Disclaimer: Nothing in this article should be taken as legal advice. Every workers’ comp case is different, and you should consult with an attorney before taking legal action on your case.
When you get hurt, it can seem like your whole life is crashing down around you. Knowing that you might qualify for workers’ comp helps relieve some tension, but what if you need surgery for your injury or illness? The stress accompanying such a realization can be overwhelming and interfere with your peace of mind as well as your ability to heal. Pathfinder Injury Law will be here to guide you through your workers’ comp claim process so you can spend more time on healing and returning to your daily life.
While workplace injuries can occur to any part of the body, certain areas are more common than others. According to the 2020 Virginia Workers’ Compensation Commission report, upper extremities are the most common body part injury area reported by injured employees involved in Virginia workplace accidents.
The upper extremities are your arms, extending from your shoulder joint down to the tips of your fingers. This area contains some 30 bones as well as numerous muscles, nerves, and blood vessels. Injury can occur in any section, including the hand, forearm, or upper arm.
When determining whether the location of the workplace injury will affect the workers’ comp settlement amount for injured workers, it will depend on specific factors, including the extent of the personal injury and resulting effects, such as the level of impairment (temporary or permanent).
According to the Code of Virginia § 65.2-503, compensation for permanent disability (permanent partial disability, permanent total disability) and disfigurement falls under legally specified amounts. For example, if you lose a thumb or one of your other fingers, you may be compensated for a set period of time at the rate of 66 ⅔ percent of your average weekly wage.
After undergoing treatment and when you reach a point of what is referred to as maximum medical improvement (MMI), your attorney can seek certain designated disability compensation benefits for your workers’ compensation case.
Further specifics are laid out in the Virginia workers’ comp law, such as for the loss of the following body parts:
To potentially receive compensation for permanent and total disability or incapacity, certain injuries must include the loss of:
Also, when looking at specific wording in these sections of the Code of Virginia, it is important to understand that workers’ comp case settlements are not actually “awarded” but instead are completely voluntary agreements between claimants and insurance companies. There is never a time where a judge tells either side how much they have to pay or accept — so there is no such thing as an injury settlement being awarded. It must first be negotiated.
While knowing how much you can receive in compensation due to a surgery from a workplace accident can help, it is essential to also manage your expectations. The answer to that question will be dependent on the type of injury and surgery, the manner in which you sustained the injury, future medical needs (e.g., treatments, physical therapy), future lost wages, permanent damage, and more. There are so many things to take into consideration here, including before, during, and after your surgery, that seeking legal advice is imperative.
However, most importantly, it all depends on whether the accident is legally compensable in the first place. A person could be left completely paralyzed by an accident, but they would get $0 for it if the accident does not meet Virginia’s legal standard for workers’ compensation claim compensability.
Meeting these legal standards in Virginia all begins with the requirement that the accident must “arise out of and during the course of the employment” to be considered compensable, according to the Code of Virginia.
As for how much you can receive, while you can conduct your own research online, understand any mention of an average workers’ comp settlement amount or range is not considered a standard. Every claim is different and, as such, must be treated differently. Also, keep in mind that any advice on workers’ comp amounts reported to you by family members and friends is not reliable. It does not matter if your cousin receives a million dollars for a toe injury in another state. Your workers’ comp case will be unique based on the specific circumstances and the fact that your accident took place in Virginia.
In addition, while pain and suffering may be available in another state, Virginia workers’ compensation law does not cover it, so you should not expect to get paid for it as part of your compensation.
The Virginia Workers’ Compensation Commission website has a calculator to figure out how much in accrued wage loss benefits a claimant could be entitled to for their claim for a certain period of time. This calculator, however, is not at all meant to help with calculating a settlement amount.
Instead, several factors will need to be included in a calculation to determine the type of lump sum payout that may be available to you. It is essential to know, however, that a lump-sum settlement with medical benefits included is rare. You are unlikely to receive a chunk of money plus an agreement to pay for all your past and future medical expenses.
When it comes to workers’ compensation insurance, there are different types of settlements potentially involved. It helps to understand the differences ahead of time, so you will not be left with questions or concerns that you got taken advantage of by the insurance company or your employer. Below are the different types you may be offered for your workers’ compensation claim.
The full and final settlement agreement type is the most common in workers’ compensation cases in Virginia. This workers’ comp settlement involves the employer’s insurance company paying out one large lump sum payment to cover your work-related injuries.
With this payout, the insurance carrier ends its liability and responsibility for providing you with any further workers’ compensation benefits, including medical treatment for the job-related injury.
This settlement of your entire claim then transfers the responsibility of paying future medical care expenses relating to your injury on to you. For this reason, prior to agreeing to the settlement offer, you need to ensure you obtain an accurate estimation of what your medical costs and needs will be going forward.
With a structured settlement, you will receive several set payments over a specific timeframe, usually a number of years. In exchange for agreeing to this settlement offer, the employer and its insurance company are no longer liable for your workers’ comp insurance claim.
You may choose to receive all of your workers’ comp settlement amount in this manner, or only part of it. A schedule will be outlined for the periodic payments.
In most cases, structured settlements are reserved for higher settlement amounts.
While this type of workers’ compensation settlement type is rather rare, they are possible here in Virginia and often require working with a workers’ comp attorney so you understand the process. It may not be in your best interest to accept a structured settlement, however, and seeking a lump sum settlement instead may be better.
Full and final settlements with Workers’ Compensation Medicare Set Aside (WCMSA) involves a specific arrangement facilitated and funded by your employer or its workers’ compensation insurance company.
This settlement type applies only to certain workers’ compensation claimants and sets aside a separate account that you must use to pay medical expenses that relate to the work injury or illness. If the set aside account is depleted, Medicare will usually step in and pay for the remaining medical care you require, as long as the set aside funds were adequate and were used correctly.
Reasons for going with this settlement type can include:
Suffering an injury or illness at work interrupts not only your career but also your day-to-day life. When medical care and surgery are necessary, you may feel stressed or overwhelmed instead of focusing only on your healing. By hiring a Virginia Workers’ Compensation attorney, you can take care of your health while also knowing your injury claim is in good hands.
A workers’ comp lawyer will help you through the workers’ compensation process by talking with the insurance company and adjuster on your behalf. They will also represent you before the Virginia Workers’ Compensation Commission and ensure you are adequately represented there as well.
By having experience with workers’ compensation claims and understanding how to communicate with all those involved, you may have a higher chance of receiving workers’ comp benefits and a fair settlement so you can rest easier at night.
Pathfinder Injury Law can also help with mediation, where we do a workers’ comp settlement conference with the insurance company and a judge to try and work out the case for a lump sum settlement. If this fails or settlement is not an option, our law firm may need to take your case to litigation.
While you cannot sue your employer in Virginia, there are legal actions we can take on your behalf to potentially gain compensation. You generally should not discuss settlement value with your employer and its insurance carrier without the advice and guidance of a seasoned workers’ comp attorney.
Experiencing a work-related injury or illness is stressful enough, but when you need surgery, medical bills can pile up quickly. If you are worried about what happens if this occurs, we can help. At Pathfinder Injury Law, we take each case personally, treating you as more than just a number. The attorney-client relationship is extremely important to us, and we provide you with the individualized attention you need and deserve.
In addition, our law office only handles workers’ comp cases. We always work for you and will seek compensation that meets your individual needs.
If you need a workers’ compensation lawyer you can count on in Richmond or the Central Virginia area, look no further than Pathfinder Injury Law. We will be glad to provide you with an initial consultation and case evaluation virtually or over the phone. Call (804) 505-0633 today or go to our website and fill out the available contact form. We look forward to talking with you soon!