Both settlements and lifetime medical benefits have benefits and drawbacks. Knowing which route to take really depends on your injury, claim, and other situational variables specific to you. Often, persons filing a workers' compensation claim will be too quick to accept a settlement, not using protective language and undervaluing his or her claim or they're too quick to decide on litigation believing that more money will be rewarded to him or her, which is not always the case.
A settlement is a lump sum rewarded to a person who suffered a work-related injury. The amount is offered by the insurance carrier and you or your attorney has the opportunity to negotiate. Neither you nor the insurance carrier can reward the settlement. Only the Virginia Workers' Compensation Commission can approve settlements and they only approve if they believe the settlement is in the best interest of the injured worker.
Settlement amount offered and rewarded is valued based on how much temporary total disability benefits and permanent partial disability benefits are remaining out of the 500 weeks, projected future medical costs, and the risk of losing litigation if the claim is contested. Additionally, other parties such as Medicare, Medicaid, Social Security, and child support may have a claim on your settlement money.
The benefits of a settlement are that you get the money fast, you don't have to deal with the insurance carrier, you can manage your own medical treatment, and you don't have to go through the risk of litigation. The process is simpler and you are gaining full control of your medical treatment.
The drawback of a settlement is that you are forfeiting your rights to future lost wages and medical benefits. This disadvantage may hurt you more in the long-term, depending on the settlement amount and whether or not injuries surface after the settlement.
Lifetime Medical Benefits
Lost wages and permanent partial disability benefits can be rewarded for a maximum of 500 weeks, but medical benefits are lifelong as long as the authorized treating physician claims the treatment is a result of the work-related injury and that it is reasonable and necessary.
The benefit of lifetime medical benefits is that your medical treatments and services related to your on-the-job injury will always be covered. Money is a great stressor on people's lives and the security have of having lifetime medical benefits can greatly reduce stress.
The drawback of lifetime medical benefits is that each time you require services you must prove that the treatment you need was caused by the work-related injury and is reasonable to the insurance company. Because the insurance company wants to pay for as little as possible, they choose which physicians you can see and they hire a nurse case manager to change the mind of the doctor so that your claim will get denied. If your claim is wrongfully denied, you are burdened with going to litigation, which costs money, is a lengthy process, and is still likely to be denied because in the event of a tie, the ruling sides with the insurance carrier.
Which is Best: Settlement of Lifetime Medical Benefits?
It really depends on your injury, claim, settlement plan, and other situational factors. The decision to accept a settlement versus receiving lifetime medical benefits should not be made lightly and you should consult an attorney before making the decision. The best thing you could do is to get multiple opinions from an attorney about your workers' compensation claim and your doctor to discuss the potential long-term effects of the injury suffered.