Our experienced workers' compensation attorney in Portland can help you with your workers' compensation settlement.
Oregon Workers' Compensation Settlement Amount
Workers' Compensation Settlement Amount in Oregon
Understanding and evaluating Oregon workers' compensation settlement amounts requires a great deal of experience with the workers' compensation system. A good settlement evaluation considers the worker's current and future needs. The evaluator must understand the reasonable cost of medical services, as well as possess the ability to rate and project the worker's permanent impairment, calculate their time loss and assess their entitlement to vocational benefits.
As an adjuster, Nathan Goin was trained how to determine Oregon workers' compensation settlement amounts early in his career. He learned first hand how insurance companies value claims and work them up for settlement. He also understands the internal conflicts that sometimes arise between employers and insurers when settlement authority is discussed. While working for one of the pacific northwest's largest insurance defense firms, Nathan Goin performed legal presentations and trainings for many of the major insurance carriers and third party administrators in Oregon on settlement evaluations using materials and guides he personally created.
Settlements are as much an art as a science. When it comes to the settlement of your claim, Goin Law Group recommends seeking the advice of an experienced workers' compensation attorney who understands how to evaluate settlement amounts in Oregon. Call today for a free consult.
Stipulated settlements are simply an agreement about a fact. It is important to remember that stipulated settlements are generally narrow and only settle specific issues. For example, if the insurance company owes you money for unpaid time loss, the parties would sign a stipulated settlement explaining that time loss is owed. If your claim was denied, the parties may sign a stipulated settlement stating your claim is now excepted. If the insurer refused to authorize surgery, the parties could sign a stipulated settlement stating surgery is now authorized. Once signed and approved by an Administrative Law Judge, the parties are obligated to abide by the stipulated settlement, which, using the examples from above, would mean owed time loss will be paid, a notice of acceptance will be issued or the insurance company will call and authorize the previously denied surgery. All stipulated settlements must be approved by the Board and take effect immediately after they are approved.
Disputed Claim Settlements
Disputed Claim Settlements are used to either settle denied claims or settle a worker's future medical benefits for an accepted claim. If the claim was denied, a Disputed Claim Settlement affirms the prior denial, which means the worker will not receive any benefits for their workers' compensation claim.
If the claim was accepted, the Disputed Claim Settlement will include a current condition denial. which serves to deny the worker's right to future medical treatment. It is important to remember that in Oregon, a worker cannot settle their right to future medical care. It is therefore theoretically possible to seek treatment again following a current condition denial of an accepted condition; however, proving an entitlement to medical benefits following a current condition denial Disputed Claim Settlement is exceptionally difficult. Consultation with an experienced Oregon workers' compensation attorney is always recommended before agreeing to any settlement, particularly a Disputed Claim Settlement. All Disputed Claim Settlements must be approved by the Board and take effect immediately after they are approved.
Claim Disposition Agreements
Claim Disposition Agreements settle the worker's future right to time loss, permanent impairment, vocational retraining and fatality benefits on an accepted claim. Importantly, a Claim Disposition Agreement cannot be used to settle the worker's right to future medical benefits. Like Stipulated Settlements and Disputed Claim Settlements, Claim Disposition Agreements must be approved by the Board and take effect immediately after they are approved. If you are unrepresented, the Board will wait 30 days before approving your Claim Disposition Agreement. This is known as the "cooling off period." If you have an attorney, the cooling off period can be waived.
How is a workers' comp settlement amount calculated?
Oregon workers' comp settlement amounts are based upon a variety of factors. Insurance companies train their adjusters to look at the total value of current and future medical treatment, time loss benefits, permanent impairment, and vocational retraining when determining an Oregon workers' compensation settlement amount. Each category is totaled and then all four categories are added together for a "total claim exposure," which simply means how much the insurance company will have to pay if forced to provide the worker with every benefit they could be entitled to. This is the maximum Oregon workers' compensation settlement amount they will have to pay. Most insurance companies will then reduce the "total claim exposure" by the likelihood they believe certain benefits, such as a large permanent impairment award or vocational benefits, will not be provided, thus lowering the final Oregon workers' comp settlement amount.
