The overwhelming majority of claims are over within a year. Those are the claims where, fortunately, there is no or little lost time from work and there is no permanent disability.

If your claim is denied the best estimate is that it will take a year to get a decision from the Industrial Commission. It may be quicker, but not a whole lot quicker. An appeal by the insurance company will add at least another six months to that.

You are entitled to lifetime medical benefits and, of course, you are entitled to be paid disability for 500 weeks from the date of your injury. In some very limited cases you may receive disability for life. (For injuries occurring prior to June 2011 lifetime benefits were much more common.)

Most of the claims that we handle involve people who have permanent injuries. Most of these folks return to work, although many do not return to their old line of work due to those injuries. As a practical matter, it is difficult to settle these cases until your medical condition stabilizes – that is, you reach maximum medical improvement. While nothing says you cannot settle prior to that you can be sure that the insurance company will offer you smaller sums of money along with their confident prediction that you will have a 100% recovery and move to a new job which pays even more than your current job. That would be lovely… if it were true. We will want to err on the side of caution and assume that you’re going to have a significant wage loss and incur substantial medical bills in the future. Basically with so much uncertainty in a case it is difficult to settle it.

Realistically you need to wait until after maximum medical improvement to settle. How long that may take depends on your doctors. Once you are at MMI we can talk settlement with the other side. Things can be wrapped up fairly quickly after that.

Medicare Set-Asides are phenomena that has come into full force in the last several years. In the old days if an injured worker was on Medicare and his workers’ compensation claim was still open it was pretty common for the worker and the insurance company to settle the claim. Medicare got stuck paying for all the future medical treatment. By “Medicare” we mean the taxpayers of America.

Washington, D.C. got wise to this gambit and now requires that a portion of the settlement be “set aside” for future medical treatment. Once that money is used up Medicare will pay for any additional necessary treatment even if the treatment is related to the workers’ compensation claim.

In larger cases, those involving settlements over $250,000.00, a division of the Social Security Administration has to review the Medicare Set-Aside Agreement to ensure that Medicare’s interests are protected. The problem with this is that we are required to ask the government how much money they would like to take from you. All too often the answer is “more.”

From the insurance company’s viewpoint they don’t necessarily care how the settlement is divvied up between you and Medicare. The adjuster has a certain amount of money to spend on a case and that’s it. The problem arises if Medicare wants too much. Without enough left over you may have no interest in settlement.

It’s important that Medicare be given the proper medical records so that a fair and reasonable estimate may be made. This is all quite complex and usually the job is given to independent companies who specialize in drafting Medicare Set-Aside Agreements.

It depends exactly what you mean by “settle.” If you take the rating in your case then you’ll sign an Industrial Commission form and the adjuster will send it into the Commission for approval. Once it is approved the insurance company will pay the rating out to you. This usually occurs over a period of weeks however sometimes the adjusters are willing to do it in a lump sum.

In this situation you are still entitled to medical treatment. We recommend at least an annual visit to the doctor to make sure your condition is stable. This also keeps the claim active with the insurance company.

If you enter into a complete settlement, or clincher, then you’ll sign a lengthy document. That settlement agreement will go to the Industrial Commission for approval. Once approved, the adjuster must pay you out promptly. Unless you’ve agreed to different terms these settlements are paid out in a lump sum.

While it is occasionally possible to settle only the portion of the case involving weekly checks and leave the medical portion open that doesn’t happen often. In all honesty we’ve found adjusters very difficult to deal with when there is ongoing medical treatment. It seems that because we don’t have a lot of leverage over them in terms of future weekly checks they get a bit slack. Frequently, we’ve needed to go to a hearing to enforce the treatment that was promised by them.

This question: “I settled my Workers’ Comp case, can I get out of it?” calls for our favorite lawyer answer: it depends.

It depends on what you mean by “settled.” If the North Carolina Industrial Commission has approved a complete settlement and you’ve received money already then no, you cannot get out of the settlement.

On the other hand, if your “settlement” was payment for your rating then you are still entitled to medical treatment in many situations. While we’ve seen adjusters try to tell injured workers otherwise they are often wrong.

If you went to a mediation and reached an agreement at the mediation and signed a Mediated Settlement Agreement form then the defendants can go to the Industrial Commission and try to enforce this agreement. It is generally unsuccessful to argue that you were under duress or confused when you signed it. The better approach is to argue the Industrial Commission shouldn’t even approve the agreement because it is patently unfair. That has some, but not a great, chance of success.

If you just made a verbal deal you can probably get out of that. But understand that if you do so there’s probably little likelihood of getting another or better deal anytime soon. Many adjusters and defense attorneys will simply decline to deal with you because they suspect you may back out of the new deal as well.

If you’ve been offered a settlement, by all means call us before accepting it. We are happy to discuss it with you and let you know our honest impression. It may be a good deal, a great deal, a fair deal, or an awful deal. We’ll tell you what we think and if there are any ways to improve it. With 25 attorneys and over $275 million is Workers’ Compensation awards and settlements, we can advise you on getting the benefits you deserve.

Often, but not always, an employer will ask you to resign as part of a certain type of settlement. Those settlements usually are significantly larger than being paid for your rating. When you take your rating it is extremely unlikely that you’d be asked to resign.

The reason that an employer may do this is that the insurance company is paying you to give up their obligation for your future medical care. So say they give you $50,000.00 to give up the right to medical care for your back. And then six weeks later you blow out your back again… that $50k is in your pocket and you have a whole new claim. Which is going to cost them a bunch of money again.

We’ve had potential clients tell us that their employer fired everyone who filed workers’ compensation claims. Many times we’ve represented the “fired” employee and they, in fact, were not fired at all. Their employer had paid them a lot of extra money to get them to resign. This was something that our clients considered and willingly did because it fit into their goals. Many of them had other jobs lined up, some were ready to retire, and others were planning on staying home and raising a family. Why would an employer spread the rumor that these people had been fired? A possible answer is that the rumor was intended to deter other workers from filing workers’ compensation claims. Think about it… if you ran a company and wanted to prevent people from filing workers compensation claims would you say that people who had claims got paid tens, or hundreds of thousands of dollars? Or would you quietly create an atmosphere of fear and let potential claimants wonder if they’re going to lose their job and be destitute.

One last thing while we are on this point. If you’re employer has changed insurance companies while your claim was going on it is much more likely that you can settle the case – even get the extra money for giving up future medical care – because that insurance company is no longer paying for your employer’s new claims. So the need to get you out of there isn’t an issue anymore.