Some websites claim that a lump-sum settlement takes merely 30 days. In contrast, others quote “6-18 months,” depending on the nature of your work-related injury, WCAB’s workload, the insurer’s response frequency, and the medical treatment required.
However, the workers’ compensation lawyers at The Law Office of Joseph Pluta know through their experience and expertise that the answer is not so simple. By knowing the ins and outs of California’s Workers’ Compensation System, you can learn approximately when you can start receiving your settlement.
First, take a good, long look at the typical stages of a workers’ compensation settlement process laid out on California’s Department of Industrial Relations website. You may have recognized yourself standing at the last stage of this process.
Naturally, you must eagerly anticipate your settlement amount anytime soon. We hate to be the bearer of annoying news, but you might expect different timelines for your payout based on one or a combination of factors. Which factors? Several, actually. So, without wasting another moment, let’s jump right into the variables that come into play when your worker’s compensation case is close to resolution.
What Is A Workers Comp Settlement? Types & Respective Timelines Explained
A workers’ compensation settlement is an agreement between the injured worker and their employer’s insurer to resolve the workers’ compensation case with an amount agreed by both parties, payable continuously, one-off, or in another agreed manner. Such settlements are arrived at in adherence with the laws outlined by California’s Divisions of Workers’ Compensation.
After your Qualified Medical Examiner (QME) has declared your condition stable enough for Maximum Medical Improvement (MMI) but still unsuitable for returning to work at the capacity before your work-related injury occurred, you can apply for a workers’ compensation settlement under Temporary Disability or Permanent Disability Benefits. Usually, employers and insurers agree to settle an amount depending on the degree of severity of the injury, the ongoing costs of future medical treatment mandated, lost wages, and vocational rehabilitation needs. Your settlements can be one of the following types:
1. Stipulations with Request for Award (Stips)
Under this settlement system, you and the claims administrator agree on weekly medical payments for your ongoing and future treatment, considering that your QME declared you unfit to work entirely or partially compared to your pre-workplace-injury capacity. Therefore, Stips recognizes a degree of Permanent Disability borne of industrial injury to one or more body parts. This would award you access to medical coverage, open for life. You can expect to start receiving your settlement within 30 days of approval by the Workers’ Compensation Appeals Board (WCAB) judge.
Since Stips are open for life, you can reopen a claim with the WCAB within 5 years of being awarded this settlement, provided you still need treatment for your disability. This helps your case further since you can claim unused weeks of temporary disability or claim settlement for a newly developed disability after your case is resolved.
2. Compromise and Release (C&R)
When people talk about workers’ compensation settlements, they usually refer to this type. Once you and your insurer agree on a final payable amount, your case closes after you receive your settlement, a portion of which may be reserved for “Medicare-set aside.” You agree to receive a lump sum, one-time payment for your injuries as agreed by the insurer. This is different from Stips, which has periodic issuance.
Take note of the fact that a Workers’ Compensation Judge (WCJ) can approve your C&R settlement at multiple stages of your worker’s compensation claim process, according to Cal. Lab. Code § 5001. Thus, you may get your approval during the Mandatory Status Conference (MSC), the Settlement Conference, before going to trial, or even without a trial! As long as you and the insurer agree on the settlement amount, a WCJ judge must only approve it.
3. Supplemental Job Displacement Benefits (SJDB)
You may qualify for an SJDB voucher as part of your Workers’ Compensation settlement for partial permanent disability under the “Thomas Finding,” if applicable. As soon as your employer/claims administrator receives a “Return-To-Work & Voucher Report,” aka (Form DWC-AD 10133.36) from your designated physician upon declaring Maximum Medical Improvement (MMI), he has a limited window to offer you an alternative, modified, or regular work for you to return to.
Note:
- You will get disqualified from receiving the SJDB Voucher if you refuse your employer’s offer.
- Your employer or the claims administrator must make the offer within 60 days of receiving the “Return-To-Work & Voucher Report.”
- As soon as your employee’s window to offer you a suitable alternative expires, your SJDB voucher will be automatically issued within 20 days from the date.
- You will be eligible to receive $6000, regardless of your permanent disability level, to receive skill training and education in your desired alternative vocation.
- 10% of the $6000 you receive can be used for the services of a licensed placement agency or a vocational counselor.
- Your employer must pay a minimum of 85% of your pre-injury wages or recommend an alternative that does, with 12 months of guaranteed work stability.
Factors That Influence The Workers Comp Settlement Process
Your workers’ compensation settlement might include several benefits, such as ongoing and future medical treatment for your injury, lost wages, and Supplemental Job Displacement Benefits, among others. The question of “WHEN” you receive your payout after the workers’ comp settlement process depends on factors such as:
Your Employers’ Organizational Complexity
If you are injured while working under multiple employers (termed general-special employment relationship), you may be liable to compensation from one or both. Additionally, if you were injured at work under a “Self Insurance Group,” aka a group of multiple member organizations, disagreements may arise over the share of liability.
Your employer/employers and their insurers might be required to navigate additional layers of legal and financial obligations arising from your payroll status, indemnification claims, and regulatory requirements from The California Office of Self-Insurance Plans (OSIP). Naturally, you can expect delays in your settlement.
Your Claims Administrator/Employer’s Insurer
Insurance companies have always been one of the most notorious reasons for delays in workers’ compensation settlements. They may extensively investigate your case to determine the validity of your injuries and the evidence you submit to prove them. They may also compel you to negotiate for a lower settlement amount or decrease one or more benefits you may be eligible for. Should you choose to contest the insurer’s actions in a WCAB court, as you must if you are being denied fair compensation, the trial can further push your settlement’s arrival to a later date.
Disagreements Over Your Treatment & MMI
If you are so critically injured that your treatment takes longer than the settlement period, disputes may arise over what should be your stipulated medical costs. Therefore, you and the insurer must agree on an estimated amount that would likely cover your future medical requirements (should you choose C&R settlement.)
Moreover, per their medical discretion, your QME might delay sending in your “Return-to-Work & Voucher Report” and declaring your MMI. Such a situation may arise because declaring the degree of severity of your temporary, partial-permanent, or permanent disability might require close monitoring over a few weeks to months. Only then can your physician send a rating of your disability in their report. This could delay a swift resolution of your workers’ compensation settlement from your designated physician’s end.
How Can The Law Office Of Joseph Pluta Help?
We can remove all the excess hurdles and delays in your workers’ compensation claim, influencing WCAB’s decisions through legal precedents extracted from experience. In a multi-party liability scenario, we’d know whom to single out, how to respond to their delay tactics, and how to resolve disputes toward finality. We’ll help you glide through overwhelming paperwork, deadlines, and insurer negotiation maneuvers with solid legal representation.
If your claim has already been denied, don’t lose hope—we can challenge the decision and fight for the benefits you rightfully deserve.
Don’t burden yourself with the nitty-gritty of California’s legal machinery and demands when you can simply allow us to fight on your behalf shoulder-to-shoulder, leveraging our knowledge and years of experience. Focus on rest, recovery, and rebuilding your life while we handle your path toward emancipatory victory.