It is important to remember that, while "total claim exposure" means how much the insurance company will have to pay, it does not mean how much the insurance company will have to pay the worker for their Oregon workers' comp settlement amount. For example, medical benefits, such as surgery, are factored into "total claim exposure;" however, medical payments are made to the doctor, not to the worker. A claim may therefore have a "total claim exposure" of $200,000.00, but the worker may only receive $25,000.00 of that $200,000.00 in cash payments if they do not settle the claim.
Settlement can be a benefit to workers who want to maximize the cash value of their Oregon workers' compensation settlement amount. Using the example above, if the worker did not settle their claim they would receive $25,000.00 in cash benefits for time loss and/or permanent impairment. If they settle the claim, they might be able to increase this number to $125,000.00. While the settlement is less than the $200,000.00 "total claim exposure," it is still significantly higher than the $25,000.00 they would have received if they did not settle the claim.
It is important to remember an Oregon workers' compensation settlement amount is not free money. Workers exchange valuable rights, such as time loss benefits, medical treatment, permanent impairment awards and the opportunity to receive vocational retraining in exchange for an Oregon workers' comp settlement amount. Once the Oregon workers' compensation settlement amount is approved by the Board, the settlement is final. It is therefore very important the worker get an accurate assessment of their claim's value before agreeing to an Oregon workers' comp settlement amount.
When determining a fair Oregon worker's comp settlement amount, the evaluator should consider what current and future medical treatment the worker will need. The costs of those medical services should then be assessed based upon Oregon's fee schedule. The total will provide a reasonable Oregon work comp settlement amount for medical benefits. The worker's current, retroactive and future time loss should also be totaled when analyzing an Oregon worker's compensation settlement amount for time loss benefits. This assessment should also include an evaluation of the average weekly wage used by the insurer and audit of all paid time loss benefits when arriving at the final Oregon workers' compensation settlement amount. Permanent impairment must also be rated and determined based upon current medical records and the worker's anticipated findings at the time of closure. The final number or range will guide and inform the Oregon workers' compensation settlement amount for permanent impairment. The worker's entitlement to vocational benefits should be analyzed to determine the Oregon work comp settlement amount for vocational retraining. If the worker is believed to be a vocational candidate, the type of program they may qualify for should also be considered when arriving at the Oregon workers' compensation settlement amount. Finally, for fatality cases, future spousal and dependent benefits should be totaled based upon each recipient's age so that an Oregon workers' compensation settlement amount can be determined.
What is the average workers' comp settlement amount?
The worker's final settlement amount will depend upon a variety of factors. First and foremost, the severity of the injury must be considered. The Oregon workers' comp settlement amount for a fatality will be significantly higher than a contusion. Serious injuries, such as disc bulges, protrusions, herniations and annular tears or meniscus tears and rotator cuff tears or labral tears and SLAP tears will require extended treatment. Permanent impairment and permanent work restrictions are also likely. These factors will increase the Oregon workers' compensation settlement amount.
Another important factor is whether the worker is represented. The workers' compensation system is foreign to most injured workers. It is difficult for workers to accurately determine the value of their claim. For this reason, they may accept a settlement amount that is too low without realizing it.
When do you need a workers' compensation lawyer?
Most injured workers are able to file a workers' compensation claim in Oregon without the assistance of an attorney; however, as the claim progresses navigating the workers' compensation system can become increasingly difficult and confusing. As treatment continues, disputes over time loss and medical authorization for therapy or surgery become increasingly likely. Many workers treat for months before finding out their disc herniation, rotator cuff tear or meniscus tear was only accepted as a strain. When a dispute arises, or treatment continues for longer than the insurer would like, a settlement offer could be made in an attempt to quickly and cheaply close the claim. An experienced workers' compensation attorney can assist with guiding the injured worker, advocating for their benefits and ensuring that any settlement of the claim is fair.
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Oregon Workers' Compensation Attorney Today
Nathan Goin began his career as a claims examiner for one of the major workers' compensation insurers in Oregon. Through this experience, he learned firsthand how workers' compensation insurers view injured workers, manage their claims, value settlements and, ultimately, attempt to close claims while paying as little as possible. Nathan's legal career now focuses on fighting for the rights of injured workers to ensure that they receive the benefits they deserve.
We understand how difficult the workers' compensation process can be for an injured worker. Goin Law Group values every client and will work tirelessly to maximize your benefits. Schedule a free consultation with an experienced Oregon workers' compensation attorney today. Call now for assistance with your claim. You don't have to do this alone.