Do All Workers Comp Cases End in a Settlement?

Do All Workers Comp Cases End in a Settlement?

Written by Dennis Grossman

Attorney Dennis Grossman has managed thousands of cases, obtaining millions of dollars in settlements and jury awards for his clients.

It is time for you to file for workers’ compensation when you have been injured while at your work location. Workers’ compensation helps injured workers recover from their wounds and deal with lost wages. However, even if you are eligible for workers’ compensation, that doesn’t mean that you are guaranteed to receive it. A large number of applicants have been denied workers’ comp for various reasons. If you are denied benefits, you can work with a workers’ compensation attorney to help remedy your situation. Reach out to reliable attorneys today to learn more about how you can receive a fair amount of coverage. Contact Personal Injury Attorneys Fresno now for a free consultation regarding workers’ compensation. 

All Workers’ Comp Cases Don’t End In A Lump Sum Settlement

While many workers are eligible for compensation after a devastating physical injury, not all of them receive a settlement. Around 7% of applicants are initially denied. Fortunately, a little under 70% of those denied receive compensation after appealing to the state workers’ comp claim board. In about a year, the denied claims are transformed into paying claims. The applicants often find themself with a lump sum settlement that is larger than their original claim. They receive about 55% percent more in benefits. The average claim may receive $10,153 in financial coverage, but if denied, on average the applicant will receive $15,694. About 70.6% of denied claims are litigated, resulting in an average claim compensation of $36,991

Types Of Workers’ Comp Claim Settlements

Benefits that are covered by workers’ compensation include the following:

Temporary Disability Benefits

You may be partially are totally temporarily disabled, requiring you to experienced reduced or lost wages. When you are partially disabled, you may be able to continue working but in a modified role. You receive 60% to 70% of your average wages up to the maximum amount. For total temporary disability, you receive two-thirds of your average wages up to the maximum amount of $1,356.31 per week. 

Permanent Disability Benefits

If you’ve reached your MMI after your doctor’s review of your workers’ comp case and your injury still prevents you from working, you can receive permanent disability benefits. Depending on your workers’ comp case, you can receive benefits for life. 

Death Benefits

If your loved one passed away, you may be eligible to receive compensation on their behalf. This mostly applies to spouses and dependents. 

Medical Care

All medical expenses that were the result of your personal injury will be compensated for, in addition to future medical expenses. 

Funeral Benefits

The surviving family members of fatally injured workers can be compensated for the funeral and burial costs. 

Job Displacement Benefits 

You may require vocational rehabilitation and job placement services. This can include re-education and training to help you enter a new career. All of this is covered through these benefits. 

What You Should Do After You Receive A Workers’ Compensation Settlements Offer

While you are receiving lump sum benefits, do your best to recover from your injuries. Comply to all of your doctor’s requirements and pay attention to your health. This is required for workers’ comp settlements. If you don’t fully recover, you may be permanently disabled and can receive further compensation.

How To Receive Fair Workers’ Compensation Settlements Cover For All Your Injuries

When you file a workers’ compensation claim, you have to make sure that you include accurate and correct information to get a fair settlement. Additionally, you shouldn’t do anything that can jeopardize you receiving your benefits. Attorneys work with their clients to make sure that their workers’ compensation cases end in a settlement. Some of the information that should be on your workers’ settlement include:

Who Is Involved

When you report your workplace injury, you have to mention all the relevant parties that were involved in your injury. In addition to your name and contact information, you must include your employer and all the medical providers that responded. Include any witnesses that saw your workplace injury take place.. 

Policy Information

So that your files can be properly documented, you would have to include the policy number, policy coverage period, coverage exclusions, policy endorsements, and states covered by the policy. 

Accident Synopsis 

You should cover how your accident happened and give your official statement. This includes details of how the accident happened and any witness testimonies. 


Add information about the evidence that supports your insurance claim.

Disability Status

If you were temporarily totally or partially disabled, you will have to mention it so that the insurance company knows how severely you were hurt. Also, the amount you will receive is based on the type of disability that you have. 

Modified Duty

Your employer can let you know what access you will have to perform a modified duty after you’ve recovered from your injury. 

Index Bureau

There will be a section that allows you to mention any prior insurance claims you made and past history of workers’ compensation payouts. 

Background Information

You need to provide your current job title, your duties, any equipment required for your work, and other pertinent information about your job. How long you have been with the company must also be provided. 

Doctor’s Input

After you’ve had a medical exam, you should know what medical care will be required for your full recovery. Information about all of your injuries, the diagnosis, the prognosis, and your treatment plan will have to be included in your application.

