Workers' Compensation Settlement for a Back Injury

The phrase “disabling injury” probably brings to mind sudden traumatic injuries that lead to a temporary or permanent loss of ability or bodily function in the victim. Surprisingly enough, the world’s leading cause of disability is back pain. Employees cite back and related spinal injuries as the primary reason for missing work.

The prevalence of disabling back injuries has increased by more than half over the past 30 years. Experts agree that sudden injuries from falls, car accidents, overuse, and work-related conditions cause more back injuries than age-related diseases. If you hurt your back at work, either suddenly or due to overuse, you’re not alone. An experienced workers’ compensation attorney can help you negotiate a settlement for your disabling spinal condition.

Understanding Workers’ Compensation Insurance

Nearly every state has adopted workers’ compensation legislation over the past few decades. Often referred to simply as workers’ comp, employers must carry workers’ compensation insurance to cover their employees for injuries suffered on the job.

This insurance might reimburse or provide coverage for:

Some policies also provide coverage for necessary career changes, such as the cost of training to move from a field to a desk job, as well as workplace disability modifications, such as installing handicap ramps or setting up at-home workstations.

Employers generally pay for coverage provided by a federal, state, or a private insurer. Injured workers might claim workers’ comp benefits regardless of the reason for the injury. If you hurt your back while working within the scope of your job and a doctor determines that you cannot perform your duties, you could request immediate worker’s comp coverage.

Employees covered by workers’ compensation insurance waive their right to sue their employer for workplace injuries. As such, workers’ comp payments and settlements might represent the only way workers could recover their past and anticipated future losses.

Parties Qualifying for Workers’ Compensation Benefits

Every state has slightly different rules related to workers’ compensation claims. You may claim workers’ compensation, provided you were employed when the injury occurred. Workers’ comp is still applicable even if another employee must replace you due to your injured state.

However, most states agree that to qualify for benefits, the injured person must:

• Have been a W-2 employee (as opposed to a 1099 independent contractor).
• Suffered a back injury while at work or engaged in work-related activities.
• Be prevented from performing most or all of their daily job responsibilities due to their injuries.

To avoid liability, many insurers try to disprove one or more of these factors. An attorney can help workers suffering from back pain avoid these common insurance traps.

Employees versus Independent Contractors

Independent contractors pay their own taxes, are exempt from wage and overtime laws, and do not receive employer-sponsored insurance benefits. As such, companies often unlawfully categorize employees as independent contractors to lessen employer liability and save money.

The difference between employees and independent contractors generally depends on the level of control an employer asserts over an employee. If a company sets the worker’s mandatory hours and pay rate, provides equipment, requires their presence on certain days and times, and dictates how to complete tasks, the individual probably qualifies as an employee eligible for workers’ compensation benefits.

On the other hand, if an employee sets their own hours, controls their job performance, and provides their equipment (for example, a computer or vehicle), they are likely to qualify as an independent contractor. Courts will examine all relevant factors in making this determination, and an attorney may argue that an independent contractor qualifies as an employee covered by insurance.

Work-Related Injuries

To be considered work-related, a disabling back injury must occur on the job or develop at work. These injuries can happen suddenly, such as from slipping and falling in the office bathroom, or in a car crash while performing a delivery for the employer. Work-related back injuries also develop over time, such as from a decade of lifting heavy bags of concrete mix at construction sites, or from the posture of sitting at a work computer year after year.

To recover compensation for disabling conditions that developed over an extended period of time, additional evidence linking the injury to a job function is required.

Most workers’ compensation insurers review claimants’ medical records and perform independent medical examinations after benefits are requested. Following these examinations, many injured workers receive letters that deny the source of their back pain is their jobs, instead pointing to naturally occurring conditions like arthritis or citing a previous injury found in the claimant’s medical records.

Do not be surprised by such denials. Personal injury lawyers will expect them and challenge such claims by highlighting the patient’s medical records and bringing in expert healthcare professionals to testify.

Complete or Partial Disability

Back pain must prevent the worker from engaging in essential job functions to qualify for workers’ compensation. This determination generally requires reviewing the employees’ offer letters, job advertisements, contracts, or other documents outlining their job duties. Courts and insurers may also use agreed-upon testimony or national occupational manuals to establish job functions when no written description exists.

Employers must accommodate employees if they can no longer perform one of the job functions, such as filing, due to a back injury. When the required accommodations substantially change an employee’s job description, the employee may claim workers’ compensation benefits.

Most Common Workplace Accidents Leading to Disabling Back Injuries

Back pain often results from strained muscle or intervertebral disc damage. Because the tendons in the back run from the head to the buttock, a neck strain might affect the entire upper and lower back. Muscle-only injuries often heal with treatment, including anti-inflammatories, physical therapy, rest, and workplace accommodations. Employees needing a few months of treatment might claim worker’s comp benefits during this period without substantial insurer pushback.

Unfortunately, slipped, bulging, or ruptured spinal discs often result in disabling back conditions requiring surgery and continuing care. A ruptured disc might push against the delicate spinal nerves, causing numbness, tingling, and pain, or cause two vertebrae to painfully rub together. Herniated discs often result in additional muscle strains and back pain, further exacerbating your condition. Constant back pain also affects many claimants’ ability to sleep, sit, stand, or drive.

