Workers' Compensation

Differences in workers’ compensation settlements.

At the end of your workers’ compensation claim you will likely be entitled to an award of some type. Technically there is a difference in workers’ compensation law between an award and a settlement. You are automatically entitled to an award once you reach maximum medical improvement. Your workers’ compensation claim is open even after you get an award. A settlement — usally called a clincher, but properly known as Compromise Settlement Agreement — closes your claim at least in part. An award occurs, or is supposed to occur, automatically. Usually a workers’ compensation lawyer will be involved in a settlement. A workers’ compensation attorney can often increase the amount of an award as well.

An award of your rating is pretty much the least amount a workers’ compensation insurance company can give you to bring any kind of closure to your case. You only take a rating if you’re able to return to work making as much or more money as you did prior to your workers’ comp injury (or at least enough so that the rating is greater than your wage loss). You still have the right to future medical care and can reopen your workers’ compensation claim for a change in your condition.

A clincher usually, but not always, involves giving up all future rights under your worker’s compensation claims. Occasionally a clincher only requires you to give up the right to either the rating or to ongoing weekly  workers’ compensation checks and leaves medical benefits open. This is true in some medically complex cases where it would just take too much money to close out the medical side of things. In those cases the workers’ compensation insurance company simply cannot or will not pay out the money necessary to settle out the medical side of a claim.

A huge difference between a rating and a clincher is that the latter has no set figures at all. Whatever you and the workers’ compensation adjuster negotiate is what the clincher amount will be. If there is ever a point where a workers’ compensation attorney can prove their worth it is at this point. Unless you know the ins-and-outs of workers’ compensation law and how that would apply to the facts of your case you really cannot calculate what the value of your claim is for settlement negotiations. Clearly the workers’ compensation adjsuter is not going to volunteer information which would cost her money. The rating is what the treating physician says it will be. If you think the rating is too low you are entitled to select your own physician to give you a second opinion. The workers’ compensation adjuster has to pay for this visit. The adjuster is entitled to a second opinion as well. The North Carolina Industrial Commission usually averages the ratings from the different doctors.

A rating is usually paid out over a number of weeks. If you’re taking your rating it’s most likely that you are working. Your current income will make no impact on the payment of your rating. The parties will sign an Industrial Commission form, this and your medical records are sent to the Industrial Commission for review, and the Industrial Commission will order payment. You should begin getting your checks in two to three weeks. Because a rating is payment for a physical impairment rather than for wage loss payments for a rating should have zero effect on Social Security Disability payments, or any payments under a short-term or long-term disability plan.

A clincher is usually paid out as a lump sum. Unlike the simple forms used for ratings a clincher requires a lengthy statement about the case, remarks about the opposing views of the injured worker and the employer and workers’ compensation insurance company, and a recitation of the course of medical treatment. If health insurance or Medicaid/Medicare has paid any of the medical treatment there will be specific language about that. Most importantly if you are on, or may be on, Social Security Disability there needs to be some technical parts about how the settlement is structured and allocated. Once the workers’ compensation clincher is signed it is submitted along with all relevant medical records to the Industrial Commission where it will be reviewed and approved. As with the rating you should be paid in two to three weeks after the clincher is approved.