Types Of Workers Compensation Settlements Negotiated By An Orange County Workers’ Compensation Lawyer
As a top Orange County workers’ compensation lawyer, Thomas F. Martin, PLC explains the main types of settlement formats options in workers’ comp law:
- Stipulated Findings and Award
This type of settlement is an option when an injured worker and the employer (or its insurance company) agree on the permanent disability rating and need for future medical treatment. The stipulation is the parties’ agreement about the findings of the case. These findings include the disability rating percentage, the fact that a work injury caused the disability, and the need for future medical care.
When the settlement paperwork is presented to a workers’ compensation judge, the agreement will have the same force and effect as if the Judge made the findings after a trial. In most cases, after obtaining the medical reporting and other evidence, the parties are often able to agree on what the Award should be.
A Stipulated Findings and Award settlement will require the insurance company to make a payment to the injured worker every two weeks for a specified period of time depending on the percentage of permanent disability. Sometimes, if the insurance company has not paid the permanent disability owed, a lump sum payment be paid to the injured worker to catch up on the payments owed according to the agreement.
This settlement is common in cases when an injured worker continues to work for the same employer.
- Compromise and Release
An Orange County workers’ compensation lawyer may negotiate a Compromise and Release if the injured worker wants to close out all rights in the case, including the right to request future medical treatment. In these cases, the injured worker accepts a lump sum of money to settle the worker’s compensation claim and close the case forever.
The workers’ compensation judge must still review approve the Compromise and Release to ensure it’s fair. Most Compromise and Release settlement agreements are approved if the worker has an experienced Orange County workers’ compensation lawyer representing them.
One advantage of this type of settlement is the immediacy of payment. Workers don’t need to wait for installments payments but receive the full payment. In many cases, clients receive a more favorable financial payment since insurance companies prefer not to be under any future obligation.
- Hybrid settlement
An experienced Orange County workers’ compensation lawyer may be able to negotiate a Compromise and Release ( closing out all rights for a lump sum) AND have future medical care left open in certain cases.
Not all lawyers are made equal. Some actually routinely go to court, and others spend their time promoting their catchy nicknames on billboards, radio and TV. Some even have songs that tell you absolutely nothing about their skill as an attorney.
When people suffer a work injury, it’s serious business. You deserve information about the lawyer that tells you what makes them qualified to help you navigate the California workers’ compensation system.
What qualities does a truly exceptional workers’ comp attorney have in Orange County?
- Communication With A Lawyer – Not A Paralegal
Clients have a right to know where their case stands at every point of the legal process. Having access to the attorney that is representing you shows they are personally involved in your case.
Some law firms have dozens of non-lawyers processing your claim. Why hire a law firm if you hardly ever get to talk to a lawyer? Does the lawyer even now about what is going on in your case? Or is he or she just relying on their staff to deal with the issues of your case?
Cases, like people, are dynamic – things can change rapidly. Is the lawyer available for unexpected developments? Is the lawyer ready to get a court date to deal with the problem, or are you going to just get talk from the non-lawyers at the firm? These are questions to ask BEFORE you hire a workers’ compensation attorney.
A workers’ comp lawyer should do what he or she says they are going to do. Ask the attorneys you are considering to help you what the game plan is on your case, and how they plan to give you feedback on your case.
If, for example, benefit checks suddenly stop coming without explanation, clients should be able to contact their lawyer immediately. There could’ve been a technical mistake or the insurance company could’ve decided benefits are no longer necessary, despite doctor’s orders. Can you rely on your lawyer to have a game plan? Or are you going to get the run around by the firms non-lawyers? Ask how such things will be handled BEFORE you decide on a lawyer to hire.
When interviewing lawyers to hire, are you sensing that the lawyer is paying attention to the unique aspects of your case, or are they just running through their “script”? If you aren’t straight answers to your questions, that may be a sign that you will be treated the same way as a client
An attentive lawyer will HEAR what you are saying, and do his or her best to answer your questions. know the details of every settlement offer — even if it’s unacceptably low — and share that information with their client before rejecting the offer.
