Work injury victims who ask for workers’ compensation have a right to a hearing. A workers’ compensation hearing is similar to a trial, but the claim is decided by an administrative law judge rather than a jury.

Like other legal claims, there can be advantages to settling the case rather than allowing a stranger — the administrative law judge — to determine the injury victim’s fate. Settlements give injury victims some control over the outcome of their claims. Since it takes time to schedule hearings and since the administrative law judge might not decide the case promptly after the hearing concludes, settlements also resolve the case more quickly.

Not every case should or can settle. Sometimes an administrative law judge will award benefits that an insurance company refuses to pay voluntarily. Many times, it is not immediately clear whether a dispute will arise that needs to be settled. Workers’ compensation attorneys are in the best position to advise clients whether and when to pursue a settlement.

Settlement of Medical Benefits

Workers’ compensation claims arise under state or federal law, depending on the nature and location of the victim’s employment. While there are significant differences among the various workers’ compensation systems, they generally pay the same kind of benefits.

Workers’ compensation laws require the employer to provide healthcare to treat work-related injuries. Florida state law requires employees to accept the medical care provider that the employer chooses, while federal law gives employees more latitude to choose their own doctor. In either case, when an injury is clearly work-related, employees do not usually need to make a formal claim to obtain payment of medical benefits. When the entitlement to medical care is not disputed, there is nothing to settle.

Insurers occasionally dispute the need for a treatment that they regard as unnecessary. Injury victims should seek legal advice when they believe they are denied necessary treatment. A workers’ compensation lawyer may be able to resolve that dispute by communicating with the insurer. When insurers refuse to be reasonable, it may be necessary to file a formal claim.

Insurers may also deny coverage on the ground that the employee’s injury is not work related. In those cases, it may be necessary to file a formal claim. If the case can be resolved without a hearing, the injury victim’s lawyer may be able to negotiate reimbursement of the medical expenses the employee incurred because the employer’s insurer refused to provide treatment.

Medical benefits continue until the injury is completely healed or has healed as much as it ever will. When an injury stops healing and leaves a worker with a permanent impairment, the worker must generally pay a part of continuing medical care. In that situation, medical benefits are taken into account when the worker settles a claim for permanent disability benefits.

Settlement of Temporary Disability Benefits

Temporary disability benefits are paid while the injured employee is recovering from a work injury but has not recovered sufficiently to return to work. The benefits are intended as a partial replacement of the employee’s income. Temporary disability benefits end when the employee returns to work or when the injury is no longer healing.

Temporary disability benefits are calculated pursuant to a formula that is based on the injured employee’s earnings and whether the employee is unable to do any work at all or can work at a job that pays less than the employee was earning when the injury occurred. Disputes about temporary disability benefits are usually based on the insurance company’s claim that the injury victim is able to return to work, has finished healing, is not injured, or was not injured at work.

A ”settlement” of a temporary disability benefit claim usually involves an agreement that the injury victim is entitled to receive the benefit. If the benefit was wrongfully withheld, the settlement may specify the number of weeks of unpaid benefits that the insurer will pay. When insurance companies refuse to be reasonable, temporary disability benefit disputes are usually decided by an administrative law judge who can award back benefits in a lump sum.

Settlement of Permanent Disability Benefits

Most settlements of workers’ compensation claims involve permanent disability benefits. A permanent disability benefit compensates workers for injuries that have stopped healing and that prevent the worker from returning to his or her former job. Cases are usually settled when a doctor advises the worker that the injury will never get better and that the worker’s limitations will prevent a return to the same job.

Permanent disability benefits depend on the extent of the injured worker’s impairment and the amount the worker was earning before the injury occurred. The extent of the impairment is expressed as a disability rating. The rating must follow Florida guidelines but those guidelines and the medical evidence can be open to interpretation. Insurance companies strive to minimize benefits by minimizing the disability rating.

Lawyers for injured workers can negotiate lump sum settlements. If the case goes to a hearing, the benefit will be paid out over time. Most workers with disabilities that are unlikely to need further treatment prefer a lump sum. A lump sum settlement resolves the insurance company’s obligation to pay disability benefits and to provide future medical care. Because insurers do not want to be responsible for providing long-term medical benefits that may not be easy to predict, they may be willing to pay a larger lump sum in exchange for giving up the right to future medical care. A lump sum settlement can be a good choice when injured workers believe their future healthcare needs will be manageable.

Injured workers might want to seek an award of benefits from a workers’ compensation judge if it is likely that future medical benefits will be substantial or unpredictable. In addition to awarding a permanent disability benefit that will be payable in installments, the judge will order the insurer to continue providing medical care, subject to a co-pay. Employees who know they will need continuing treatment and have no other way to pay for it might not want to settle for a lump sum.

An experienced Florida workers’ compensation lawyer can evaluate the employee’s injuries and advise the employee about settlement options. If the employee decides to settle, a workers’ compensation attorney is in the best position to negotiate a favorable lump sum settlement.