Resolving and settling workers’ compensation claims is a complex process requiring adjusters, medical providers, attorneys, and workers’ compensation coordinators to have an in-depth knowledge of multiple areas of the law, including workers’ compensation, product liability, and general liability legal issues.
The effective adjuster develops the talent to negotiate the claim by emphasizing its strengths. Prior to starting the settlement negotiations, the adjuster outlines in an Action Plan the strengths and weaknesses of the claim, obtains settlement authority, and develops a strategy to stress the reasons the claim should be settled for the amount the adjuster recommends.
Establish Value of the Claim
As part of any negotiation, the adjuster must establish the value of the claim and a settlement range for the claim based upon the strengths and weaknesses evaluation. Establishing future medical costs and the degree of medical disability is critical to a fair settlement value. In some states, medical costs cannot be closed or settled but other parts of the claim can be.
Ability to Return to Work
Lack of future employment and the disabled employee’s inability to return to work increases the value of a claim. The longer the employee has been out of work, the higher the settlement range is likely to be. For this reason, adjusters and workers’ compensation coordinators must determine if there are other positions available for the employee with permanent disability restrictions. It is generally better to find a position within the organization, but there are times when employment must be found elsewhere. Try to find employment for the employee as close to, or higher than, the original wages because the settlement will be larger if the post-injury wages are lower than the pre-injury wages.
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