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Many people may be familiar with the idea that their Workers’ Comp case can be settled, but it might not be obvious what this means.

Workers’ Comp cases can be settled early on, preventing the need to go to court. Others are settled while the case is pending before a Workers’ Comp Judge (WCJ), while others have the payments settled after the WCJ decides the case. In any case, you should have your attorney review your claim, negotiate with the employer, and help you figure out what your case is worth before you sign or accept anything.

Call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945 for help with your case and a free case review.

When Do Settlements Occur in Workers’ Comp Cases?

Workers’ Comp claims have a few main stages:

You are injured and get medical care.
You file notice of your injury with your employer.
Your employer files a claim with their insurance carrier.
The claim is initially denied.
You file a Claim Petition and go before a Workers’ Comp Judge (WCJ), who hears and decides the case.
You get benefits granted and get payment.
You continue to get benefits until your needs change.

Settlements typically occur in three places:

Instead of denying your claim, the insurance carrier offers you a settlement.
Instead of waiting for the WCJ’s decision on your Claim Petition, you settle with your employer/the insurance carrier.
After benefits are granted, instead of receiving ongoing benefits, you settle the claim for a lump sum.

When your specific case settles will depend heavily on…

What the insurance carrier wants
How much they are comfortable paying
How strong your evidence is
Your needs and demands.

If you can show them from the beginning that they will lose if they go before a WCJ, they may be willing to settle earlier. However, if they think they can fight it, it might not settle until after the WCJ rules in your favor.

Steps to Settle Your Workers’ Comp Case

If you want to achieve a fair settlement, you should take the following steps:

Get Medical Care

You need to document your injuries and go through other required exams to show what your injuries and disabilities are and prove they are related to your work.

Report Injury

Injuries usually need to be reported to your employer within 21 days. Injuries reported after 120 days are barred from recovery.

Assess Costs

When you settle your case, it needs to include compensation for everything: all future medical costs, any unreimbursed costs, lost wages you still haven’t received, future lost wages, and specific loss benefits.

Negotiate Settlement

Your Pennsylvania Workers’ Comp attorneys handle all of the negotiations for you, but you get final approval over whether to settle or not.

Sign Agreement

A settlement is not valid until you sign a Compromise and Release Agreement detailing the terms of the settlement. This also releases your employer from any other claims you might have, meaning the case is dropped entirely after this is signed.

Get Approval

Compromise and Release Agreements need approval from the WCJ on the case before they are valid.

What to Look for in a Good Workers’ Comp Settlement

A good settlement should meet these three requirements:

Covers Needs

Workers’ Comp pays three areas of benefits:

Medical expenses to cover any costs of treating your work-related injury, including ongoing care needs like physical rehab.
Lost wages at a rate of 2/3 of your average weekly wage (AWW) as long as you cannot work, or 2/3 of the difference in pre- and post-injury wages if your injury reduces your wages. These are capped at the statewide AWW, and the minimum is the lesser of 1/2 the statewide AWW or 90% of your AWW.
Specific loss benefits paid at a rate of 2/3 of your AWW for a number of weeks listed in the statute, depending on your injury. There is also a cap at the statewide AWW and a floor at 1/2 that. These are paid for amputation, total lost function, lost vision/hearing, and serious facial scars.

Follows Requirements

There are rules about what goes into a Compromise and Release Agreement and what the WCJ needs to check on before allowing a settlement. For example, if you may be eligible for Medicare soon, you may need a “Medicare set aside” in place to prove to Medicare that you will be using this money, not theirs, to cover care for this injury. You may also need to sign certifications stating you do not owe back child support, or else the settlement gets garnished.

You Understand It

It is vital to go over your settlement with a lawyer and make sure you understand what rights you are giving up.

Settlement FAQs for Workers’ Comp Cases in Pennsylvania

What is a Compromise and Release Agreement?

In Workers’ Comp Claims, settlements happen through a document called a Compromise and Release Agreement. This says you are compromising to come to an agreed-upon value for benefits, and it says you release the employer from future claims. Judges need to approve these agreements before they are valid.

What is a “Global Settlement”?

Most cases involve a “global settlement” that settles both your medical costs and your wage-loss benefits (plus specific loss benefits). Some cases may alternatively settle just the wage-loss (and specific loss) portion of the case, leaving your ongoing medical care coverage “open” so it gets paid as expenses arise.

Talk to your lawyer about what your specific settlement covers.

Can I Undo a Settlement?

Usually, settlements can only be undone in cases of fraud or duress – i.e., actual physical threats of violence. Because parties have a lawyer review and explain the settlement, then have a judge question them to make sure they are agreeing to settle of their own free will, overturning a settlement in Workers’ Comp is very rare.

What Are Lump Sum Settlements vs. Structured Settlements?

Wage-loss benefits are paid over time, and medical expenses are billed to the insurance carrier as they come up. Settling in a lump sum or structured settlement puts all of that money into the settlement instead.

A lump sum settlement is paid at once, giving you the flexibility to invest the money and spend it as you go. A structured settlement or annuity instead pays the money in installments.

While lump sums often offer more flexibility, a structured settlement may help you keep your resources low enough to qualify for other benefits programs or lower tax payments.

Can I Settle Without a Lawyer?

WCJs might require workers to go over the settlement with a lawyer before they approve the Compromise and Release Agreement, making it hard to settle your case without an attorney.