Any injury or illness suffered on the job can be a challenging experience for a worker. Thankfully, California has a workers’ compensation system that helps employees receive medical assistance if they have a work-related injury. What’s more, it also provides employees time off and even financial compensation.
However, the system seems ideal in theory but isn’t that robust in practice. Legal processes usually take a really long time to end, despite having internal deadlines for various things. As such, settlements of claims are an easier way for both parties to reach a solution that benefits everyone involved.
However, there is no standard time period that a case takes to settle. Obviously, cases with lesser issues in dispute settle faster, but there can always be exceptions. The willingness of the parties to compromise and cooperate affects the time taken to settle. But, most importantly, the presence of legal representation also affects the case timeline.
How Long Does A Workers’ Compensation Case Take To Settle In California?
Some minor cases can settle in as quickly as 90 days. Of course, these cases are not proceeding through all of the normal steps that a normal case goes through. But both sides of a case are willing to compromise a settlement can be reached. Although most injured workers require medical treatment and do not have their own medical insurance and do not have the luxury of an early settlement. In these cases, a settlement takes much longer. Obviously that parties cannot begin to discuss settlement until an injury is cured or has reached Maximum Medical Improvement (MMI). How long it takes an injury to resolve is different for each person. A person typically reached a state of MMI within 6 months to 3 years from the date of injury.
Once you have reached Maximum Medical Improved you will usually be seen by a Qualified Medical Examiner (QME) At a minimum, the process of selecting a QME, obtaining an appointment, and waiting for his report takes 160 days. But, in many cases, the QME cannot reach a final opinion without additional testing and review of your medical records which can drag the process out even. Once you do have a final report then the negotiation part can be started.
Workers’ Compensation carriers have 1000’s of opened claims at a time and their responsiveness can be very slow. In many cases, there are disputes regarding issues of a particular case that can affect the settlement value and an easy compromise cannot be reached. This can delay settlement more and, in many cases, require court intervention and possible trial. All of which can add months to reaching a settlement. The bottom line in order to get fair compensation in case of significant injury you can expect the settlement to take at least a year. If you do not have the patience to go through the various steps of a workers’ compensation case you can settle faster but the dollar value of your settlement will most likely be less than full value.
Initial Delays In A Workers’ Compensation Case
To determine the amount of time taken to settle a case, it’s essential to know the procedure that comes before it.
The first step in a workers’ compensation case is to file the case. The claim cannot move forward unless specific applications are filled out and formalities completed. California law mandates the worker to report a workplace injury within 30 days and file a claim within a year. The longer the worker takes to do the aforementioned, the longer the case goes on.
Once a claim has been filed, the employer must submit it to a claim’s administrator. Claims administrators have a period of 90 days from the date of submission of the claim to undertake an investigation.
However, the administrator must mandatorily authorize medical treatment before one working day. In addition to that, if the worker is temporarily disabled, then payment must be made to them within 14 days of the administrator getting to know of the injury.
Other delays can be the need for additional QMEs in different specialities, waiting for court dates, and waiting for medical procedures.
The Process Of Settlement
The next step toward the resolution of this claim is to attempt a settlement between the injured worker and the insurance company, usually through their Workers’ Compensation Lawyer.
When there’s a case that relates to a workers’ compensation claim in California, there is a possibility that it can be settled before trial in two distinct ways. This, however, depends on the issues that are involved in the case and happens when the parties are on the same page regarding the merits of the case.
- Compromise and Release
The process of settlement commences with an offer made by the insurance company that is on the worker to accept. This method of settlement is called a “compromise and release.”
Acceptance of the lump sum characterizes a successful “compromise and release,” and the worker, in turn, drops all charges and cases. The Workers Compensation Judge approves the “compromise and release” documents, and after that, the hurt worker is liable to pay for all medical expenses themself.
In addition to that, the case cannot be reopened in the future and is dispensed with for good.
- Stipulation With Request For An Award
In this kind of settlement, the worker is paid over a period of time in the form of permanent disability. Apart from this, the injured worker also reserves the right to ask for medical care in the future as well. These situations are all enumerated in the agreement and must be paid off entirely by the insurance company to the extent mentioned in the agreement.
Settling such a case can be a time-consuming process because the parties have to warm up to the idea of compromising. Reaching that point where each side is able to understand the other is not very common. A lot of facts have to be uncovered and analyzed before a settlement is made.
For instance, medical reports have to be looked at to determine the extent of the worker’s injury, and their past medical records may also have to be subpoenaed and examined. This entire ordeal can often take up to a year or more.
To put it succinctly, the duration of the settlement process depends on certain variables that differ from case to case.
Settlement is advantageous for both the parties, i.e., the applicant as well as the insurance company, because both parties get at least a fraction of their demands fulfilled. Especially for the applicant, the sum of money they receive on settlement is massively helpful in paying medical expenses.
However, it is advisable to wait until the “maximum medical improvement” stage, determined by a Qualified Medical Practitioner, before contemplating settling. This is because MMI is the stage beyond which the injured worker won’t improve, and the correct determination of the settlement amount can be done at this juncture.
Once the MMI stage is reached, a doctor evaluates the extent of disability, and on that basis, the amount is decided upon, which then constitutes a permanent disability.