Our survey explains what happened to injured workers' medical conditions after their cases were closed, and what they would have done differently.
If you’ve been injured or became ill on the job, it can be difficult to know whether and when to settle your workers’ compensation case. A big part of that decision relates to what might happen with your injuries in the future. If your medical condition gets worse after your settlement is final, you usually can’t go back and ask for more money.
In 2016, we asked our readers who resolved their workers’ comp cases whether their injuries were better or worse afterwards. We also asked about other reasons they weren’t happy with the outcome of their workers’ comp claims. Here’s what we learned.
Changes in Work-Related Injuries After Workers’ Comp Cases Close
A third (33%) of workers reported that their medical conditions had gotten worse after they received a settlement or award in their workers’ comp cases. Almost half (45%) said their conditions remained the same, and less than a quarter (22%) reported an improvement. (Although our survey was conducted in 2016, there is little evidence to suggest the figures would be much different today.)
To make sense of what a worsened medical condition can mean for those who already settled their cases, it helps to understand workers’ comp settlement agreements. With some settlements, insurance companies may agree to pay for future medical expenses or leave open the right to collect additional benefits.
Most of the time, however, insurers insist on settlements with a “full and final release” of all claims. That means the injured workers have given up the right to any future compensation for the injuries covered by the settlement, including the right to future medical care if their condition worsens (unless they live in a state that prohibits that kind of waiver).
The situation might be different for injured workers who received an award after a workers’ comp hearing, rather than a settlement. Most states allow them to reopen their cases if their medical condition changed significantly since the award, and the change was because of the original work-related injury. The specific requirements and time limits can vary from state to state. (Learn more about how to open a closed workers’ comp case.)
Other Reasons for Dissatisfaction With Workers’ Comp
Naturally, if your medical condition deteriorates after you’ve agreed to a full and final settlement of your workers’ comp case, you’ll be unhappy with the results. But that’s not the only reason many injured employees are frustrated with the workers’ comp process. In fact, half of the readers in our survey (56%) said they were dissatisfied or very dissatisfied with the outcome of their workers’ comp cases, and less than two in ten (18%) were satisfied to some degree.
Readers cited various reasons for their dissatisfaction, especially low benefit amounts, inadequate medical care, and poor treatment from insurance companies.
Not Enough Compensation
The most common reason readers gave for being dissatisfied was feeling they weren’t paid enough to make up for their losses. For example, one reader felt that the $10,000 to $15,000 award that she received was not enough to compensate her for a lifetime partial disability of her neck.
Another reader, who lost her job as a clinical lab scientist because of her injuries, felt that the $15,000 to $20,000 award that she received was not enough to compensate her for the loss of her career.
Unfortunately, this is a common complaint about workers' comp. By design, the system doesn't compensate injured workers for the full extent of their losses. Under the "grand bargain" of workers' comp, you typically can’t sue your employer in court for a work-related injury. In exchange, you can get benefits regardless of who was at fault for the injury. However, the biggest drawback is that workers’ comp limits the types and amounts of compensation you can receive.
For example, in most states workers’ comp pays injured employees only two-thirds of their lost wages while they're out of work—up to a legal maximum. Also, they only receive set amounts for permanent disabilities. In a typical injury lawsuit, in contrast, you could collect the full amount of your lost wages. You might also be compensated for the full amount of any lost earning capacity due to the injury—for example, if you had to switch careers because of your injury and now earn less than you did before.
Inadequate Medical Treatment
Many injured workers were unhappy with the quality of the medical treatment they received through workers’ compensation. This isn't too surprising, given that many states allow the employer (or its insurance company) control over selecting your treating doctor.
When that's the case, the doctors may have an incentive to keep costs down in order to continue to receive business from the insurance companies. They may send you back to work too soon, minimize your diagnosis, or refuse to send you to specialists. Even when you can choose your own doctor, insurance companies may typically refuse to authorize recommended treatment or tests, especially when they're expensive. (Learn more about medical disputes in workers' comp cases.)
This can also lead to slower or even incomplete recoveries. For example, one reader with a back injury said that he was misdiagnosed for two months because the insurance company didn’t want to pay for an MRI and instead went with the cheaper option of physical therapy. For two months, he was treated for mild back strain, when he actually had a herniated disc.
Biased System
Another common complaint from our readers was that the workers’ comp system seemed to be stacked against them from the beginning. Many readers were frustrated with how much control the insurance company had over the process, the fact that they never received a full and fair evaluation of their injuries, and the general distrust that they felt from the insurance company about their claims.
What Injured Workers Would Have Done Differently
Based on the above, we asked our readers what they wish they had done differently and what advice they would offer to fellow injured workers. Here’s what they said.
Report your injury right away. Many workers regretted waiting to report their accidents or injuries. Insurance companies often routinely deny claims that are reported late.
Educate yourself. Several workers wished that they had learned more about their rights under workers’ compensation laws, whether they had a lawyer or not. Having a better understanding of your rights can help you know what questions to ask during the process and how to better evaluate your options.
Keep detailed records. Many of our readers also suggested keeping better records throughout the process, including communications with the employer or its insurance company, notes from medical appointments, and daily notes about the pain they experienced.
Go to all appointments. Our readers also emphasized the importance of going to all appointments and being on time. Missing medical or other appointments can delay your case and compromise your right to collect benefits.
Learn more tips for collecting workers' comp benefits and survey results on winning benefits after workers' comp claims are denied.)
About This Report
The reader survey data referenced above is from Martindale-Nolo Research's 2016 workers' compensation study, which analyzed responses from readers who had workers' comp claims, had researched hiring a lawyer, and agreed to participate in the survey. The names of any quoted readers have been changed to protect their privacy.
