Do Most Workers’ Comp Cases Settle?

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While there certainly are exceptions, the vast majority of workers’ compensation cases do end in a settlement. The simple fact is that settling workers’ comp cases is typically in the best interest of all parties involved. Neither you nor the insurance company wants to go to court. 

Going to court means more time, more cost, and more risk. A settlement is essentially a compromise. Neither side gets precisely what they might be hoping for, but neither side loses out completely, either.

Can I Sue My Employer Instead of Filing for Workers’ Comp?

Workers’ compensation is typically your only route to receiving a payout for an accident that occurred in the workplace. Workers’ comp is no-fault based, which means that, with a few exceptions, it doesn’t matter who was at fault for your injury. You are covered and are entitled to compensation, no matter what. The other side of that coin is that you can not sue your company. Workers’ comp protects workers from injury while also protecting employers from liability.

Even if you performed your duties in an unsafe manner and brought the injury upon yourself, you are still entitled to compensation. The only time you are not qualified to file a claim for workers’ comp concerning a workplace injury is if you sustained your injury due to gross misconduct, such as performing your job while under the influence of drugs or alcohol, fooling around, or fighting.

While you are generally unable to sue your employer over a workplace injury, there are a few exceptions. The most common ways for an employee to sue an employer for a workplace injury are:

  • No workers’ compensation insurance
  • Insufficient workers’ compensation insurance
  • Intentional harm

No Workers’ Compensation Insurance

You can sue your employer for a workplace injury if they do not carry workers’ compensation insurance. In Texas, employers are not required to carry workers’ comp insurance, so you are most likely to come across this situation there. If you are in any other state and it turns out that your employer does not have this insurance, then they are breaking the law, and your workplace injury is just one of the many problems they will be facing.

Insufficient Workers’ Compensation Insurance

If you have a particularly costly injury, it is quite possible that your employer carries workers’ compensation insurance but does not have an insurance plan that is sufficient to cover the cost of your claim. In this situation, you are entitled to sue your employer to make up the difference so that your injury costs are paid in full, without a negative effect on your personal financial situation.

Intentional Harm

A less common scenario in which you can sue your employer for an injury is in a case of intentional harm. If your employer does something deliberate to hurt you, then they are no longer protected by their workers’ compensation insurance. An example of this would be your boss throwing a stapler at your head. In addition to suing your employer for your injury, in this situation, you could also press assault charges against your boss.

What if My Claim Gets Denied?

Some workers’ compensation claims don’t end in a settlement because, for one reason or another, the two sides can’t come to an agreement and instead choose to go to court and let a judge determine the outcome. Others don’t reach a settlement because many compensation claims don’t get past approval. There are many reasons that a workers’ comp claim may be denied, including:

  • Influence of drugs or alcohol
  • Fighting
  • Playing games rather than working
  • The injury didn’t occur at work
  • Exaggerated injury
  • Failure to inform the employer of injury in time
  • Failure to file papers on time
  • Did not receive medical treatment
  • Not treated by an approved medical provider
  • Missed doctor’s appointments
  • Failure to listen to medical advice
  • Injury is the result of a pre-existing condition
  • Social media posts after injury
  • Employer disputes claim

Some of the reasons above destroy any possibility you have of getting workers’ compensation. Many others, however, can be appealed. While not required, hiring a qualified workers’ compensation lawyer can be a very smart move at any point in the process. They can help you make sure that everything is in order so that your claim is correctly filed the first time around and can also make sure that any settlement offer that you receive from the insurance company is fair.

However, many people don’t want to deal with lawyers and the costs associated with hiring representation. So, they decide to go it alone. With proper research and if your case is strong, you may very well win your initial claim. If your initial claim is denied though, then you should turn to an attorney for your appeal. The most important thing is to make sure you get the compensation you deserve to cover your injury expenses, and having someone with experience on your side is the best way to ensure that happening.

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