Determining Settlement Value In California Work Injury Claims

Factors That Help Determine California Work Injury Claim Value

The subjective factors evaluated by the parties in California workers’ compensation claims used to determine fair settlement value are different than in normal tort lawsuits. The following factors are considered by the parties in coming up with an appropriate settlement. Of course, there are many more issues that motivate a party to settle for a certain amount of money. Only a legal professional licensed in the State of California can render an opinion of appropriate settlement value AFTER reviewing the specific facts and circumstances of your situation. Nevertheless, here are some things that an attorney will consider during the bargaining process.

a. Trials Do Not Result In Lump-Sum Award.

Work Injury Settlement

In work accident cases, trial awards do not come in the form of a lump-sum. Instead, trial awards result in a sort of bifurcated compensation to the injured worker. In the event the judge awards in the favor of the applicant, the award will be of future medical care and permanent disability payments. The future medical care (or FMC) will be provided by the insurance company for the injured body parts found to be industrial in nature and in need of continuing treatment. The permanent disability (or PD) will be provided by the insurance company at a defined weekly rate until PD money is exhausted. Because a lump-sum of cash is never the outcome of a trial, the motivation of the insurance carrier to offer issue lump sum payment amount in exchange for a release of liability under the policy is different than in negligence actions in civil court. Where the carrier provides medical treatment, they do so at deeply discounted rates and under the control of a process known as Utilization Review (or UR). This means that the cost of treatment will not be valued at fair market cash value. Instead, cash out value of future medical care will be what the carrier estimates it will cost them to provide and administer the health benefits. This factor sometimes leads to settlement values for medical care that are significantly lower than in personal injury outside of the workers’ comp. system.

b. Relative Risk Of Adverse AOE/COE Ruling

When bodily harm arises out of and in the course of employment (or AOE/COE), where no other defenses exist to block the claim, trial results in a ruling in favor of the applicant on the issue of causation (or that it happened at work and qualifies as workers’ compensation). Some cases are admitted by the claims administrator while others are put in denied status. When it is admitted (or accepted), the adjuster should already be issuing payments to medical providers and provided monetary compensation in the form of temporary disability (or TD) in accordance with the law. Admitted injuries are sometimes stronger than those that are denied, but not always. Many that are denied at first can be shown to be very strong cases and involving serious injuries. On the other side of the coin, admitted claims can later be shown to be very weak cases and involving only minor, non-existent or fully healed injury. The relative strength of a case on AOE/COE will determine value as discounts or premiums are paid based upon risk of losing an issue that could knock out the entire claim.

c. Nature And Extent Of Injury

The actual nature of the injury is also an important factor to consider when determining settlement value. Certain body parts are worth more money and/or cost more to treat than other body parts. Therefore, it is imperative than an analysis of the worth of a claim take into account the nature of the injury. Additionally, the analysis should include consideration for the extent of the health condition involved. Does it affect other body parts and/or systems on a secondary level? How severe is the disability, pain and/or loss of function to the hurt employee? The more extensive the impairment, the more potential value exists. Remember, only medical experts can render opinions that constitute substantial medical evidence in work comp. cases. However, an experienced lawyer can give guidance based upon past experience of how much disability and medical care will be necessary for common types of injuries.

Getting To Settlement With A California Injury Lawyer

Because of the extensive factors and issues to consider, as well as the bargaining process with the administrator and/or their attorney that occurs in a lump-sum compromise and release (or C&R), it is probably wise to have a lawyer do it for you. The insurance adjuster knows that laypeople (ordinary people without professional legal training) do not have the knowledge of the costs the company will face absent a C&R. Furthermore, ordinary people do not know how to navigate the claims process and the court system to maximize procedural rights that can significantly increase money value.

Here at our law office, we have California Injury Lawyers who you can trust to assert your rights, counsel you on the best decision, and perform the bargaining process for you. Call us right now for a free consultation to see if we can be of help to you like we have for countless others in Southern California! Dial 844-584-8444 to speak with a knowledgeable professional at no cost out of pocket!