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Settling a Case

Settling a Case

I’ve Been Offered a Settlement, What Should I Do?

A settlement closes your case completely, which means that the workers’ compensation insurance company will not be responsible for paying you any additional compensation and, more importantly, will not provide any more medical treatment for your injury. DO NOT assume health insurance will provide treatment after you settle the case, as the health insurance company may refuse to pay for treatment that should have been the responsibility of the workers’ compensation insurance company.

Just because you are offered a settlement does not mean you have to settle your case now.  If you feel you are not ready to settle now, DON’T!

What Issues Should I Consider Before Accepting a Settlement?

There are many issues you should consider before accepting a settlement. Below are some examples of issues, please note that not all of these will apply to every case and your case may also include issues that are not listed:

  • Have I been appropriately compensated for time I lost from work due to my injury or due to surgery for my injury? 
  • Have I been appropriately compensated for expenses for traveling out-of-town to see doctors or for physical therapy?
  • Have all my medical bills been paid? Have I had to pay out-of-pocket expenses for prescriptions or other medical-related items?
  • Do I have ongoing medical needs due to my injury, such as prescription medications, orthotic or prosthetic devices, or other medical devices?
  • Am I unable to work (anywhere) because of my injury? If I am still able to work, does my injury limit the type of work tasks I can perform?
  • Should I be filing a claim against the Second Injury Fund?
  • Will a settlement affect my Social Security Disability benefits, my Medicare benefits, or unemployment benefits?
  • If I was injured in a vehicle accident and I am pursuing a liability insurance claim against another driver, how will that affect my workers’ compensation benefits?
  • Have my workers’ compensation benefits been calculated using the appropriate wage information?

What options do I have?

When offered a settlement, you have several options. Some of them are:

  • Accept the settlement offer. If you believe you are ready to close your case, and you believe that the settlement offer is acceptable, then you may want to accept the offer.  The settlement must be approved by a judge before it is final. This usually requires you to appear before a judge along with the insurance company’s lawyer, discuss the proposed settlement, and answer any questions that the judge may have.
  • If you feel that you need more medical treatment, or you feel you are not ready to settle the case now (for any reason), tell the insurance company that you are not ready to settle and what your concerns are.
  • If you are unsure about whether you will need any more medical treatment and would like a second opinion, ask the insurance company to send you to another doctor for a second opinion. The insurance company is not required to provide you with a second opinion, but may do so if you ask!
  • If you are ready to settle, but the amount of the settlement offer is not acceptable, you have the right to negotiate a different amount with the insurance company or the insurance company’s lawyer. You should be specific (in dollars) when discussing settlement. Statements such as “I just want what’s fair” do not help settlement discussions.
  • If both parties agree, the judge (at a conference) may give his or her thoughts regarding an appropriate settlement amount.
  • You always have the right to consult with a lawyer or hire a lawyer before settling your case. It should not cost you anything to consult a lawyer. Lawyers who regularly practice workers’ compensation law offer free initial consultations.
  • As the settlement offer is often based upon a disability rating (this will be explained below) provided by a doctor chosen by the insurance company, you may want to see a doctor of your own choice to verify the accuracy of the disability rating. (This would be at your expense.)
  • If you have ongoing or future medical needs (which have been documented by a physician) as a result of your injury, you have the right to ask the insurance company to include, as part of the written settlement agreement, a promise to provide certain medical benefits to you in the future, or to pay an additional amount in the settlement for future medical needs.

What is a Disability Rating?

Once you have completed treatment and the doctor finds you to be at Maximum Medical Improvement, which means the doctor thinks you have recovered as much as possible, the doctor will issue a rating which amounts to his/her medical opinion as to what your permanent disability will be. The rating will be for either Permanent Total Disability, which means the doctor does not think you are able to return to any employment (not just the type of work you were doing before the injury), or it will be for Permanent Partial Disability which means while you may be unable to do certain jobs or certain job tasks, and will have physical complaints that will remain on a permanent basis, you are still able to work at some full-time job.

