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Settling Claims

Maximum Medical Improvement (MMI) marks a turning point in your case. At this point, your doctor no longer expects to see improvement in your situation, meaning that any disability you have – whether partial or total – is likely to be permanent. The extent and nature of your disability and the date of your injury determines your standard benefits; however, you may also be eligible for additional benefits for a permanent injury.

Schedule Loss of Use Awards

If the accident resulted in loss of hearing or vision; an injury to (or amputation of) your fingers, hands, arms, toes, legs, or feet; or if you suffered an injury to your wrist, knee, shoulder, or any other extremity, you may be entitled to an additional cash payment to compensate you for this loss. This is called a Schedule Award. These awards are available even if you did not lose time from work or if you are already back at work. You must request a Schedule Award after you have reached MMI and the full extent of your disability is known – awards are not automatically granted. You must request a hearing where your medical records will be reviewed to determine the percentage loss of use. The Board requires two opinions, one from your doctor and one from the insurance company on the percentage loss of use. If either is missing from your file, the SLU claim may be delayed. The type of injury and percentage loss of use will be compared to the schedule loss award tables as set by statute. As an example, if you lose your arm (100% loss), the current schedule allows for the payment of 312 weeks of benefits. Loss of use of a hand is set at 244 weeks. If your injury involves partial loss – for example, if you have a 50% loss of use of your hand – then the award will be 50% of the maximum.

Non-Schedulable Impairments

Not all permanent injuries are listed on the Schedule. The most common non-schedulable impairments are head, neck, and back injuries. These injuries require your doctor to provide additional information. This information will include the affected body part, the impairment class, the impairment table, and a severity ranking. Functional capacity will also be considered before a Non-Schedule Award is paid. Functional capacity takes into account your age, education, and ability to effectively participate in vocational rehabilitation and obtain gainful employment.

Compensation Caps

For injuries prior to March 13, 2007, there is no time limit for the payment of benefits. After that date, compensation is capped at 10 years. Once the cap is exhausted, the presumption is that medical services will continue,.

Facial Disfigurement

Additional awards may also be paid for any injury that results in scarring to the face or neck. These awards are set by the Judge and are capped at $20,000.

Section 32 Agreements

A Section 32 Agreement is a voluntary settlement between the injured worker and the insurance company or employer. This agreement provides you with a final, lump-sum settlement that is intended to pay you for future medical care and lost wages. After the Section 32 Agreement is signed and filed with the Board, your case will be closed. The agreement must be approved by a Workers’ Compensation Law Judge at a hearing. It may also need to be approved by Medicare so they can ensure the agreement is sufficient to cover any expected future medical expenses. We strongly caution against accepting a Section 32 Agreement without speaking to your doctor and a Workers’ Compensation attorney. Why is that? Unless you have an experienced Workers’ Compensation lawyer represent you in negotiating a Section 32 Agreement, you are at a disadvantage. The insurance company has a lawyer protecting their rights; it is important that you have a lawyer protecting yours.

A Section 32 Agreement makes sense when the negotiated lump sum of money you receive is greater than your future rights for medical care and wage replacement. Again, do not enter into a Section 32 Agreement without first speaking to a lawyer so that you maximize your financial benefits and fully understand the long-term consequences.

Contact Schwartzapfel® Lawyers P.C.

If you have been injured and are attempting to obtain benefits, you need strong legal counsel to inform you of your rights and the best course of action in your situation. Insurance companies are not you friend, as they will do everything possible to limit the amount of compensation you receive. Contact the offices of Schwartzapfel® Lawyers P.C. today and we will make sure that you are not taken advantage of, but receive all of the money and benefits you deserve for the debilitating injuries you have sustained. Contact us online or call 1-516-342-2200 to get started.

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