Settlement negotiations generally start after we issue our demand letter. That’s our official offer to the insurance company containing our analysis of your case with all the evidence that supports the money we’re asking the insurance company to pay.
The process doesn’t start in most cases until you reach maximum medical improvement, meaning the doctor decides you’re as good as you’re going to get.
After that, there’s a flurry of activity on your case, since the insurance company can request a hearing to decide your case that must be scheduled within 60 days. That’s not a lot of time to prepare. That’s why we prepare your case all along—so by the time you get released from treatment, we usually have only your last few medical records to gather before launching settlement negotiations.
Here’s our process to do it.
1. Get the Rest of Your Medical Records Analyzed
Two words should jump out at you here.
- “Rest.” That indicates that we already have some of your medical records, so there’s not as much to get. Preparing your case as it develops instead of waiting until the end relieves pressure on us. It gives us the luxury of taking time to make sure critical details get noticed, giving you and your case critical care when you need it most.
- “Analyzed.” Medical evidence is vital to your case. We don’t just collect your records; we make sure they are read and summarized to evaluate this crucial aspect—and use clinical evidence to support our case for a solid settlement.
2. Analyze Your Impairment Rating
Doctor impairment ratings often drive settlement value. They are based on a book, the AMA Guide to Permanent Impairment. I have it. When I get your rating, I compare it to the range of ratings given by the Guide. Based on that review, I determine if we can make arguments for a higher rating based on the Guide, or if we should get a second opinion for a more accurate rating.
3. Find Out Your Permanent Work Restrictions and Physical Limitations
Your doctor supplies your work restrictions. But your injuries affect not just work, but also your life. The physical limitations come from you. We’ve got a process allowing you to tell us how you can’t do things in life like you used to. We use that to assess your next step.
4. Develop a Strategy for the Highest Workers’ Compensation Disability Rating to Maximize Your Settlement
Based on the severity of your permanent injury, you may qualify for maximum financial and medical benefits such as workers’ comp total disability or wage loss. If so, strengthening our case for those may require me to refer you for a vocational evaluation.
But many settlements involve an injury to a single body part—resulting in a settlement centered around your impairment rating, work restrictions, and limitations. The workers’ compensation disability rating should be higher than the impairment rating because it measures the impact on your ability to work and live.
We create a strategy taking all this into account to help achieve your case goals.
5. Focus on the Goals of the Most Important Person in the Case—You
Before I issue the demand letter, I determine what you want to achieve, since workers’ compensation offers complex settlement options even in a typical case. A key consideration is often whether to keep your right to future care or “clinch” the case, meaning give up medical care for additional money.
6. Last Step Before the Demand Letter—a Written Settlement Evaluation
I give my folks a written settlement evaluation explaining your rights, the strengths and weaknesses of our case, and a range of amounts to settle for. I send it with the final draft of the demand letter, or with a copy of the demand you’ve already approved.
7. The Demand Letter
This formal letter to the insurance company, often sent to its lawyer, has one chief aim: justify a maximum settlement for your case. The letter summarizes your case, especially its strengths. It includes:
- A little background on you.
- A description of how you got hurt.
- An analysis of your medical records. If you’re seriously hurt and go forward without an attorney, you need to be able to do that. How else can you expect the insurance company to grasp how bad you’re hurt?
- A description of your injuries. Importantly, it describes your pain and permanent limitations in meaningful terms that I know the workers’ compensation commission bases its decisions on. You’ve got to prove to the insurance company and its lawyer you can prove your case in court before they’ll take you seriously.
Using all this ammunition, we justify the money amount we’re asking for.
Despite all my work, I never forget we’re a team and who’s the boss. We don’t issue the demand letter until you approve the draft. Once you do, I send it immediately, and settlement negotiations start.
8. Settlement Negotiations
As these go on, I keep you updated every step of the way. I notify you of insurance company counteroffers, and I have you approve any response. Many cases end in settlement. If so, our next step is minimizing how long it takes to get your settlement check.
If the insurance company won't do the right thing to settle it, we request a hearing for a workers’ compensation commissioner to decide it. Don’t worry. I’ll be ready, and so will you.
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