Ametros Industry Blog

Settling workers’ compensation and liability claims does not need to be a long, arduous process. Done well, it is truly a win-win for everyone involved, especially the injured party.

There are typically a number of people involved, depending on the person’s needs. It’s important to make sure all the key people are included and that they are all on the same page. Doing so ensures the course will run smoothly.

The Players

Once an injured party has agreed to at least talk about settling their claim, it’s important to determine what is needed immediately and at various stages throughout their life. This can only be done by building a trusting relationship with the person.

Every person is different and has different issues that must be addressed. In addition to present and future medical expenses there may be a variety of other needs or goals that can be revealed through conversations. For example:

  • Will they need a Medicare Set-Aside
  • Do they have a family that depends on their income?
  • Are there young children they would like to send to college?
  • Do they need a caregiver for themselves or a member of their family?
  • Are or will home or automobile modifications be needed?
  • Would they like to set up a business in the future?
  • Are they interested in purchasing a home at some point?
  • Do they receive public benefits that need to be coordinated with any settlement money, such as SSDI, SSI, Medicare, Medicaid, or Veterans benefits?
  • Would a special needs trust be appropriate for them?

Knowing the injured party’s particular situation will help identify who should be involved in the settlement process. Experts on issues such as home modifications, government benefits, or tax considerations may need to be brought in.

They may want certain people close to them involved, such as family members or others. Plaintiff and/or defense attorneys, insurance adjusters, TPAs and structured settlement brokers may need to be included in the conversation.

Working with the appropriate people as soon as possible can help determine a realistic dollar amount needed to settle the claim and how the settlement should be structured. Once the full team is in place, the next step is providing each one with the same information.

Working Effectively with Settlement Players

The settlement process must take into account all aspects of the injured party’s current and future situation. That means every stakeholder involved is equally important and must be treated as such.

Having an outside party involved who advocates solely for the injured party can be a tremendous help in taking the stress off the other parties. This person, typically a professional administrator, should be an expert on everything related to workers' comp and liability claim settlements, and only have the best interest of the injured party in mind.

Each member of the settlement team should understand why other participants are included. For example, knowing that home modifications will likely be an issue at some point will help the carrier appreciate the presence of an ADA-certified expert. Everyone included should be working toward a common goal.

The settlement group members should be cognizant of the entire process and have access to the same resources. The professional administrator can fully explain each step required and answer questions that arise.

Concerns about Medicare Set-Asides, complying with Medicare reporting requirements and prices for pharmaceuticals and medical procedures should all be addressed up front. Quality professional administrators often provide savings on medications and providers through medical networks and should be able to demonstrate realistic expenses that are required.

The professional administrator should have a variety of resources and connections available to help at various stages of the process. For example, special needs trust administrators can be helpful in determining whether a particular procedure could impact Medicaid or other government funded assistance programs the injured party may be using.

Ametros Changes the Lives of Injured Workers

One of Ametros' Care Advocates, Jessica, has seen firsthand how having the right players can make for a smooth transition to post-settlement life for an injured worker.

A 20-year old construction worker who fell off a roof and was rendered a quadriplegic in a 2006 injury had agreed to settle his claim. Gabriel Leonardo* had moved in with his parents, who became his caregivers. His total future medical care was estimated at $7 million and would pay for various medical needs; such as converting his van, purchasing a wheelchair lift, and acquiring home health care.

Aside from monetary concerns, additional issues needed to be addressed and resolved when Jessica became involved in his case. For one, both his parents spoke only Spanish. Also, his medical situation needed to be clearly communicated with all his doctors to allow for a smooth transition.

Having Jessica, a bilingual point-of-contact, present for all conversations helped to ensure his parents trusted Ametros through the on-boarding process. Jessica helped everyone involved feel comfortable and helped them understand what Gabriel's post-settlement life would entail. Jessica made sure all his medical providers were given thorough, accurate information about Gabriel to provide the very best care going forward.

The transition from settlement to medical care and savings was seamless and immediate. Gabriel and his family told us they were quite happy with the process.

Conclusion

Settling workers’ compensation and liability claims works best when no side is the sole ‘winner.’ Those involved should come to a mutual agreement about the amount of money involved and how and when the injured party will access it. Ultimately, this will be the best outcome for everyone, and give the injured party peace of mind.

*Name was changed to protect identity

MSA

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