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How Do They Determine Workers Comp Settlement Amounts

How do they determine workers comp settlements

An attorney will often determine a workers comp settlement amount by estimating the schedule loss of use award a claimant would be eligible for. Schedule loss of use awards are known in the business as “SLU” awards. These awards apply to permanent injuries to the extremities, such as the arms, legs, hands and feet. A large SLU value can lead to a significant settlement amount.

How Will the Injured Worker Determine a Workers Comp Settlement Amount in a SLU Case

In order to determine a workers comp settlement amount in a SLU case, a doctor must evaluate the injured worker. Then, the doctor must provide the injured worker with a medical report. The report should contain a SLU percentage. For example, the doctor may state in the report that the worker suffers from a 20% SLU to the right arm. Under NY workers comp law, the right arm has a value of 312 weeks of compensation. The Board will calculate the rate of the award by looking at the injured worker’s Average Weekly Wage. The rate the award is payable is two thirds of the worker’s Average Weekly Wage. The lawyer must then add weeks of compensation to the award if there is a protracted healing period. This will depend on how long the worker was benefits at the temporary total rate of compensation.

So in this case, lets say the rate is $900 per week. If that were the case, the worker would receive a SLU award in the amount of $56,160 for 20% SLU of the arm. The workers comp attorney will then look at whether the worker lost time from his or her job. The attorney must then reduce the SLU award by the amount the worker was paid while out of work. That will leave the final SLU value for settlement discussions. To determine the workers comp settlement amount for a SLU case, the injured worker cannot just rely on his or her own valuation. They must also look to how the insurance carrier will value the case. Also, how the Board may value it.

How Will the Insurance Carrier Value a SLU Case for Settlement

Insurance carriers want to reduce all settlement amounts. They will determine a workers comp settlement amount in a SLU case in a similar manner to the injured worker’s attorney. The insurance adjuster will review the report and opinion of the injured worker’s doctor. They will then consider whether the SLU opinion of the injured worker’s doctor is consistent with the Workers Compensation Guidelines for Determining Permanent Impairment. The adjuster will also consider sending the injured worker for a SLU opinion with the insurance carrier’s retained medical consultant.

This doctor, a paid consultant, is known as an “IME doctor.” An IME doctor will typically give a significantly lower SLU opinion than that of the injured worker’s doctor. When that happens, the parties will often determine a workers comp settlement amount between the doctors’ opinions. If the parties do not reach an agreement, they may file for a hearing. In such a case, a Workers’ Compensation Law Judge will determine the SLU award percentage and value. The parties will also depose each side’s doctors and cross-examine them about their respective SLU opinions.

How Do the Parties Finalize the Agreement Once the Settlement Amount is Determined?

Once the parties have determined the workers comp settlement amount for SLU, they can either enter into a stipulation or execute a Section 32 Settlement Agreement. If the parties stipulate, medical coverage on the claim will continue. The Board will authorize maintenance medical care. However, if the parties enter into a full and final S32 Settlement, it will include the value of future medical care within the settlement amount. How the parties determine a workers comp settlement amount will depend on the fact of each case. A seasoned workers comp lawyer is able to properly value and structure each settlement in a way most favorable to the injured worker. We have a team of workers comp lawyers who can do just that – contact us for next steps.

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