A Personal Injury Case Study
The process of workers compensation settlements is a little different than other personal injury claims. This case study illustrates some important legal issues in these types of cases. We’ll cover the specifics of the accident, injuries, liability, negotiations, and the final settlement.
Amanda had worked at the local bar and grill for 10 years as a part-time waitress and hostess. Even though Amanda only worked part-time, her employer still provided benefits to her such as insurance, vacation pay and sick leave. She was also covered by workers compensation benefits because, on occasion, she worked nearly full-time hours.
One day as her shift was coming to an end, her supervisor asked for help carrying several large boxes that had just been delivered from a wholesale food distributor. As she lifted a box off the truck, she pulled a muscle in her back and dropped the box. She could instantly feel the pull from her lower back all the way to her neck.
Her supervisor did not know how heavy the boxes were, but should have known given what was being delivered. In addition, the approximate weight of the contents was printed on the side of each box.
Amanda resided in a compulsory workers compensation state meaning that an employer is required (or “compelled”) to carry workers compensation insurance. In Amanda’s case, her employer did not have to cover her because she was a part-time employee, however once he decided to, she was covered by his policy.
Because Amanda’s injury occurred on the job and in the scope of her employment, versus a random injury that had nothing to do with her job, it was covered by worker’s compensation insurance in terms of liability.
In Amanda’s situation it was a clear case of employer fault in that they asked Amanda, a small-framed woman weighing 110 pounds, to lift a box that was 80 pounds. Even though it was the supervisor that asked her to lift the box, the employer is still liable for Amanda’s care.
Amanda experienced a soft tissue injury to her back and neck which required physical therapy for three months. “Soft tissue” means that it is non-surgical and essentially a muscle injury.
In the worker’s compensation system, they have specified doctors for injured employees to see. Prior to accepting liability, Amanda underwent an IME (Independent Medical Examination) where the workers compensation doctor assessed her degree of injury and determined whether it was related to a work condition, which it was.
She then went to a worker’s compensation approved physical therapist for the remainder of her treatment. The physical therapist scheduled her for treatments 2 times per week as well as an MRI.
Once Amanda had concluded her treatment, the insurance adjuster assessed her degree of injury at only 12% because she was nearly back to her pre-injury condition. Because Amanda was young (mid-30’s) and in good health, she healed much quicker than expected.
She was offered a choice of either: $10,000 as a workers compensation settlement with no residual payments or medical expenses, or $3,000 with one year of medical care. All of her previous medical treatment was paid for by the workers comp insurance, so she was not required to reimburse the physical therapist, etc.
Amanda had some pressing expenses and was in need of immediate cash, so she took the lump-sum settlement for $10,000. This meant that any future medical care as a result of this injury would not be covered.
- Once the workers comp adjuster determines that the employer’s workers compensation coverage applies, they send the employee to authorized providers.
- Workers compensation settlements are typically offered in tiers: Either one global settlement for a higher amount without medical, or a far lesser settlement with provisions for medical care for a specified period of time.
- If an injury occurs on the job and within the scope of employment, it is usually covered by the employer’s workers compensation insurance.
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