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What Is Covered by Workers' Compensation and What Is Not?

What Is Covered by Workers' Compensation and What Is Not?

The Workers' Compensation Act essentially provides for five different categories of benefits. In summary, these categories consist of two categories of income or indemnity benefits payable for income loss due to injury-related disability; one category of disability benefits payable for a partial or complete loss of the use of a body part or of the body as a whole as a result of the injury; medical benefits for treatment of the work injury; and vocational rehabilitation benefits. There are other factors and expenses that can come into play when evaluating a Workers' Compensation claim for settlement, as discussed further below, but these five categories are the primary sources of exposure for the Employer/Insurer, and are therefore the primary focus of evaluation for settlement purposes.

The only benefits provided to the Employee/Claimant in a Workers' Compensation claim are those benefits specifically provided for by the Workers' Compensation Act, as listed above, and those services and costs which are ancillary to benefits provided for by The Act. No benefits not authorized in The Act are available in Workers' Compensation. Accordingly, for example, it is very important to observe that The Workers' Compensation Act provides no compensation whatsoever for pain and suffering, or general damages. This is a major factor that greatly limits the value of Workers' Compensation cases as compared to Personal Injury Cases.

The careful practitioner will point this out to the new Workers' Compensation client very early on in the representation, in order to avoid a problem with expectations later on when it becomes time to settle the case. Of course, this point should be part of a broader discussion when representation commences as to the various categories of benefits that are recoverable in Workers' Compensation, as well as what is not recoverable. Many clients in injury claims seem to have had an uncle who's friend's cousin's nephew had exactly the same injury and recovered an astonishingly large sum for it, and an early discussion regarding what Workers' Compensation pays for and does not pay for will lead to a more savvy and content client throughout the claim, and will make settlement discussions much easier when the time comes.

Another difference between valuation in Workers' Compensation and Personal Injury claims, as pointed out earlier, is the fact that the Employer/Insurer in the Workers' Compensation case must pay weekly indemnity benefits and medical benefits throughout the life of the case as these benefits become due. Accordingly, in a normal compensable case, by the time settlement negotiations are undertaken, the Employer/Insurer has already paid most or all benefits that have already accrued under the Workers' Compensation Act. When settlement negotiations commence, then, the exposures for settlement purposes are prospective benefits only; the benefits that will have to be paid by the Employer/Insurer going forward, potentially over the remaining life expectancy of the Employee/Claimant. (This is not true when a case has been denied or controverted, of course, in which case all exposures accrued but unpaid to date are also part of the analysis.)

The statutory categories of benefits payable under the Workers' Compensation Act lend themselves to a succinct analysis of exposures the Employer/Insurer faces going forward, considered in light of the client's injury and his subjective background factors and employability. These categories of benefits should be quantified in the demand letter and in negotiations in a Workers' Compensation claim.

If you would like to learn more about what your workers' comp benefits will cover and what they won't, be sure to contact Atlanta workers' compensation lawyer Douglas Kaleita from our firm today!


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