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Whether You Should Settle or Keep Your Claim Open?

Many injured workers are not sure how they should go forward with the claim and many of them ask us for our advice on whether it is better if they settle their claim or leave it open. There are a lot of different factors that need to be considered when making the decision of what to do with the claim. Ultimately, it is the injured worker’s decision to make regarding how to proceed with the claim. As the client’s attorney, our job is to lay out their options and explain what we think is the best thing to do given the circumstances.

Maximum Medical Improvement

If the injured worker does not have private health insurance and their main concern is to receive medical treatment, then we would generally advise the client to keep the claim. One of the issues with receiving medical treatment in the workers compensation system is that the authorized physician may place the injured worker at maximum medical improvement (“MMI”) at some point which is basically when the physician has released the worker and does not believe there is any form of treatment which will help the injury or condition. When MMI is reached, there is a $10.00 co-pay for visits to see the physician and a very good chance that the physician will not recommend any treatment going forward.

Requesting a One Time Change

In each claim, the injured worker may request a one-time change in physician. Therefore, if MMI has been reached, the injured worker may use the one-time change in order to request a new physician. One of the risks of using the one-time change is that the new physician may agree with the prior physician and place the injured worker at MMI as well. If that happens, there are not too many options going forward with the claim, and the value of the case for settlement purposes will also be negatively affected.

Generally if MMI has been reached, and the injured worker still has a one-time change to use, settlement may be a good option. However, it is once again the injured worker’s decision to make. In this situation, treating with a new physician per the one-time change is similar to rolling the dice and taking a risk as the new physician’s opinion basically determines what will happen with the claim going forward. The new physician may completely disagree with the prior physician and recommend many different forms of treatment which will strengthen the injured worker’s case for settlement purposes and also leave open the option of getting more treatment for the injuries sustained.

The Risk Vs Reward

The flip side of seeing new physician is where the injured worker is once again placed at MMI, which as previously discussed, will hurt the claim. Given the circumstances and which doctor is authorized as the new physician, we can go over the risks and rewards of what to do in this situation.

As you can see, making a decision on whether to settle a claim or to keep it open may be very difficult to make. That is why it is important to hire a Workers’ Compensation attorney who handles these types of situations in order to get advice about how to proceed with the case. If you are in this situation or know of someone who is, have them give us a call at (877) 817-4127.


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