Do All Workers’ Compensation Cases End with a Settlement?

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When you file for workers compensation, you expect the insurance company to pay you quickly and fairly. If it denies your case, or if it pays you less than you deserve, then you may wonder what comes next, and whether your case is going to settle or go to trial.

Do all workers’ compensation cases end with a settlement?

Not all workers’ compensation cases end with a settlement. A small percentage of cases go to a hearing for a determination of benefits.

What happens if my workers’ compensation case does not reach a settlement?

If your workers’ compensation case does not reach a settlement, the case proceeds to a hearing. The hearing is in front of a neutral commissioner. The commissioner accepts information and arguments from both parties. Then, the commissioner decides what compensation you deserve.

What are some reasons that a workers’ compensation case may not reach a settlement?

No two cases are alike. There may be many reasons–even multiple or complex reasons–that a case does not reach a settlement. 

Here are some reasons that a workers compensation case may not reach a settlement:

  •       Information is missing about your right to medical coverage or wage payment
  •       Disputes whether notification of the employer was made within required time limits 
  •       A second opinion may be needed from another medical professional
  •       Necessary wage information to calculate benefits is lacking
  •       There is a dispute about the severity of your injury
  •       Treatment was not obtained from an approved medical provider
  •       Questions arise as to whether the injury occurred at work
  •       Certain defenses are raised, including intoxication or self-harm
  •       Horseplay may have contributed to your injuries
  •       Questions whether an injury is the result of a pre-existing condition
  •       You didn’t ask for a hearing

 

The insurance company may look for reasons to try and deny your claim. A workers’ compensation hearing is your opportunity to refute whatever issues are raised by the insurance company. Therefore, requesting a hearing, when necessary, is an important part of the process. A hearing can force the insurance company to provide benefits if they are unwilling to do so voluntarily.

When faced with the evidence and an approaching hearing date, the insurance company may be eager to reassess and discuss a settlement. Your workers’ compensation lawyer can assist you with how to approach negotiations and interactions with the insurance company.

What is a workers’ compensation hearing?

A workers’ compensation hearing is a trial-like proceeding to resolve a dispute about a person’s entitlement to benefits. If the employer denies coverage, or if you think you did not receive all the appropriate benefits, the hearing is the process to determine what you deserve.

At the hearing, you present information about your claim. Your lawyer makes arguments on your behalf about why your benefits are deserved. 

For the purposes of workers’ compensation hearings, the commission divides the state into districts. Greenville and Pickens are in District 1.  Anderson, Laurens, Oconee, and several other counties are in District 2, and Spartanburg is in District 6.

Why ask for a workers’ compensation hearing?

If the insurance company for the employer is not willing to pay you fairly, a hearing is the way to have someone else review the case. If the commissioner decides the case in your favor, the insurance company must pay your benefits even if they disagree with the commissioner’s decision.

How do I request a workers’ compensation hearing?

To request a workers’ compensation hearing, complete and submit South Carolina Workers’ Compensation Commission Form 50. Check box 13b, asking for a hearing.  For line 14, estimate the amount of time that you expect to need to conduct the hearing. There is a filing fee. Form 58 allows you to brief facts in controversy and legal issues.

Will my workers’ compensation case reach a settlement?

Of course, it’s impossible to know if a workers’ compensation case will reach a settlement. If your claim is denied, it’s important to review the reasons given and respond with more information, if appropriate. As your case proceeds to a hearing, you may participate in mediation and direct negotiations with representatives of the insurance company. 

A fair settlement is the result of careful case preparation and skilled legal strategy. A workers’ compensation lawyer can represent you throughout the process. 

How can a workers’ compensation lawyer help?

Our workers’ compensation lawyers help you from start to finish. We file the paperwork to pursue your case. In addition, we determine what information and evidence is necessary and gather it on your behalf. 

We handle talking with the insurance company, and, if necessary, can skillfully present evidence and arguments at your hearing. We are experienced litigators who can take care of everything for your claim.

Contact our workers’ compensation lawyers today for a free review of your case.

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