Does surgery increase workers comp settlement in california

1. DWC

How is my case resolved

Your case is resolved when there is an agreement between you and the claims administrator or a judge issues an order about your workers' compensation payments and future medical care that will be provided to you. In order to protect your rights, whether or not you are represented by an attorney, settlements must be reviewed by a workers’ compensation administrative law judge, to determine whether they are adequate.

What types of settlements are there?

There are two different ways to settle your case:

• Stipulations with Request for Award (stips)
  • Payments - You and the claims administrator agree on the amount of temporary or permanent disability payments you will receive. This is usually paid in weekly payments
  • Medical care - The claims administrator usually agrees to pay for medical care if needed.
• Compromise and Release (C&R)
  • One payment - The claims administrator agrees on an amount to resolve your claim. This is usually paid in a lump sum
  • Medical care - If the lump sum includes the estimated cost of future medical care, the claims administrator will no longer pay your doctor. This becomes your responsibility.

What if my case doesn't settle?

If you and the claims administrator are unable to agree on a settlement, your dispute will need to be decided by a workers’ compensation judge.

Want to learn more? Find it in the guidebook

• Topic 7: Permanent Disability Benefits
• Want a complete version of the injured worker guidebook?

Did you know?

• You can contact the Information and Assistance Unit if you have questions or call 1-800-736-7401 for recorded information
• You are not required to accept the claims administrator’s offers. You can negotiate a settlement. If you can’t reach an agreement with the claims administrator, you can present your case to a workers’ compensation judge. The judge will decide what benefits you will receive. This decision is called a Findings and Award. It will be sent to you in writing
• You can consult an attorney. Lawyers who represent injured workers in their workers’ compensation cases are called applicants’ attorneys. Your attorney can’t directly charge you for his or her services. Your attorney’s fee will be paid out of a portion of your workers’ compensation benefits. You can get names of applicants’ attorneys from the State Bar of California, a local bar association, or the California Applicants’ Attorneys Association.

Questions workers have:

• How is my claim finally resolved?
  
  
  More FAQs

March 2013

Learn about the different kinds of workers' comp settlements in California, and what you should consider before cashing out.

If your employer's insurance company has denied your workers' comp claim or hasn't approved all of the benefits you think you deserve, you have a right to appeal that decision by filing an "application for adjudication of claim" (see how to file a California workers' comp claim for details).

However, only a small portion of disputes end up going to a hearing before a workers' comp judge. Most of the time, insurance companies and injured employees resolve their disagreements by reaching a settlement.

Throughout the course of your case, you'll probably have several opportunities to negotiate with your employer—or more likely its insurance company.

Should I Settle My Workers' Comp Case in California?

The wisdom of accepting a settlement offer will depend on several factors, including the amount of money being offered, the severity of your injury and resulting permanent limitations, the strength of your medical evidence, your financial situation, and your willingness to wait it out longer.

On the one hand, if the offer is good enough and you need the money now, it might be worth accepting a lower amount to avoid the hassle and time it takes to go through a workers' comp hearing.

On the other hand, if the insurance company insists that you're less disabled than you think you are, and you have reliable medical evidence supporting your claim, it may be worth trying to convince a workers' comp judge to award you more benefits.

Before considering a settlement offer, you should at least wait until your medical condition has stabilized (a stage called "maximum medical improvement" or "permanent and stationary").

Until then, you won't know how much your case is worth. Once your physician says that you won't improve any further, even with more treatment, the doctor will decide whether and to what extent your injury has caused permanent limitations that would result in a permanent disability award.

For more on how this process works, see our article on getting workers' comp permanent disability benefits in California.

Types of Workers' Comp Settlements in California

In California, there are two ways to settle your workers' compensation case: a "compromise and release" or "stipulated findings and award."

Compromise and Release

With a compromise and release, you are agreeing to close out your workers' comp case for good in exchange for a lump sum payment. This means workers' comp won't pay for any future medical care related to your injury, and you won't be able to reopen your case if your condition gets worse. In return for that uncertainly, however, you'll receive a larger payment up front and won't have to take your chances at a hearing.

A compromise and release is final. As long as you signed the agreement voluntarily, workers' comp judges usually won't let you take it back—even if you end up needing more money later. So before agreeing to this type of settlement, make sure that your condition is stable and that either:

• you won't need any more treatment, or
• the lump sum payment will cover the cost of future medical bills.

Stipulated Findings and Award

If you settle your case with a stipulated findings and award, you and the insurance company will agree on the extent of your permanent disability and the amount of your benefits. You'll receive biweekly payments rather than a lump sum—unless you can show a financial need for part or all of your benefits to be paid up front. This type of settlement has two advantages:

• The insurance company will pay for your future medical treatment as you need it, although you'll have to follow California's workers' comp rules for getting medical treatment.
• If your medical condition gets worse within five years after your injury, you may be able to reopen your case.

Who Approves a Workers' Comp Settlement in California?

Any settlement that you agree to will need approval from a California workers' comp judge. You—or your lawyer, if you have one—will file paperwork with the California Workers' Compensation Appeals Board detailing the terms of the agreement. A judge will usually hold an informal hearing to make sure you understand the agreement and that the terms are fair. If the judge approves the settlement, you will receive your lump-sum payment within 30 days.

Do I Need a California Workers' Comp Lawyer?

Unless your injury was minor and you healed completely, you should consult with a lawyer before settling your case. This is especially true if you are considering a compromise and release, which will take away your right to seek additional benefits or medical treatment in the future.

A lawyer can tell you how much your case is probably worth, evaluate settlement offers, and negotiate with the insurance company for a higher sum.

A lawyer can also make sure that the settlement agreement doesn't ask you to waive any rights that you shouldn't give up. If you're also receiving Social Security disability insurance, your attorney can save you money by making sure the settlement minimizes how much workers' comp benefits will lower Social Security payments.

To learn more, see our article on what a good lawyer can do for you in your workers' comp case.

How do I maximize my workers comp settlement California?

What is the maximum payout for workers compensation in California?

What is the average Workmans Comp settlement in California?

How long does a workers comp case take to settle in California?