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Workman’s Compensation

workers comp buyout

Buying Out Worker’s Comp Awards

When settling a workers’ compensation case, the judge might issue either a Findings and Award or Stipulations with Request for Award to the defendant, the workers’ compensation insurance carrier. When this occurs, the carrier may offer the plaintiff a lump sum settlement to “buy out” and completely close out the compensation claim. This is not done out of the goodness of the insurer’s heart. Instead, a workers’ compensation insurer might do this because the plaintiff’s claim is costing their company too much money and it reduces their liabilities owed on the company’s financial statement.

Pros and Cons of a Workers’ Compensation Buy Out

Accepting a buyout for a compensation claim is not always beneficial for the plaintiff. Often, the injured party is offered a lump sum of cash. Sometimes he or she is given a hybrid lump sum with the remainder dispersed over several years through an annuity. Once a claim has been settled for a lump sum, the insurer will no longer cover medical treatment through the workers’ compensation system. For some patients, this is a positive because it allows them to seek treatment from a doctor of their choice.

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Monument Occupational Medicine

The Jones Act was created to help protect those who work at sea. Before the creation of the Jones Act, workers had a tough time receiving compensation for accidents or injuries that occurred while at sea. Specifically, this act would cover a sea worker in an event where another worker was responsible for creating conditions that caused someone to be injured. The Jones Act was created to cover workers known as “seamen,” a term that can fit a wide variety of sea working positions.

An added benefit of the Jones Act is that it allows for employees to make a negligence claim against the employer. If it can be proven that unsafe risks were taken, either by a co-worker or employer, the chance of winning a negligence claim is improved. In situations where the boat itself was responsible for the damage, the person in charge of the operation is at fault.

The Jones Act has greatly improved how sea workers are able to seek compensation for injuries suffered at sea. After it has been determined who is at fault, the injured party can begin to seek economic and non-economic damages.

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workers compensation

On March 1, 2017, Iowa lawmakers introduced two bills, House Study Bill 169 and Senate Study Bill 1170. These bills are aimed at overhauling the state’s workers’ compensation system in a move to reduce costs to employers. In the past, Iowa’s workers’ compensation system was considered one of the best in the country, having low premiums for employers and good benefits for injured workers. However, with these new bills that favor employers, workers’ compensation benefits are now in danger of being scaled back.

What This Means for Workers

In seeking to reduce workers’ compensation premiums for employers, there are no benefits offered to workers in either of the bills. Most at risk are workers who perform manual labor because their options to returning to work or another job after being injured are limited.

The rights of injured workers stand to be reduced if these bills are passed by:

  • Ending workers’ compensation benefits when an injured worker reaches 67 years old
  • Reducing late fees for employers who do not pay benefits on time
  • Allowing employers to deny benefits when an injured worker has tested positive for alcohol or drugs, regardless if they were a factor for causing the injury
  • Limiting the amount of legal fees a workers’ compensation attorney can receive
  • Targeting high cost injuries, including shoulder injuries

What This Means for Taxpayers

If workers’ compensation benefits are scaled back to injured employees, the unmet costs are anticipated to shift from employers to Iowa taxpayers. This would be in the way of adding burden to already struggling Medicare, Medicaid and Social Security systems.

HB 169 and SB 1170 if passed will likely hurt injured workers and taxpayers in Iowa.

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Medical Review

Medical legal cases often require medical review and unbiased opinions from a doctor who is not associated with an insurer, injured party or negligent party. A second opinion can weed out fraudulent claims, spot treatment errors and helps ensures that an injured party receives the care that they need to recover from his or her injury as quickly as possible.

Prevents Cutting Corners in Patient Care

Insurance companies are not in the business to lose money. Their goal is to make money for their shareholders. When managing the care of claimants in workers’ compensation or other personal injury cases, there always exists the possibility that corners could be cut in patient care. Insurance doctors may avoid recommending expensive diagnostic tests or treatments that patients need. This could be to keep expenses down for the insurer or ensure that they will continue to receive referrals from the insurer.

This practice hurts not only the injured party, but also the employer or negligent party. Improper or unneeded treatment can prolong the time out of work and extend the length of time that the injured party is under medical care. With workers’ compensation cases, the employer is also entitled to request an independent medical examination (IME) if he or she has concerns regarding extensive medical treatment, including surgery or other long-term treatment.

When a Second Opinion is Needed

A medical review and unbiased opinion from a second physician is advisable and/or required in legal cases that involve claims for:

  • Workers’ compensation
  • Insurance claims for accidental injuries (e.g. motor vehicle, slip and fall, falling objects)
  • Medical malpractice
  • Medical negligence
  • Wrongful death

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Dr. Anjmun Sharma

A Medical Review Officer is a fully licensed physician who works in the laboratory to ensure that data and results collected by the drug screen are examined and addressed. They play an imperative role in the drug screening process for both the employee and the employer. Some of the roles are described below.

He or she helps to interpret and review the laboratory results. This consequently protects the employers from making decisions regarding the employee’s claims that his or her drug test results were caused by medical treatment or medication. It also keeps the employer from dealing with complicated matters related to the disclosure or the release of private medical information pertaining the employee.

The Medical Review Officer reviews the results from the lab to ensure that the correct test was undertaken and the right procedures followed. If a drug test is positive, it is his or her responsibility to contact the employee to explain the validity of the outcome. Results are reported to the employer in cases where the employee fails to provide feedback. Additional information concerning the laboratory and federal agency is also shared with the employer.

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Workers' Compensation

Fraudulent workers’ compensation claims occur when a worker has falsified an injury. Most often, these false claims are done strictly to get compensation from an employer. An employee can also work somewhere else while already drawing workers’ compensation from another business.

Keeping in constant contact with the injured party is highly recommended throughout the duration of their claim. In addition, learning what behaviors are consistent with false workers’ compensation can save a business large sums of money.
There are methods that can help spot a fraudulent claim. A lack of witnesses is a potential sign that workers’ compensation fraud is occurring. Another behavior that could entail potential fraud is if the injured party keeps changing their story or gives differing details. After a workplace injury has occurred, medical treatment will likely follow. However, if the injured party shows any reluctance or refuses treatment, this is a telltale sign of workers’ compensation fraud.

Fraudulent workplace injury claims are estimated to cost businesses about $5 billion each year. It’s important to learn what signs of a false workplace claim are to avoid being a business paying out part of that yearly $5 billion.

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