How is a workers’ comp settlement calculated?

Answer

To settle a workers’ compensation case, assuming you are already entitled to and are receiving benefits, there’s no precise formula to calculate the settlement amount, since not all cases settle. But generally, from the insurance company’s perspective, they start by assessing whether the injured worker is partially or totally disabled. This matters because the insurer has to consider its worst-case financial exposure. For partially disabled workers—which is the majority—the maximum duration for receiving weekly benefits is six years. So, both the insurer and your lawyer will do the math: your weekly benefit multiplied by six years. That total often becomes the upper ceiling for settlement value. If the worker is totally disabled, however, they can theoretically collect weekly benefits for the rest of their natural life. In that case, settlement evaluation involves calculating life expectancy, weekly benefits, and any applicable cost-of-living adjustments (COLA), which only apply to those on total disability. As a result, totally disabled workers often see higher settlement values, since there’s no six-year cap. There are rare exceptions where partially disabled workers may qualify to continue benefits beyond six years, and those exceptions also affect settlement value. Ultimately, lawyers use these calculations to make a settlement demand, and if the insurer is open to settling, they’ll respond with an offer. Negotiations continue until both sides agree on the amount and terms of the settlement.

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