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How Are Workers' Comp Settlements Calculated

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Workers’ compensation benefits between one case and the next will always be different. Everyone suffers a workplace injury unique to themselves and everyone earns a unique wage. Both of these factors will already greatly influence what a workers’ comp claimant can expect to receive in terms of benefits after filing a claim.

However, there are some basic steps you can take to get a better understanding of what a successful workers’ compensation claim will provide you. Knowing how to calculate your deserved benefits is crucial if the insurance company is trying to write off your claim by offering an initial settlement. In most cases, such settlement offers are lower than the claimant really needs, so understanding how total damages are calculated can help you avoid this common claim pitfall.

Consider the following about your workplace injury and workers’ comp claim:

  • Medical expenses: The California Division of Workers’ Compensation (DWC) requires a workers’ compensation plan to pay for all medical treatments necessary to “cure or relieve” a claimant’s injuries. Furthermore, the costs must not include a deductible or any out-of-pocket costs to the worker, even for treatments that range well into the future like rehabilitative physical therapy. Problems can arise, though, if the insurer argues that you have received treatments that were medically unnecessary. Any care deemed elective or experimental might not fall under workers’ comp coverage.
  • Missed work: In California, you are eligible to collect temporary disability payments if your work injury is serious enough to cause you to miss three or more days of work. Wage replacement benefits are usually set at 2/3 of your average weekly wages. You can also receive temporary disability payments if you are working part-time due to your physician restricting the number of hours you can work in a day or week.
  • Disability rating: If you are permanently unable to return to the job that you held before your injury, or you have a permanent impairment, then you could be eligible for weekly permanent disability benefits. The term ‘permanent’ is a bit misleading, though. Most permanent disability benefits can and do end. The duration depends on how much your benefits are paying you and your permanent disability rating, which is set by a medical professional. For example, a workers’ compensation plan might pay an injured worker $3,000 a month until a total of $1,000,000 in benefits are paid, the claimant passes away, or the claimant can return to gainful employment again, whichever event happens first.
  • Supplemental job displacement benefit: If your employer doesn’t offer you alternative or modified work, and you do not return to work for your employer within 60 days of losing temporary disability, you are entitled to supplemental job displacement benefits. In most cases, this benefit will allow you to attend education-related training courses at no cost to you.

How Do You Add All of These Benefits Together?

Understanding what factors will influence the true cost of your workplace injury and disabilities is one thing. Knowing how to accurately calculate all of those costs together to represent the benefits you truly deserve is something else altogether.

There are always going to be outside and unpredictable factors in a workers’ compensation claim. Accurately calculating those costs so you know you are getting a fair settlement or biweekly wage replacement can be extremely difficult if you are not familiar with California’s full workers’ compensation laws. Trying to gain that familiarity while your case is pending might be downright impossible.

To progress your claim with confidence, allow Alavandi Law Group in Orange County to represent you. In many cases, our workers’ compensation attorneys have been able to negotiate a higher settlement offer than insurance companies first try to give our clients before they obtained our representation. No past case result can promise a future case’s outcome, but we think our experience and background with all things workers’ compensation-related speak for themselves.

Contact us by dialing (800) 980-6905 and request a free consultation today.

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