Calculating Benefits & Settling Your Claim

Calculating Benefits In Workers’ Compensation Claims

A key component of calculating benefits in workers’ compensation claims in Florida is determining the average weekly wage. This figure serves as an anchor for assessing future benefits for injured employees. Naturally, the process for determining this figure is multifaceted and takes into account various scenarios.

In its simplest form, say, if an employee has worked uninterrupted for a period of 13 weeks prior to the accident, the average weekly wage is determined by dividing the total earnings over those 13 weeks by the number of weeks worked. This calculation yields a weekly average that becomes the basis for calculating future benefits. Furthermore, if the employee received fringe benefits that are no longer available due to the injury, these too can contribute to the average weekly wage calculation.

For employees who have not worked the required 13 weeks, alternative approaches are needed. These methods can include incorporating wages from prior employment if a substantial portion of the 13-week period was worked elsewhere or assessing the earnings of coworkers in the same workplace.

The compensation formula then comes into play once the average weekly wage is determined. For employees who are completely unable to work, benefits are calculated at two-thirds of their average weekly wage during the period of inability. On the other hand, employees who are able to work with limitations are compensated at 80 cents for every dollar they earn below 80% of their gross average weekly wage.

Factors To Consider Before Settling

Before embarking on the path to settle your workers’ compensation case, there are several important factors you’ll need to consider….

• Your Future Medical Needs & Earning Capacity

It’s crucial to have a reasonably accurate idea of what your future medical care and treatment will involve, as well as how your ability to earn will be impacted in the future. While doctors can’t predict the future of your condition with absolute certainty, they can offer informed opinions of what the road ahead may entail — cost and all.

• Your Alternative Options For Medical Coverage

Another crucial aspect to consider is the availability of alternative medical care and treatment options. For instance, if you foresee the ability to obtain private health insurance coverage through your spouse, you may be better positioned to settle. Conversely, if you lack any alternative resources to access medical care, you’ll likely approach settlement from a very different angle.

• The Impact On Your Existing Benefits

It is also wise to consider how settling could impact any existing government benefits you may be receiving. For instance, settling a workers’ compensation claim while receiving Social Security disability benefits can trigger ramifications that extend to your ongoing medical care, treatment, and payments. Beyond government benefits, private pay benefits, such as long-term disability insurance and other wage replacement programs, can be affected as well.

When it comes to private benefits, the relationship between a workers’ compensation settlement and other sources of support is often laid out in contractual agreements which set the rules for the impact a settlement may hold. As such, it’s essential when considering a settlement to carefully review these agreements and find the language that explains the potential impact on benefits received from external sources.

This is where legal guidance truly becomes essential. An attorney who is well-versed in the intricacies of workers’ compensation law can provide invaluable advice on how a settlement might affect your future and the continuation of benefits you receive from sources outside the workers’ compensation system.

Lump Sum Settlements Versus Weekly Benefits

A lump sum settlement is an agreement between an employer, a carrier, and an employee. In this arrangement, a single payment is made in exchange for a release from any further obligation to provide workers’ compensation benefits. However, deciding whether such an arrangement aligns with your best interest hinges upon several crucial factors, each of which requires careful consideration.

Central to this decision is forecasting your future medical care and treatment needs. Evaluating whether you will require ongoing medical attention is pivotal in determining the value of a lump sum settlement. Additionally, the availability of other benefits that could potentially cover lost work time or medical expenses plays a significant role in this decision.

It’s important to underscore that each situation is unique, shaped by the condition of your health and your potential access to additional benefits. On one hand, if a medical professional advises that little or no future medical intervention is expected and the settlement offer is reasonable, opting for a lump sum can be a good choice. If, on the other hand, your need for future treatment is uncertain, accepting a lump sum could result in the amount falling short of covering the ongoing care you need or missed time away from work.

Given the complexity of these decisions, consulting with medical and legal professionals is truly invaluable. Their insights can help you make informed decisions that align with your unique circumstances.

Examining The Potential Downsides And Future Implications Of Full And Final Settlements

Once you make an informed decision to reach a full and final settlement, reopening a claim that has received court approval becomes exceptionally challenging. Even if your injuries worsen over time or pose greater issues in the future, you will likely have to assume the responsibility of funding ongoing care and treatment either independently or through alternate sources of collateral benefits.

Because of this, it may be in your best interest to keep your claim open by choosing to receive indemnity payments or medical benefits from the employer and carrier periodically – at least as often as once a year. This approach ensures your claim’s ongoing viability. However, it’s important to keep in mind that those who do opt to keep their cases open tend to lose track of time, which can prove to be devastating to the claim. In such cases, if you fail to visit a doctor for follow-up care or don’t ensure you’re properly compensated for the time you’ve missed from work, your claim could reach the statute of limitations and expire.

To reduce these risks, it’s crucial to keep track of time and appointments. Personally, I recommend seeing a doctor every six months as a proactive measure to provide you with enough time to consult with an attorney if any issues arise. Then, if the insurance carrier denies ongoing care and treatment, you can address these challenges by filing a petition for benefits with the judge of compensation claims. This way, as long as you file the claim within one year of the last medical care provided or within two years of the initial accident, you still have access to the possibility of ongoing care.

For more information on Settling A Workers’ Compensation Claim, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (386) 388-6260 today.