The doctor’s opinion as to your disability is based upon several factors including his/her experience with people who have had similar injuries and treatment. Understand that the “rating” is one doctor’s opinion and another doctor may agree or disagree with that opinion. The doctor’s rating is not binding on anyone.

If you are determined to be Permanently and Totally Disabled (“PTD”) you may be entitled to receive weekly benefits for life, or for so long as you remain permanently and totally disabled. If the parties agree, a PTD case may be settled for a lump sum.

If you are determined to be Permanently and Partially Disabled (“PPD”), your PPD benefits will generally be paid in a lump sum. The legislature has created a three part formula in order to calculate what PPD benefits you would be entitled to in a lump sum settlement.

Part 1 of the formula depends upon the part of the body injured. The legislature has assigned a total of 400 what is referred to as weeks or units to the entire body and from there assigns a portion of the total weeks or units to different parts of the body. For example, 232 weeks have been assigned to the shoulder, 175 weeks to the hand, 160 weeks to the knee and so on. A complete list of the schedule of body parts and the number of weeks assigned to each is set out in Section 287.190 RSMo of the Missouri Revised Statutes and a “body chart” is also available on this website. The “body chart” is also available in print form at any Division of Workers’ Compensation Office, or at any workers’ compensation docket.

Part 2 of the formula depends upon the percentage of your permanent partial disability related to the injured “body part”, for example 5%, 10%, 25%.

The third and final part of the formula is based upon your compensation rate. Generally your compensation rate will be equal to 2/3 of your average weekly wage at the time of the injury not to exceed a maximum rate which is presently 55% of the state average weekly wage (“SAWW”). For example if you were injured on June 1, 2009 and your average weekly wage was $600 a week your PPD compensation rate would be $400 ($600.00 x 2/3). However, if your average weekly wage was $700 instead of $600 your PPD compensation rate would be the maximum rate for injuries occurring on that date which would be $404.66. (NOTE: 2/3 of $700 would be $466.67 but your rate can not exceed the maximum).

Now let’s put this all together in an example. Remember the formula for a permanent partial disability is: Number of weeks assigned to the part of the body injured –times- the percentage of the disability –times- compensation rate. Again let’s use the example of a shoulder injury occurring on June 1, 2009 and an average weekly wage of $600.00. Let’s also assume that, in the doctor’s opinion, your permanent disability is 10% of the shoulder. Remembering that 232 weeks have been assigned to the shoulder the formula would be as follows: 232 x 10% x $400.00= $9,280.00. In this example had the doctor determined the disability to be 5% instead of 10% the formula would result in $4,640.00. If the doctor determined your disability to be 15% the formula would result in $13,920.00.

Also keep in mind that Workers’ Compensation does not include compensation for pain and suffering.

Workers’ compensation is intended to be a streamlined benefits system, but many workers’ compensation cases can be extremely complicated. For example, your workers’ compensation case can affect your entitlement to social security benefits, Medicare benefits, or unemployment compensation benefits. Before you make any decisions on settling your workers’ compensation case, you should read all the information available to you on this website, or consult with a lawyer.

Should you have any additional questions, feel free to call an information specialist toll-free: 800-775-2667.

You always have the right to consult with a lawyer to obtain a full explanation of the facts and law as they apply to your case as well as whether a settlement might affect your social security, Medicare, unemployment, or other benefits.

DISCLAIMER - More Information

The Injured Workers section of the Workers' Compensation portion of this web site is targeted specifically to injured workers and is intended to be a resource throughout the workers' compensation claim process. It is NOT intended to be a substitute for legal representation.

Employers seeking information about the workers' compensation process and their responsibilities regarding workers' compensation should use the Employers section of the Workers' Compensation portion of this web site to find information targeted specifically to them.

Additional information about Missouri Workers' Compensation laws, the Division of Workers Compensation, the Second Injury Fund and more may be found via the Workers' Compensation home page.

Please keep in mind the information specialist cannot act as your legal counsel and cannot give you legal advice. The information specialist can provide you with general information but cannot advise you whether the settlement offer is appropriate for your injury.