Severe disc herniations suffered at work typically result from the following accidents and conditions:

• Falls, including tripping and slipping
• Lifting heavy or awkward objects
• Repetitive activities causing cumulative strain, such as reaching, typing, driving, or climbing
• Car, truck, or heavy equipment accidents
• Being struck by a falling object, resulting in a spinal condition

It is not uncommon for employees in physically demanding jobs, such as construction, firefighting, and police work, to suffer from debilitating back conditions.

Making a Workers’ Compensation Claim for Crippling Back Pain

Reporting an injury to your supervisor using the proper incident report form is the first step in the workers’ compensation claims process. If you begin experiencing back pain at work, consider reporting the condition to HR, even if it does not prevent you from working. Describe what activities aggravate the condition and request accommodations. These reports may support a later claim for compensation if the back injury worsens due to cumulative strain.

Claimants must also seek medical treatment. Doctor’ reports and treatment history often form the basis of a workers’ comp claim. Your attorney will assist you in obtaining copies of your incident report, pay stubs, and initial medical exam to attach to a workers’ compensation claims form. The insurer may begin paying for medical bills directly and reimburse you part of your lost wages.

Most claimants with treatable back pain do not require a lump sum workers’ compensation settlement. However, they might request a small settlement if they decide to change careers to avoid future back pain.

Reviewing a Workers’ Comp Settlement Offer

Every workers’ comp case involves a risk-benefit analysis. Once an insurer determines you qualify for benefits, adjusters closely monitor your situation to determine if they should make a settlement offer. Private insurers may offer claimants enticing lump-sum settlements if claimants reached maximum medical improvement but still have disabling pain, suffered a permanently disabling back injury, or require long-term treatment. If it would cost a workers’ comp insurer less to settle your entire claim now, rather than continue providing benefits over an extended period of time, adjusters often propose a settlement.

Insurers hope these settlement offers will seem tempting to injured claimants living on a reduced income. An adjuster may manipulate a recipient into accepting a settlement by hinting the insurance company may deny the claimant’s future benefits. Always discuss any proposed settlement offer with a qualified workers’ compensation lawyer.

In all likeliness, you will waive all claims related to the back injury once you sign the settlement waiver, meaning all workers’ compensation benefits for that claim cease. You may not request additional benefits if you decide later that the settlement does not sufficiently cover your future lost wages and medical expenses.

Factors to Consider During Work-Related Settlement Negotiations

Workers’ comp insurers often lowball claimants with the first settlement offer. While a five, six, or even seven-figure offer may seem like a high amount, you must compare the settlement with your anticipated future needs.

Factors to consider include:

• The value of any lost promotional opportunities
• The replacement cost of employer-sponsored fringe benefits, such as medical insurance premiums, disability insurance, paid vacation time, or new parent leave
• Necessary future surgical treatments, pain management, or medical equipment
• Difficulties associated with transitioning to a new career, including educational needs and age-related opportunities
• Any salary cuts related to accepting a new job
• Claimants’ potential remaining work-life; for example, the difference between injured at 24 years of age and injured at 56
• The overall severity of the injury, including the pain and mental anguish associated with the condition
• Cost of future medical conditions that may occur due to the back pain, such as depression, nerve damage, weight gain, and fatigue

Legal professionals often obtain expert reports from medical providers, occupational therapists, and economists to calculate the value of a workers’ compensation claims. Expert orthopedists, chiropractors, and spinal surgeons may help a claimant understand future medical treatment costs, treatment timelines, and necessary accommodations.

Occupational experts can outline future career opportunities and the overall value of any lost wages and benefits. Economic experts often take this information and calculate the total anticipated value of the claimant’s losses due to a workplace back injury. An attorney may submit these reports to a workers’ compensation insurance before beginning settlement negotiations.

Holding Third Parties Liable for Causing a Spinal Injury

In some cases, multiple parties bear responsibility for a back injury suffered at work. Construction workers might speak with a personal injury attorney about bringing legal claims directly against a negligent property owner, subcontractor, or general contractor. Workers’ compensation insurance only protects employers from injury lawsuits brought by employees. It does not protect third parties from legal claims. Further, workers’ comp laws do not shield fellow employees from being sued for intentionally inflicted injuries, such as an assault.

In rare cases, grossly negligent safety violations might give employees grounds to sue employers under federal or state labor laws. Some employers might also forgo legally mandated workers’ compensation insurance by paying employees in cash. Such circumstances may allow employees to bring personal injury litigation directly against an employer for their back injuries. Always speak with a local workers’ compensation attorney about your recovery options, regardless of the cause of your injury, your employment status (employee vs. independent contractor), or an insurer’s attempt to deny you back injury coverage.

Cost of Retaining a Workers’ Compensation Settlement Lawyer

Most workers’ compensation lawyers accept workers’ comp cases on a contingency fee basis, meaning the legal counsel will take a percentage of the claimant’s overall back injury settlement as their fee. Most law firms provide free legal consultation and front all expert witness and medical record costs during settlement negotiations.

With the help of your lawyer, you can recover a fair workers’ compensation settlement for your back injury without any upfront or out-of-pocket costs. If an attorney accepts your case but cannot recover compensation, you may owe nothing in legal fees or costs. There’s little to no risk in scheduling a free and confidential consultation to discuss your back injury with a local workers’ compensation lawyer.