How Are Claims Finalized?

There are two ways to finalize a workers’ compensation claim:

Findings and Award

A Findings and Award is an agreement of the parties or decision of a Judge resolving all issues. Benefits are technically paid on a weekly basis as set forth above. Any retroactive payments due may be paid in a lump sum. There are two advantages of this resolution. The first is that the injured worker has 5 years from the date of injury to reopen the claim in the event there is a worsening in the condition in order to obtain further permanent or temporary disability. The second advantage is that the injured worker is entitled to all reasonable and necessary future medical treatment, although the insurance carrier frequently raises defenses to the award for future medical, care making it difficult to enforce. This gives the injured worker some protection in the future, but there is not necessarily a lump sum payment and less money then under the alternative.

Compromise and Release

This is a lump sum payment, which terminates the injured workers’ right to all future benefits. It is usually based on the amount that would be awarded under a findings and award, with an additional amount to terminate the injured workers’ right to future benefits.

The parties must agree on doing a compromise and release and the amount of one. A judge cannot order a compromise and release based on the request of one of the parties.

Social Security and Medicare have become a significant factor on the ability to enter into a compromise and release. Many seriously injured workers have at least applied for social security disability or on it, by time the case is settled. The injured is eligible for Medicare, 30 months from the date of disability. Medicare requires that all settlements that come within this parameter consider their interests and be coordinated with them when an individual is actually eligible for Medicare. The effect of this is that the ability to settle out all benefits by a compromise and release in many cases can be foreclosed
This results in many of these cases resolving with a findings and award; or in some cases, a lump sum settlement of the permanent disability with the injured still receiving future medical care.