- Strong Negotiation Skills
Insurance companies know who the prepared attorneys are. Making certain that your case is fully documented is hard work, and it puts your lawyer in a strong position to negotiate the result you deserve. If the insurance company is dealing with an attorney that is routinely unprepared or relying on non-attorneys to handle your case, your case is not going to be taken as seriously. Ask the lawyer you are interviewing how they process cases and what their reputation is for being prepared BEFORE hiring them.
The successful outcome of a case depends on the lawyer’s commitment to preparing the case for trial. Ask the lawyer if he or she is PERSONALLY preparing the case for the Judge, and PERSONALLY appears before the Judge BEFORE you hire them. If all the lawyer is relying on non-lawyers to do the critical work and appearances on the case, you deserve to know that ahead of time
- Knowledge About The Workers Compensation System
Does the lawyer you are interviewing doing a lot of different types of law, or ONLY workers compensation? Are they recognized by a past client and other lawyers as a skilled and ethical lawyer? An experienced workers’ comp attorney in Orange County is known and respected for their knowledge and skills.
Making The Decision
Look for these qualities in a workers’ comp lawyer before retaining a workers’ compensation attorney. It can make a big difference in the outcome of your case and your life.
If you’ve never sustained a work injury before, the prospect of going through the legal process can seem daunting — especially if you’re receiving medical care and struggling to figure out how to manage other daily responsibilities. However, not all work injuries require an Orange County, CA Workers’ Compensation lawyer, so it’s important to know what to consider to decide whether to hire an attorney.
Should You Consider Hiring an Orange County, CA Workers’ Compensation Lawyer?
- Your employer or insurance carrier denies the accident is work-related.
Minor work injuries are often denied by the employer or insurance company. If an injury goes untreated, it could become more serious, and even provide an excuse for denying the injury. Injuries that occur over time, such as exposure to toxic chemicals or repetitive activities, such as typing or lifting need to be documented by a physician as soon as possible.
A workers’ comp attorney in Orange County, California could help a worker secure the proof necessary to obtain the compensation an injured worker deserves.
- Your employer isn’t taking your injury seriously.
It is the employee’s job to report the accident or injury to the employer as soon as possible. Once the employer is notified, it is their responsibility to follow California law and report the injury to its workers’ compensation carrier.
If your employer refuses to report your injury to its workers’ compensation carrier, or the carrier hasn’t contacted you within a week after you reported the injury to your employer, consider contacting a workers’ comp attorney to take appropriate actions on your behalf.
- You anticipate permanent disability.
If you anticipate permanent disability, you may not be able to return to the work you were performing at the time of the injury. Your future income may be reduced due to the injury and you may be entitled to permanent disability compensation to address your reduced earning capacity. Insurance companies are more likely to fight and deny claims with permanent disability because they tend to cost insurance companies more money.
- The insurance company refuses to pay for doctor-recommended treatment.
Insurance companies often deny much-needed medical treatment – even when their own doctors recommend it! An experienced Orange County, CA workers’ compensation lawyer can help you get the treatment you need so you can get back to work.
- The insurance company denies your legitimate claim.
When your legitimate claim is denied by an insurance company, a workers’ comp attorney can assist in gathering the information and documentation your will need to have a workers compensation judge decide the issue.
- The insurance carrier makes an inadequate settlement offer.
If the settlement offer made by the insurance company makes you a settlement offer that doesn’t come close to considering your financial losses and permanent injury, you may want to consider securing legal representation. Most permanent disability claims are valued based on the rating provided by an examining doctor. If the insurance company disagrees with a treating doctor’s rating of your permanent injuries, you have a right to an independent physician evaluation arranged by the State of California. A workers’ comp lawyer can assist you in documenting the permanent injury compensation you are entitled to.
- You have a preexisting condition.
Insurance companies try to blame your current Permanent Disability on “preexisting conditions” – even if you recovered from prior injuries and conditions. A workers’ compensation attorney can help you fight the insurance companies’ attempt to get a “discount” on the permanent disability compensation you deserve.
- You intend to file for Social Security Disability Insurance ( SSDI ) benefits.
