Case Study: Workers’ Compensation Settlement for Back Injury

Work-related back injuries happen every day. Here we follow a part-time food server from her injury through the final settlement of her workers’ comp claim.

Back sprains and strains are common work-related injuries. This case study follows a part-time food server who suffers a back injury on the job.

This case study is for educational purposes only. It is based on actual events, although names have been changed to protect those involved. Any resemblance to real persons or entities is purely coincidental.

We’ll cover how our victim was injured, her eligibility for workers’ compensation benefits, and the final resolution to the injured worker’s case.

Our study finishes up with a list of important points about workers’ compensation claims.

How the Worker Was Injured

Amanda had worked at the local bar and grill for ten years as a part-time waitress and hostess.

One day as her shift was coming to an end, her supervisor asked for help carrying several large boxes that had just arrived from their 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 to her neck.

Amanda worked in a compulsory workers compensation state, meaning that an employer is required (or compelled) to carry workers compensation insurance.

Because Amanda’s injury occurred on the job and in the scope of her employment, it was covered by worker’s compensation insurance.

On-the-job injuries are covered regardless of fault, so long as the employee was not injured in the commission of a crime.

Medical Treatment Under Workers’ Comp

Amanda experienced a soft tissue injury to her back and neck, which required physical therapy for three months. “Soft tissue” means that it is essentially a muscle injury that can be treated without surgery.

In many state worker’s compensation systems, they have specified doctors for injured employees to see.

The doctor treating Amanda was approved by her employer’s workers’ compensation insurance company.

She was initially treated for a severe back strain with muscle relaxers, rest, and advised to use a heating pad for short periods each day.

She progressed to physical therapy treatments twice weekly to help regain her ability to bend and move without pain.

After three months of treatment, the doctor believed that Amanda had reached Maximum Medical Improvement (MMI), meaning her back would not get any better with continued treatment.

Because Amanda still had pain when standing on her feet for long, and difficulty bending and lifting, the doctor determined Amanda suffered a permanent partial disability of 20 percent.

Worker’s Comp Negotiations and Settlement

The workers’ compensation insurance company sent Amanda for an Independent Medical Examination (IME), where the workers’ compensation doctor assessed her degree of injury and determined whether it was related to a work condition, which it was.

The IME doctor agreed that Amanda suffered a permanent partial disability, with a 20 percent loss of function compared to her pre-injury condition.

Amanda had been getting worker’s comp wage loss benefits for the three months following the accident. Wage loss benefits are generally two-thirds of a worker’s average wage before the injury.

Because she suffered a partial permanent disability, Amanda was offered a choice of either: $10,000 as a workers’ compensation settlement with no coverage for future medical expenses or $3,000 with one year of medical care.

Up to this point, workers’ compensation insurance had fully covered all of Amanda’s injury-related medical and physical therapy expenses.

Amanda understood that further treatment would not improve her back, so she opted to take the lump-sum settlement for $10,000.

Important Points About Worker’s Compensation

  • If an injury occurs on the job and within the scope of employment, it is usually covered by the employer’s workers’ compensation insurance.
  • The injured worker doesn’t have to prove fault to receive workers’ comp benefits.
  • Wage loss benefits are about two-thirds of the worker’s pre-injury wages; however, workers’ comp wage benefits are not taxable.
  • Workers’ compensation insurance companies work hard to avoid large payouts in injured workers.
  • IME doctors are paid by the insurance company and may be biased in the company’s favor.
  • Injured workers may need an experienced attorney for disputes over wage calculations or disability rankings.

 

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