Calculating How Much Your Workers’ Compensation Claim Is Worth

Have you been hurt at work? Workers’ compensation claims pay for the cost of your medical treatment, lost wages, and certain other expenses any time you are injured on the job.

Calculating the total value of a claim can be difficult, especially since coverage amounts for areas like lost wages can vary from policy to policy. At the same time, several factors that could affect the value of your claim.

Help with Workers’ Compensation Claims

A workers’ compensation attorney can help you collect the full amount of your total accident-related losses, including a reasonable amount for your lost income. In cases where you have unpaid medical bills, large damages, or the cost of your total damages is disputed, a workers’ comp lawyer can increase your chances of obtaining a reasonable settlement offer.

Note that certain fees and obligations can reduce the total amount of your workers’ comp settlement. There may also be caps on the amount you are allowed to recover, especially in reference to lost wages.

Be sure to review relevant state laws and your workers’ compensation policy’s expectation of benefits (EOB) statement. It’s best to do this with an experienced workers’ comp lawyer before making firm predictions about the total value of your case.

For a generalized view of what your claim could be worth, make sure to consider the following factors. If you were denied your workers’ compensation claim or you believe you deserve more money, call us today at (800) 560-5059 or contact us online to speak with a workers’ compensation lawyer.

Medical Costs

Workers’ compensation insurance is supposed to pay for all of the costs of reasonable and necessary medical treatment related to your work injury. This includes both past and future treatment costs.

Depending on your policy and state laws, you may also be eligible to receive compensation for pain relief therapy, psychological counseling, and/or alternative therapies like acupuncture. Most workers’ compensation policies don’t pay for massage therapy or any type of experimental therapy, procedure, or medication.

Lost Wages

Workers’ compensation policies are supposed to pay for a portion of your lost wages. The amount covered will vary from policy to policy, but they typically fall in the 60% – 80% range.

State laws may limit the amount of workers’ comp lost wages coverage on a per-day, per-month, or total amount basis. Policy limits will also apply, especially with specialized forms of compensation, such as sales commissions.

Calculating lost wages can be difficult for certain categories of workers. This includes freelance contractors, non-salaried workers with irregular schedules, and workers who obtain a large portion of their income based on specialized compensation arrangements, such as sales commissions or performance bonuses.

Injury victims who have difficulty calculating their lost wages can refer to an experienced workers’ compensation lawyer. The lawyer will assist them in assessing their average income over several months and use this calculation to justify a request for lost wages.

Attempting to claim non-standard forms of income like performance bonuses can be especially difficult. However, state laws and prior case rulings can provide the evidentiary weight injured workers need to strengthen their case.

Out-of-Pocket Costs

Most workers’ compensation policies only pay for specific categories of out-of-pocket costs related directly to medical treatment. This may include over-the-counter medicines and medical devices prescribed by their doctor.

Yet peripheral expenses like transportation to appointments are not usually covered. The amount and type of out-of-pocket cost covered will vary from case-to-case and policy-to-policy.

Out-of-pocket living costs are also rarely covered. Individuals who want more comprehensive coverage if they are injured at work should look into securing supplemental coverage, some of which can pay for the remainder of lost wages as well as everyday expenses like groceries.

Medicare and Other Public Benefits

Generally speaking, a workers’ compensation settlement will deduct an amount equal to the coverage received from public programs like Medicare or Social Security Disability Insurance (SSDI).

If you are eligible for Medicare and used your Medicare coverage to pay for your treatment while your workers’ comp case was pending, you will be expected to pay back Medicare for their coverage.

Notably, if your settlement includes compensation for future medical costs and you are eligible to receive Medicare, you may be expected to create a Medicare Set-Aside Account (MSA). This account demonstrates proof of financial responsibility. The Medicare program wants to avoid a situation where funds meant for future medical treatment are spent on other personal expenses. That forces them to cover injury-related costs that should have already been covered by a workers’ comp settlement.

Individuals on Medicaid, SSDI, or other programs may have similar complications.

Permanent Disability Advances

Certain states require insurers to immediately begin covering expenses related to a permanent disability. For example, California Labor Code § 4650 requires insurers to provide a permanent disability advance within 14 days.

Any amount provided through such an advance will later be deducted from the final workers’ comp settlement.

Taxes

In general, workers’ compensation settlements do not qualify as taxable income, and no employment-related taxes will be withheld from the total amount. However, the amount given does count as income to calculate income thresholds for SSDI and other programs.

If you are concerned about a workers’ compensation settlement affecting your disability claim, speak with an experienced disability benefits lawyer before making any final decisions.

Child Support

If you are currently paying child support and have an unpaid balance, your overdue payments may be deducted from your workers’ comp settlement.

A settlement may also qualify as income for the purposes of calculating the scheduled amount of child support you owe. Therefore, a portion of your settlement can potentially be withheld similar to wage garnishment.

Unpaid Doctor Bills

Depending on how you arranged for your medical bills to be paid, you may have an outstanding balance with providers. You may end up signing a delay of payment agreement that creates a medical lien, which means that the workers’ comp insurance company would reimburse the provider directly for your unpaid bills.

If no such agreement exists, then you will likely receive a lump sum to pay off your medical bills yourself. You and your attorney may even potentially be able to negotiate for a lower cost of services, allowing you to keep the final difference.

Workers’ Compensation Attorneys’ Fees and Other Costs

If you do decide to work with a workers’ compensation settlement lawyer, chances are, you’ll enter a contingency agreement.

This type of agreement means you only pay for their services if they can obtain a settlement. If you do receive a settlement, you will pay either a set fee or a portion of your total award. Your attorney will also deduct direct costs, such as the cost of court transcription services or copying medical records. Usually, these costs will be deducted before the final legal service fee amount is assessed.

Some states have rules in place that limit how much an attorney can charge for assistance in reaching a workers’ compensation settlement. For example, the attorney may only be able to assess their fees based on the number of unpaid benefits or the amount that was in dispute. A judge may need to approve all fees in advance before an agreement can be made.

Hire a Miami Workers’ Compensation Attorney to Seek the Largest Settlement Value Available

All of these factors can make it tough to calculate or predict the final amount you’ll get from your workers’ compensation insurance. Understanding how much your claim is worth can be difficult to define without the help of an experienced insurance agent or a workers’ compensation attorney. Your situation will get especially complicated if you have a large unpaid medical balance or receive certain public benefits.

Talking with an experienced Miami workers’ compensation lawyer team can help clear things up, allowing you to make a more accurate prediction. Your attorney can also help you calculate the total value of lost wages, negotiate with insurers, and justify all claimed costs as reasonable and necessary.

If you have any questions about your workers’ compensation settlement or want assistance with filing a claim, you can schedule a free, no-obligation case review with a lawyer now. Simply call (800) 560-5059 or contact us online to book your free appointment.