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Workers’ Compensation: What Is My Case Worth?

On Behalf of | Apr 12, 2022 | Workers' Compensation |

The most frequently asked question by clients is “what is my case worth”, (closely followed by how much will this cost me?!) Below are just a few of the important considerations when determining what YOUR CASE is worth.

1. Every Case Is Unique

10 or 10,000 people with the same injury will have different ‘values’ for their case, based on significant issues, such as the severity of their injury and the amount of their salary – to seemingly minor factors such as which insurance company, judge and defense lawyer are involved. [See the hypothetical cases below].

An experienced, Workers’ Compensation Specialist lawyer knows which factors are the most important in YOUR case, which could be very different than the focus in the next case.

2. No Pain & Suffering

There is no compensation for “pain and suffering”, loss of enjoyment of life and other factors that do have a “value” in personal injury claims. As a general rule, workers’ compensation pays lost wages (based on a formula), and medical bills for treatment that is reasonable, necessary and related to the work injury.

The ‘starting point’ to evaluate each case is to identify the weekly wage loss benefit rate, and the specific injury the insurance company must pay medical bills for.

3. No Forced Settlements

No one can force you – or the insurance company – to settle the case:  Not the Judge, and not an appeal court. An insurance company can not “force” a claimant to take less than they want; and the injured worker can not force the insurance company to pay more than they are willing to offer. Every term must be agreed upon by every party involved in the case, or there is no deal. The agreement includes the amount of the settlement and every term and condition attached by any party involved. If just one terms is opposed by any party – there is no deal.

Workers’ Compensation is not like a ‘personal injury’ type lawsuit, where a Judge or Jury will decide the case and determine a value if the parties do not reach an agreement.  If there is no agreement, the insurance company can request periodic medical exams, vocational interviews and file petitions challenging the claimant’s right to benefits. Claimant can (theoretically) receive benefits for life – if they win each and every challenge and petition. The insurance company only needs to win ONCE.

4. The Formula

There is no magic formula, though insurance companies act like there is. They evaluate claims on the basis of how many weeks, months or years might they be required to pay wage loss benefits – often ignoring the cost of medical treatment, and absolutely ignoring what the injured worker stands to lose. Whether or not this is ‘fair’, this is the basis of negotiations.

For example, take the injured worker’s weekly benefit rate, and multiply it by 52 weeks for one year; by 104 weeks for two years, etc. They have done this so long, and have convinced so many claimant lawyers that this is the way to value a case – that it has become ‘the norm.’

However, this ‘formula’ completely disregards Rule #1 – every case is unique.

You NEED a lawyer who recognizes the value of YOUR case, based on the specific factors affecting you. To ‘convince’ the insurance company how much to offer (#5), it has become necessary to structure a demand in a way they will ‘comfortable’, but significantly increasing the ‘years worth of benefits’ formula to 4, 5 or 6 years of benefits – to account for the aggressive manner YOUR lawyer will fight the case, and cost them more.

5. The ‘Ultimate Figure’

Based on the factors above, the ‘ultimate figure’ to settle any case is:

The highest amount claimant can convince the insurance company to offer.

It doesn’t matter if the entire world agrees your case is ‘worth’ more; if the insurance company won’t offer it – you can’t force it.

Claimant – through a skilled specialist – must be able to convince the insurance company what that highest value is (and maybe a little bit more). The more your case will cost them – the more YOUR case is “worth” for settlement.

The cost to the insurance company includes more than just 2-3 years of possible future wage loss benefits. An experienced lawyer knows how to show the insurance company they will fight – aggressively – to protect their client’s right to wage loss benefits and payment of medical bills LONG into the future, and the insurance company will have to pay their own lawyers, expert medical witness fees and other costs just to keep fighting the case.

However, on the other side of your case is a team of trained specialists, including the claims representative and a “specialist” defense lawyer, trying just as aggressively to stop your benefits, and reduce their costs. It is a business. Insurance companies are owned by people who own stock – and want profits. The people working on your case are not paid by you. They are paid by the company – with the sole goal of making money and reducing costs.

The insurance company is NOT “your friendly neighbor”; is NOT “on your side”, and you most definitely are NOT “in good hands” – if you believe they are trying to help you.

Hypothetical Cases:

To see how different factors affect the settlement value of a case, consider 4 workers with the exact same injury – a low back herniated disc, with pain down their right leg.

  • Worker #1 is a 26 year old laborer earning $15.00 per hour ($31,000.00 yearly).
  • Worker #2 is a 35 year old nurse earning $80,000.00 per year.
  • Worker #3 is a 57 year old lawyer earning $150,000.00 per year.
  • Worker #4 is a 68 year old tech company CEO earning $2 million per year.

Using the formula of “years’ worth of benefits” fails to recognize that the lawyer and CEO could lose significantly more future income; but their jobs are in an office, allowing them to sit and stand – potentially returning to work at a modified position. The laborer and nurse have more physically demanding jobs, and may never be able to return to that level of activity.

The lawyer and CEO are older, and may have fewer years they intended to work anyway, while the nurse and laborer stand to lose income for many more years than the older workers.

Now add in factors randomly to different workers.

One of them has pre-existing spinal degeneration, already causing symptoms BEFORE the work injury.

One of them is involved in a serious car accident AFTER the work injury, causing far worse injuries than the work injury, and rendering them confined to a wheelchair for life.

One of them was injured in a work-related car accident, and has a separate lawsuit against the other driver.

One of them has been denied benefits, and is fighting a Claim Petition to prove the injury occurred at work.

One of them was diagnosed with a terminal illness, and knows they will die soon.

One of them has a Petition to Terminate benefits assigned to a judge KNOWN to usually rule in favor of employers; and another has the same petition, based on the same defense medical expert, but their case is assigned to a judge who usually rules in favor of the claimant.

EVERY FACTOR impacts the value of settlement. They are not all worth 2-3 years worth of benefits. Each of them NEEDS a lawyer who will – and knows how to – consider each factor when evaluating their unique case!

Schmidt, Kirifides & Rassias Can Help You

TO FIND OUT WHAT YOUR CLAIM IS WORTH, you NEED a Certified Workers’ Compensation Specialist Lawyer to help you. The laws and procedure involved with work injury claims are so complex, the Supreme Court of Pennsylvania and PA Bar Association have authorized a ‘Specialist Certification” for those few lawyers who have dedicated their practice to this field of law, have the required years of experience, passed the written testing requirements AND maintain Continuing Legal Education specific to workers compensation to obtain the Certification. EVERY work injury lawyer at Schmidt, Kirifides & Rassias is a Certified Specialist, and has argued cases to the highest appellate courts in Pennsylvania on behalf of our clients. We do not merely ‘dabble’ in workers compensation – it is what we do.  It is ALL we do!

Contact YOUR Specialist for a free, no obligation consultation – to learn how we can help you.

Call 610-601-5399 or contact us online.