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How Much Money is My Claim Worth?


The answer to this question is very different for every claim and depends on a lot of factors. Here is a synopsis of how we narrow in on an idea of case value.


There are two broad categories of workers’ comp injuries. The first is Body as a Whole and the second is Scheduled Member. Each are treated differently. A Body as a Whole injury is an injury to a part of your body that you can not live without, like your head, brain, or spine. A Scheduled Member injury is an injury to a body part you could live without such as a finger, arm, toe, eye, or ear. If the injury is to two or more Scheduled Members, it will be treated as one to The Body as a Whole. Here is how it works…..


Body as a Whole Injuries


Let's use a back injury as the example here. Say it was a herniated disc in the low back and surgery was required. 6 months following surgery, the doctor says, “Mr. Patient, you are as good as you are going to get and you have a 10% impairment rating to your body as a whole. You will have to be on light duty from now on”.


The impairment rating and restrictions mean little for the settlement value of this case. For the loss of wages portion of the case, the commission will look only at proof of what the loss of earning capacity will be in the future. How do we prove this? By doing a job search. What will the judges want to see? They want to see proof of an honest search for employment in your geographic area. The type jobs that should be searched are really anything the person can do, even if they seem beneath you. When I go to court I want to have at least 100 searches, the date of application, and the response received if any.


Job searches these days are easy and can be done from a computer. Just set up accounts on any of the job search web sites and start searching. One thing that needs to be kept in mind is that these searches need to be honest searches. In other words, its not best to lead with “Hey, I have a serious back injury, will you hire me?”. On the flip side, if a potential employer specifically asks about an applicant’s physical condition, an honest answer should be provided.


If the commission believes you are permanently and totally disabled, the max award for lost wages, also called indemnity, is $222,516(as of January 2019). However, the insurance will get a deduction for any temporary benefits already paid in this situation.


Medical related payments from the insurance company are separate from the wages. The comp carrier must pay for all treatments if an injury is proven to be work related and the treatment is proven to be reasonable. Settlement value on medicals is wholly dependent on what the doctor says….another reason medical records are so important.

Scheduled Member Injuries


The money paid for lost wages on a scheduled member injury has nothing to do with wage earning ability. No job search needed on these claims. The commission uses a chart for these injuries to tell how many weeks of pay are owed if there is 100% loss to a member. Let's use a finger as an example. If a pointer finger is amputated at the knuckle, there is certainly a 100% loss and the schedule says 35 weeks of adjusted pay(2/3) must be paid.


The gray area in scheduled member cases arises when the injury makes it impossible or more difficult to work in your profession. The term used in the comp world is Loss of Industrial Use. This requires a more detailed legal analysis. I won’t bore you with that here.

Medical payments are treated the same under a scheduled member injury as they are for a body as a whole injury.

Feel free to call me if you want further explanation of any of the above. I hope it helps.


Have a great day!


Kevin

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