Legal Representation

You must also include if you are being represented by an attorney. The attorney’s fee must also be mentioned. 

Reasons Workers’ Compensation Claims Are Initially Denied 

Workers’ compensation claims can be denied for many reasons or don’t receive a fair settlement, ranging from lack of information to poor cooperation. The main reasons that you can be initially denied a workers’ comp settlement include the following:

No Medical Evidence

Once you’ve been injured, you should immediately get medical help. Your doctor will review all of your injuries and tell you exactly what the issue is. Not having any medical expenses or evidence that you were wounded will make it difficult for you to receive the correct amount of benefits. 

Not Complying With Doctor

If you don’t follow the doctor’s orders, you can be declined workers’ comp benefits. When your doctor recommends medical care, you have to follow the treatment plan. Doing this makes sure that you aren’t making your injuries worse and are actually improving. 

Incomplete Information

When you don’t deliver all the necessary details of your workers’ compensation case, then you may also be denied benefits. Lack of information and gaps in data will force the insurance company to decline your workers’ comp application. 


The description of your injuries and how the accident happened have to match the evidence. If there are any discrepancies, the insurance company may launch its own investigation to find out what really occurred. Exaggerating your injuries, claiming that you required time off but really didn’t, and other forms of fraud can also result in you being penalized. 

Missed Deadlines

You have to stay on top of your workers’ compensation deadlines. When you miss deadlines or wait too long, this will result in you being automatically declined.

Uncertified Medical Provider

Any medical treatment you receive has to be provided by a designated and certified medical provider. You may have legitimate injuries that were caused by your workplace accident, but if you don’t work with a doctor that is in your employer and their insurer’s network, then this can also result in denied benefits. 

Employer Disputed Claim

Your employer or insurer may dispute the claim. It could be because the insurer wants to save money or the employer doesn’t believe you deserve it. However, just because your employer disputes your claim doesn’t mean you’re not entitled to workers’ compensation benefits. 

No Disabling Injuries

When you don’t have an injury or illness that’s not that severe, you’ll also be denied claims. This is mainly because you can still work and carry on your role at your job. If your injuries aren’t so severe that you have to take time off or you have to take on a modified role, then you will be unable to receive workers’ compensation. For example, if you only have a few bruises and scratches after a slip and fall accident but no broken bones, then you wouldn’t be considered a good applicant.

Unlawful Activity

If you got injured because you were participating in illegal activity, this can also result in denial. For example, if you were trying to break into an office and got injured, were assaulting another employee, or any other behavior that is against company policy, you may be held liable for your own injuries. Horsing around at work and using equipment inappropriately can also end in this result. 

Intoxicated Behavior

You shouldn’t be intoxicated by illicit drugs or alcohol while at work because it reduces your mobility and focus. If you were intoxicated this can be another reason you were injured at work. 

How Workers’ Compensation Attorneys Help So That It Will End In A Settlement

When you have declined workers’ comp benefits despite being eligible for workers’ compensation benefits, then you can work with a reliable attorney. They can help you begin the appeal process to make sure you receive full benefits and receive a fair workers’ compensation settlement agreement. 

They Find Additional Evidence For Workers’ Comp Cases 

Your workers’ compensation attorney will investigate your accident and find out how you were injured. They will even work with other experts to uncover how the accident occurred. Attorneys are able to substantiate your claim using additional evidence that they discover. 

They Find Flaws In Your Workers’ Comp Application

Attorneys are trained experts who know exactly what is required on your workers’ compensation claim. They may spot errors or find that there is missing information that you left out. If you have a disorganized application, you can focus on recovery while your attorney redoes your application for you. 

They Represent You At Meetings And Trials To Negotiate A Workers’ Comp Settlement

When your attorney files an appeal for you, they will not only do the paperwork but also represent your best interests. When you have to attend the pre-trial meeting, your attorney will be by your side supporting you through the process. If the pre-trial meeting doesn’t result in a resolution, then your attorney will represent you at the trial. They will explain why you deserve benefits from the judge or jury at the trial. Even if you have to appeal more than once, your attorney will help you every step of the way. 

Get Started With A Workers’ Compensation Settlements Attorney Today

When you get badly injured on the job, you not only will suffer from financial instability but you will be stuck at home with a painful work-related injury. Your workers’ compensation attorney works on a contingency fee basis that doesn’t require you to pay upfront, making their services even more convenient. To get started on how to obtain a fair settlement offer, call Personal Injury Attorney Fresno today for a free workers’ compensation consultation.