How Does a Workers’ Compensation Settlement Work?

workers compensation

Every employer in the state of Delaware with one or more employees must carry Workers’ Compensation insurance. This insurance provides benefits to employees who become ill or injured because of their employment. The illness or injury must be directly related to the performance of the job. 

Statistics reveal that nearly three million employees nationwide were injured on the job in 2019 and made Workers’ Compensation claims. It can be beneficial to employees when it works in their favor and fully covers their losses. 

What Does Workers’ Compensation Cover?

Workers’ Compensation insurance covers work-related injury, occupational disease, and death. Claims can include broken bones from a fall at work to mesothelioma caused by exposure to asbestos. Workers’ Compensation may even cover care for old injuries that are aggravated by your job. 

The illness or injury must be related to the performance of your job. For example, if someone gets cancer while working but their job does not cause it, they would not have a valid Workers’ Compensation claim. But if a worker gets lung cancer from inhaling toxic fumes in the course of their work, their claim could be valid. 

Workers’ Compensation is no-fault insurance. It is unnecessary to show that the employer is at fault or that the injured worker is free from blame for causing the illness or injury. A worker’s behavior is irrelevant in a Workers’ Compensation claim unless they were not working with reasonable care, such as operating a dangerous machine while intoxicated. 

Most Workers’ Compensation claims cover injuries that happen in the actual workplace. However, it also covers work-related injuries that occur on a job site, while meeting a client, or at a temporary office away from the usual workplace. 

The main consideration is whether the employee was performing a work-related activity at the time of injury. For example, an employee injured in a car accident while running a personal errand during her lunch hour most likely would not have a valid Workers’ Compensation claim. 

What Are Workers’ Compensation Benefits?

Workers’ Compensation benefits are designed to help injured or ill employees financially while they cannot work. It covers the following:

Medical expenses. These expenses could include doctor visits, specialist visits, hospital stays, surgeries, therapies and other treatments, medications, medical equipment, rehabilitation, home care, out-of-home stays, and even mileage reimbursement. 

Lost wages. An injured or ill employee may be off work for a short while or longer term. Sometimes they can never return to work if their illness or injury is severe or permanently debilitating. Other times the employee may return to work but with reduced hours or in a different position with reduced wages. 

In Delaware, if an employee is temporarily out of work, Workers’ Compensation will pay them up to 66 and two-thirds percent of their gross weekly wages for the duration of their disability. If their wages are reduced because of fewer hours or a lower position, their benefits are two-thirds of the difference between their pre- and post-injury wages. 

If a worker is permanently totally disabled or disfigured from the illness or injury, their payment is currently a minimum of 22 and two-ninths percent of their weekly wage, or $201.72, and a maximum of 66 and two-thirds percent of their pay, or $605.15. Payments are for the duration of the disability. 

If an employee is permanently partially disabled, their payment amounts are the same as above, depending on the nature of their injury or illness. Their payments may also be capped at a specific time or amount. 

If an employee dies of a work-related injury or illness, death benefits, including funeral expenses, may be payable to their dependents. 

How Does the Claims Process Work?

Every state has its own process for making a Workers’ Compensation claim. In Delaware, when workers are hurt or learn that their job has caused their illness or injury, they must notify the employer in writing. Most employers have a form the employee must use as well as a process for them to follow. 

The employer must be notified within 90 days of the injury or six months of learning of a work-related illness. The employer will then file a report with the Delaware Office of Workers’ Compensation within 10 days of being notified. 

At the same time, the employer will notify their Workers’ Compensation insurance provider. The insurer will either acknowledge or deny the claim. If they acknowledge it, the worker and employer will sign a benefits agreement. 

It is important to note that there may be some negotiation about benefits between the insurer and employee. It could be highly beneficial for the employee to consult with a lawyer before signing an agreement to ensure they are not leaving benefits or compensation on the table.  

If an agreement is reached, it is filed with the Delaware Office of Workers’ Compensation. Benefits should begin promptly at the same frequency as previous paychecks. 

Sometimes a Workers’ Compensation insurer will deny the claim from the beginning. When this happens, the worker should consult with a lawyer. They can appeal to the Industrial Accident Board. If denied again, they can then appeal to the Superior Court within 30 days. If Superior Court also rejects the claim, the employee can appeal to the State Supreme Court within 30 days. 

Can I Get a Lump-Sum Settlement Rather than Installment Payments?

An injured or ill employee has the right to seek a lump-sum settlement that is potentially larger than what the state will pay them in installment benefits. 

The employee would need to agree on the amount of a lump-sum settlement, also called a commutation, with the employer/insurance company, and the Industrial Accident Board must also approve the commutation.  

The amount of the lump-sum settlement generally involves extensive negotiations with the insurer. An employee could benefit from hiring a lawyer to help with these negotiations. Essentially, when a worker agrees to a lump-sum settlement offer, they give up all future benefits related to this injury or illness. 

A lawyer can help ensure that future needs and costs are considered in a lump-sum settlement. An insurer will always try to minimize their losses, so they rarely consider future financial costs or medical needs in their settlement offers. 

A lawyer will consider future health care costs, income needs, and other factors that will help an employee live without being impoverished. They will work toward fair, full, and just compensation for the employee who was injured or fell ill simply by going to work. 

How Can a Lawyer Help Me?

Workers’ Compensation claims can be stressful and complex. Your employer cannot help you get more benefits, as they are tied to state laws and their insurer’s policies. Basically, without a lawyer, injured or ill employees have no one to advocate for them but themselves. 

A Workers’ Compensation claim can significantly affect a person’s quality of life, both physically and financially. An experienced lawyer can work and negotiate with employers, private insurance companies, and state agencies. They keep abreast of laws and know how to defend your rights against an insurer’s tactics. 

A lawyer will consult with medical professionals and other experts to determine the actual cost of your future care, medical needs, and disabilities. They will factor in your lost wages, future lost wages, and reduced earning potential, along with attorney fees and other miscellaneous costs. The result will be a realistic demand for compensation that covers your actual losses. The amount is usually a far cry from what an insurer wants to offer.   

The process also requires a settlement hearing with the Industrial Accident Board or other appointed officers. Although called a hearing, this is a legal proceeding. Your lawyer will present expert witnesses and testimony on your behalf. A judge most often decides the final settlement amount. 

Delaware Workers’ Compensation Lawyers at McCann Dillon Jaffe & Lamb, LLC, Help Injured Workers 

Employees who are injured or fall ill on the job deserve to be compensated for their total current and future losses, including medical bills, lost wages, and disabilities. If you were injured or became sick at work, reach out to the Delaware Workers’ Compensation lawyers at McCann Dillon Jaffe & Lamb, LLC. We will investigate the circumstances of your injury and fight to secure the compensation for which you are entitled. Call us today at 302-888-1221 or contact us online for a free consultation. Located in Wilmington, Delaware, we serve clients in Dover, Newark, and Middletown.