 salary = $8,400
You would be entitled to $8,400 for that rating
Unfortunately, that means if you have low wages, and therefore a low compensation rate, your impairment rating will not be worth as much as another employee with a large compensation rate. Based on the above scenario, if your compensation rate is $100, that same 10% rating would only equal $2,400.
That’s why making sure your compensation rate is calculated accurately is extremely important. We’ve found additional money for lots of clients by looking more closely at their compensation rate and sometimes finding that overtime pay or additional work days had not been factored into their compensation rate.1
We can help you try to get a second opinion on your impairment rating.
Indemnity Benefits – or Temporary Total Disability (TTD)
Another factor taken into consideration when determining the value of your workers’ comp case is how much the insurance company may have to end up paying in indemnity benefits (disability benefits). Indemnity benefits are the weekly payments the workers’ comp insurance company makes to you when your authorized treating physician has written you out of work or has assigned work restrictions your employer cannot accommodate. This is also known as Temporary Total Disability (TTD) benefits.
Our firm has been representing injured workers for a long time. And one of the many things we’ve seen is that insurance companies don’t want to have to write these checks to you for any longer than they have to.
Many factors affect how long you may be entitled to these checks. Whether they continue to pay you TTD or try to settle your case is a numbers game to them to try to ensure they pay you as little as possible. Here are some of the factors they consider when deciding how much and how long to pay you.
Date of Your Work Injury Affects TTD Benefits
- If you were injured on or after 6/24/11, you can receive a maximum of 500 weeks of TTD.
- If you were injured prior to 6/24/11, you could potentially receive TTD for the rest of your life.
Work Restrictions a Factor in Workers’ Comp Settlement Amount
We may be able to help you maximize your indemnity benefits by working to prevent you from returning to work in a job that is outside of your work restrictions.
If you have temporary light duty restrictions with minimal medical treatment, and are expected to be able to go back to your regular job performing the same duties as before your injury, the insurance company may be less likely to pay a large sum to settle your case. However, if you have permanent restrictions that prevent you from returning to your pre-injury employment or other work, the insurance company may have more incentive to settle your case as soon as possible, rather than potentially paying you years of TTD.
While we cannot tell your treating physician what restrictions to assign you, we can try to make sure your doctors are aware of what your job entails and fight on your behalf to get reasonable restrictions – or a second opinion from another doctor.
As is the case with impairment ratings, your compensation rate plays a big factor in determining how much money the insurance company may have to pay you for being out of work.
Salary a Factor in Workers’ Comp Settlement Amount
If you have a compensation rate of $350, the insurance company knows that if they have to pay you for being out of work for a year they’ll spend $18,200. However, if your compensation rate is only $100, even if you are out of work for a year, the insurance company only has to pay you $5,200. They may be more likely to settle earlier on if it they believe it might cost them more to continue paying you TTD.
Pain and Suffering NOT a Factor in Workers’ Comp Cases
Many of our workers’ comp clients are surprised to find out that pain and suffering are not taken into account in workers’ comp. No matter how much frustration and suffering your work injury has caused.
Future Medical Treatment
Your claim will also be more valuable if your authorized medical physician recommends significant medical treatment for your workers’ comp injury than if there are few or no medical recommendations.
If you have a shoulder injury, for example, and your physician recommends a rotator cuff repair surgery, the insurance company may be more inclined to pay you more to settle your claim quickly so they don’t have to pay for that surgery. On the other hand, if you have a shoulder injury and your physician says you only need some physical therapy, the insurance company may likely be more motivated to simply pay for your physical therapy instead of paying you more to settle your claim.
As you can see, there are many nuances in workers’ compensation law. Thousands and thousands of legal pages have been written to explain these nuances. It can take an experienced workers’ comp attorney to understand and interpret these laws to help you try to maximize these factors to your advantage.
We can help you try to ensure your physician knows the full extent of your injuries. And we can help monitor your progress with the doctor and the insurance company.
A good workers’ comp attorney can do more than that! They can help you try to get a second opinion on your impairment rating if the first rating is too low, based on your injury. They may be able to help you maximize your indemnity benefits by working to prevent you from returning to work in a job that is outside of your work restrictions. And while they cannot tell your treating physician what restrictions to assign you, they can make sure your doctors are aware of what your job entails and fight on your behalf to get reasonable restrictions – or a second opinion from another doctor.
Choosing a Workers’ Comp Lawyer
You’re reading this blog for a reason. Are you getting the run-around from your insurance company? Are you confused by the rating and compensation process (you’re not alone)? Is your insurance company trying to force you to settle? Are they withholding checks?
If you’re struggling with your workers’ comp situation and you think you may need an attorney, download this booklet: How to Choose a Lawyer for Your Workers’ Compensation Claim.
If you follow the tips in this booklet, we believe you’ll find a good attorney for your case. Of course, we believe our attorneys embody the qualifications and ideals you should seek when looking for a workers’ compensation attorney. Several of our attorneys are North Carolina Board Certified Specialists in Workers’ Compensation Law. (Very few attorneys in in North Carolina can make that claim.) We’re committed to helping you understand your options and arming you with the knowledge you need to make an informed decision that’s right for you.
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