Pros and Cons of Workers Comp Lump-Sum Settlements

As a Virginia workers’ compensation firm with decades of experience, we frequently receive calls from injured workers who are contemplating whether to settle their Virginia workers’ comp claims for lump-sum payments or to proceed with keeping their lifetime medical benefits. Both options have pros and cons; thus it is critical to carefully consider your individual needs before making a determination.

Deciding between open lifelong healthcare benefits or a cash buyout of your future medical expenses is a critical decision, as medical costs typically account for a large majority of a workers’ comp claim. As a Virginia workers’ compensation lawyer, firm-founding attorney Mark Hurt can listen to the facts of your case, explain the potential benefits of each option, and provide guidance on the most advantageous path forward based upon your objectives and circumstances.

If you were injured on the job and are contemplating whether to take a lump-sum settlement and forgo your lifetime medical benefits, we invite you to read through the following article and to call our offices to schedule a free, no-obligation consultation.

How Does Workers’ Compensation Work in Virginia?

Workers’ compensation is a no-fault system, meaning any worker injured on the job (regardless of whether they were partially at fault for an accident) may qualify for benefits. If you or a loved one suffered a legitimate job-related injury, you might be entitled to lifetime medical benefits that provide compensation for:

• Authorized primary doctor and specialist(s) visits,
• Medically necessary care,
• Mileage Reimbursement (for travel to and from physician visits),
• Temporary Partial Disability (TP),
• Temporary Total Disability (TTD),
• Permanent Partial Disability (PPD),
• Permanent Total Disability (PTD), and
• Death Benefits.

Alternatively, workers comp beneficiaries may have the option to close lifetime medical benefits and receive a lump-sum payment for all future care. However, this may not be advisable in certain situations, as it can be challenging to accurately estimate lifelong care costs at the outset of an injury.

Can I Be Forced to Cash Our Workers’ Comp Future Medical Treatment Benefits for a Lump Sum?

No. Under Virginia law, an employer and its insurer cannot force an injured employee to accept a cash payout to close medical benefits. Conversely, an employer is also not required to offer a lump-sum buyout of future medical care.

Why is it Beneficial to Keep Open Worker’s Comp Lifetime Medical Benefits in Virginia?

There are a number of reasons why an injured worker may choose to keep lifetime medical benefits open, including:

• All medical treatment related to an injury is fully covered, including co-payments; an individual needn’t worry about estimating their lifetime healthcare needs, which can be challenging if unforeseeable complications arise;
• Applicants do not have to worry about inflation or rising healthcare expenses;
• There is no need to negotiate payment arrangements with healthcare providers;
• There is no cap on the amount of compensation an insurance carrier may have to pay for injury-related medical treatment;
• An insurance company is required to provide transportation or continue reimbursing for mileage to and from doctor’s appointments;
• You may be entitled to wage loss benefits;
• Applicants do not have to worry about finding a participating physician, as the employer is tasked with finding providers who accept workers’ compensation coverage; and
• An insurer will assist with claim handling and payments, making the process less cumbersome.

Why it May Be Beneficial to Cash Out Virginia Workers’ Compensation Lifetime Medical Benefits for A Lump-Sum Settlement

In certain circumstances, it may be highly beneficial to accept a lump-sum buyout of future medical benefits.  These circumstances include:

• If an individual has reached Maximum Medical Improvement for a work injury and does not require additional treatment, it may be beneficial to close a claim in exchange for a lump sum that is more valuable than the medical benefits.
• If an injured worker does not prefer his or her workers’ compensation doctor, taking a lump-sum payment enables the worker to take control of your care and seek treatment with physicians of their own choosing.
• Insurance companies can deny workers’ compensation benefits at any time, necessitating hearings to dispute the findings. If a workers’ comp buyout is taken, however, individuals can bypass this part of the process, as medical care will not need preauthorization and approval by an insurer.
• Under Virginia law, an employer can typically force an injured employee to attend at least one functional capacity examination (“FCE”) and one defense medical examination (“DME”) annually. By taking a buyout, an individual can sidestep these invasive appointments.
• If you have private health insurance and an employer (or its insurance company) raises defenses to your claim, it may be worthwhile to explore taking a lump sum to avoid future litigation and appeals.
• If an individual is injured in a subsequent accident that interferes with an existing workers’ compensation claim, it may be advisable to explore a buyout.

If I Accept a Workers’ Comp Buyout in Virginia, Can I Reopen My Lifetime Medical Award If I Need More Medical Treatment Than Anticipated?

No. Once an individual accepts a cash buyout of their lifetime medical benefits, he or she is no longer able to obtain medical treatment at an employer’s expense. Thus, it is critical to consult with an experienced Virginia workers’ comp attorney before accepting any settlement.

How Can Experienced Virginia Workers’ Compensation Buyout Attorney Mark Hurt Help with My Workers’ Comp Matter?

One of the most significant considerations when determining whether to take a lump-sum buyout of your lifetime workers’ compensation benefits is the amount of medical attention that will be needed in the future to care for a lifelong injury or illness. As a Virginia workers’ comp lawyer with over two decades of experience, attorney Mark Hurt can consult with experts to assist in analyzing the cost of future medical treatment and tenaciously advocate for the maximum amount possible for lifelong injuries, considering factors such as (but not limited to):

• The severity of an injury
• Age and life expectancy
• Number of doctor’s visits required;
• Whether diagnostic testing is needed
• Whether prescription drugs will be needed
• Whether additional physical therapy or retaliatory care is needed
• Pain management status
• Expected inflation rates
• Anticipated rises in healthcare costs
• Other insurance coverage
• Medical transportation needs

After a thorough and meticulous review, we can use the information provided to build a compelling case for a maximum settlement buyout value of workers comp lifetime medical.

Call Our Office Today to Schedule a Free Consultation with A Virginia Workers’ Comp Settlement Attorney.

It is critical to understand that by taking a lump-sum settlement, you will lose access to future medical benefits, even if unforeseen surgeries or treatment related to the work injury arise. For this reason, it is always advisable to consult with an experienced workers’ comp lawyer before accepting any settlement or buyout amounts.

If you are contemplating a workers’ compensation buyout, we encourage you to call the law offices of Mark T. Hurt to schedule a free consultation to learn about the options that may be most beneficial to you and your family.