There is a potential interaction between SSDI benefits and workers’ compensation benefits. A workers’ comp attorney can help you navigate these issues, and potentially reduce offsets.
- You experience employer retaliation due to your work injury.
If the employer fires or demotes you, cuts your hours, or pressures you to return to work too soon, you may have additional claims against the employer.
- Someone else is responsible for your work injury.
In addition to having a workers compensation claim, “third-parties” (a person or company other than your employer) may also be responsible to compensate you for the injuries you sustained. A workers compensation attorney can assist you in securing workers’ compensation benefits and also recover your damages in a personal injury case against the third party that caused your injuries while you were working.
Searching for the top Orange County, CA Workers’ Compensation lawyer? Contact the law offices of Thomas Martin, PLC for a free consultation.
According to research from the California Workers’ Compensation Institute (CWCI), injured worker hospitalizations fell to 17.2% in 2020, down from 47.2% in 2010. Over the past decade, the number of inpatient discharges in California have declined steadily, except for Medi-Cal.
The report compiled data on nearly 39.2 million inpatient stays from 2010 through 2020. Since 2010, workers’ compensation hospitalizations have represented the smallest share of hospital stays, just 0.4%.
Factors contributing to the decline in workers’ comp hospitalizations include the adoption of cost-cutting programs requiring treatment of injured workers to meet certain criteria not found in other provider systems. Consequently, taxpayers end up paying for treatment that the workers’ compensation insurance companies refuse to cover.
Under Governor Newsom’s leadership, many injured workers were treated via telemedicine and didn’t experience significant delays in receiving treatment. Thankfully, the vast majority of COVID-19 claimants only needed limited treatment, contrary to the insurance industry’s original predictions that the losses would be catastrophic.
2020 wasn’t a banner year for PROFITS for workers’ compensation insurers and business owners. Insurers took in less premium but also paid fewer claims, according to the Insurance Journal.
The reductions in both the losses and premiums created an 86% combined ratio for workers’ comp calendar year 2020. This would be the third-lowest combined ratio in history and the seventh consecutive year of underwriting gains, according to National Council on Compensation Insurance (NCCI) director and actuary Vicky Mayen.
Meanwhile, as insurance company profits soar, many injured workers are struggling to get back to work due to delays in their medical treatment.
A very familiar story, unfortunately.
Three bay area men — Eric Andrew Oller, Brian Christopher Mitchell, and Yama Sekander — former owners of painting companies, were arraigned September 20th in an Oakland court on fraud charges filed by the Alameda County District Attorney’s Office and the California Department of Insurance (CDI).
Oller and Mitchell owned Walnut Creek-based Signature Painting and Construction Inc. and were each charged with one felony count of conspiracy to commit a crime, six counts each of felony insurance fraud, and two counts of workers’ compensation fraud.
The defendants used Valhalla Consulting and A-1 World Class Painting, businesses owned by Oller and Sekander, respectively, as a shell company to pay painting company employees from 2017-18. SPC misrepresented or omitted information about the company’s structure, misclassified employees, and underreported payroll costs to illegally reduce their workers’ compensation premium.
Alameda County District Attorney Nancy O’Malley said, “If a business creates an environment where they falsely pay a lower insurance premium, that company has an unfair competitive advantage over one that is law-abiding.”
Mitchell and Oliver are also charged with entering into agreements to move employees from one company to another to reduce workers’ compensation costs. Authorities have accused Mitchell of using Sekander’s A-1 company to obtain a workers’ compensation policy for SPC.
SPC owners paid some employees under the table and instructed injured employees to report they worked for a different company, which allowed SPC to avoid paying and reporting the full amount of taxes owed.
Their scheme defrauded insurance carriers of more than $5 million since 2015. State Compensation Insurance Fund (SCIF) lost premium payments totaling $3.1 million and AmTrust lost about $1.9 million.
SCIF submitted a fraud referral against SPC in 2019 and authorities began their investigation. Crimes date back to 2015, according to authorities.
Charges were filed in late August and all three men have pleaded not guilty to the charges. The next court date is November 18.
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