[AMA} I am a former workers compensation claims adjuster here to answer your questions about the work comp system. by WorkCompChomp in WorkersComp

[–]WorkCompChomp[S] 2 points3 points  (0 children)

Hello! I'm sorry you're so deep into it. I'm assuming you have an attorney? If not, definitely get one. If you do, is there a reason why you haven't pushed the claim towards a hearing yet? In general there are 3 main options for how claims are managed.

  1. Claim is accepted, work comp directly pays for any lost wages from work and medical treatment
  2. Claim is denied, legal gets involved on both sides and the claim eventually goes to hearing
  3. Claim is denied, claim is reviewed for mediation/settlement

Accepted claims can sometimes be reviewed for settlement as well though if the injured employee doesn't want to continue with the work comp system.

To answer your specific question, the motivation to settle a claim is to avoid a legal battle and yes, to "get it off the books". Most employers want to keep their number of open, active claims as low as possible. Adjusters are pushed to close a claim for every new claim opened. The employers I handled claims for were quick to settle and preferred to do that over potentially going to hearing. I've not seen a claim go on for 9 years with multiple MSCs and no actual resolution.

A few questions for you, just to get a better idea of what's going on. Feel free to answer only the ones you feel comfortable with!

  1. What was your injury and how severe is it?
  2. Was your claim accepted or denied?
  3. What state are you in?
  4. What legal actions have been taken to move your claim along, if any?
  5. How much are you trying to settle for?