Although contested claims are tried before an administrative law judge under the Board of Workers’ Compensation, even settled claims have to be approved by the Board. Due to the highly regulated nature of the workers’ compensation insurance system, claims are never just between the employer/insurer and the employee. All workers’ compensation claims must be filed with the board. This in itself does not mean there will be a dispute. However, it does meant that the board will scrutinize any settlement to ensure that it conforms with the law’s requirements. This approval process is designed to protect workers who may be tempted to settle for less than what they are owed.
Procedure for Approval
The process of settling a workers’ compensation claim begins with notifying your employer of the injury. This must be done within 30 days of the injury. Ideally, this is when the negotiations begin. The employer should (and usually does) at this point begin taking responsibility for medical expenses. If there is a dispute over costs and treatments, that may become an issue later. However, notice of the injury generally gets the ball rolling.
The next step is filing the claim with the Workers’ Compensation Board. Claims should be filed with the Board as soon as possible, and are barred if not filed within one year of the injury. The employer then has an opportunity raise any issues that are in dispute. Negotiations between the employer and the employee over any disputes may take place during this time. Because of the no-fault aspect of workers’ compensation insurance, the disputed facts are most often not over whether the employee is owed compensation, but how much compensation and for how long.
Ideally, the parties will agree to a fair and reasonable settlement. When such a settlement is reached, it must be submitted in writing to the board for approval. The board will consider several factors to determine whether the settlement will be approved. If they settlement is approved, the issue ends there. If it is not, negotiations will continue or the case may go to trial.
Basis for Disapproval of Settlements
Settlements may be rejected by the board if there is a genuine controversy of fact affecting the rights of one of the parties. For this reason, stipulated settlements submitted to the board “must state with specificity the legal and/or factual matters about which the parties cannot agree.” (Stipulated Settlements, p. 2). This allows the board to determine whether the terms of the settlement unduly favor one party or another given the potential outcome of the disagreement. The terms of the settlement must fairly correspond to the rights of the parties within the range of the possibilities for the facts in dispute. For instance, if there is a disagreement over the need for long-term medical care, and the settlement requires the employee to return to work immediately or does not provide for paying for such care, approval is unlikely to be granted, because it would affect the worker’s potential rights if the case were to hypothetically resolve in his or her favor. If, however, the terms reflect a compromise that accounts for either possibility with some give and take on either side (such as four weeks of recovery time instead of six weeks, or some other care option that is reasonable in lieu of long-term care), the settlement will likely be viewed as reasonable.
The point is that a settlement reflecting a one-sided outcome despite disputed facts is unlikely to be approved. This prevents one party from steamrolling the other in the process. Employers and their insurers are generally in a better position financially than the employee, and consequently have more bargaining power. Employees can find themselves pressured by dire financial straits to accept unfavorable settlements. The approval process exists to protect employees from this pressure and ensure that their rights are vindicated at the bargaining table.
Atlanta Workers’ Compensation Attorneys at Your Service
If you are injured in a workplace accident, do not just accept anything your employer offers. The best way to make sure you get a fair settlement is to contact the attorneys at Bader Law Firm, LLC, Atlanta’s premier workers’ compensation firm. We will make sure that you and your family are taken care of for as long as you are disabled, and that you get all your reasonable medical expenses covered. Do not be taken advantage of just because you are in a difficult position. Allow us to fight for a fair and just resolution of your claim.