Before agreeing to a workers’ compensation settlement, know how you will pay for treatment and ordinary expenses afterward. Will weekly benefits stop? Will the insurer still cover your prescriptions or a procedure your doctor has discussed? Work through those questions using the proposed agreement, not just the amount offered.
Badey, Sloan & DiGenova, P.C. helps injured workers review proposed settlements and unresolved claim issues. Call (215) 790-1000 or request a free consultation before signing documents you don’t fully understand.
Identify Exactly What the Agreement Resolves
A Pennsylvania Compromise and Release Agreement can resolve wage-loss benefits, medical benefits, specific-loss benefits, or a combination of them. Read which parts your proposal includes. You may still need treatment even if the agreement would end the insurer’s obligation to pay for it.
Start by checking the injury date and description. Do they match the claim you intend to settle? Look at the body parts and conditions listed, especially if you have had more than one work injury. The agreement also needs to address pending petitions and benefits claimed but not yet paid.
If you have been told that medical benefits will stay open, find the language that says so. Have your attorney explain which injury and expenses it covers and whether any treatment dispute remains unresolved. A verbal assurance that the insurer will “take care of it” leaves too much unanswered.
Compare the Gross Offer with What You Would Receive
Ask for a written breakdown from the total offer to the amount you would receive. It should account for the attorney’s fee, litigation costs, and any required repayments or other deductions. Use that net amount when thinking about household expenses, rather than assuming the full offer will be available to spend.
Find out whether money for future medical care is part of the quoted amount or funded separately. For payments spread over time, check the schedule and conditions. Money due years from now will not pay a bill due next month. Also confirm when the agreement requires payment and which approvals must happen first.
Compare the proposed deductions with your fee agreement, and ask who is responsible for costs. Do not assume the insurer pays those costs separately. If the settlement raises questions about taxes or public benefits, get advice from the appropriate adviser before deciding how much money you can rely on.
Review Current Bills and Future Treatment Needs
Talk with your provider about the care you’ll likely need after settlement. Include ongoing prescriptions and therapy as well as possible procedures. If you’ve discussed surgery but haven’t decided, tell your attorney. Uncertainty about future care needs to be considered before medical benefits are closed.
Make a separate list of unpaid bills. A provider may send an invoice after settlement for treatment you received before it. Ask which bills the insurer will pay, whether a cutoff date applies, and what happens to invoices that arrive later. This is worth resolving in the agreement rather than sorting out after approval.
Closing medical benefits requires a plan for future work-injury care. Private health insurance and Medicare do not automatically take over those expenses. If medical benefits will remain open, have your attorney explain the payment process and any disputes the insurer could still raise about whether treatment is related to the injury or medically necessary.
Evaluate the Claim Rather Than an Online Average
Two workers with the same diagnosis can have very different claims. One may be back at the same pay; the other may have restrictions that prevent a return to the job. The accepted injury, compensation rate, and medical evidence affect the evaluation, as do disputed issues and the risk of losing a pending case.
Ask your attorney to compare the offer with continuing the claim. Begin with the benefits currently payable and what the insurer is contesting. Then discuss the evidence supporting each side and the work involved in pursuing the dispute. That comparison should help you decide without presenting an uncertain outcome as a guarantee.
Review the broader Pennsylvania workers’ compensation claim framework, but have the proposed agreement evaluated against your own records. No standard number of weeks or simple online calculator can decide whether its terms fit your circumstances.
Keep Employment Documents Separate in Your Review
Get copies of every document you would be expected to sign. The package may include a resignation or a release of employment claims in addition to the workers’ compensation agreement. Those documents deserve their own review, even if they arrive together.
If resignation is a proposed condition, find out when your employment and job-based coverage would end. Read any limits on rehire or future employment, and ask what rights a separate release would give up. Approval of the workers’ compensation agreement does not resolve every question about an employment release.
Address Medicare and Social Security Before Signing
Bring your Medicare and Social Security notices to the settlement review. Tell your attorney if you have applied for disability benefits or expect to enroll in Medicare, even if benefits have not started. The dates and status of those applications can be important to the planning.
Medicare’s interests must be considered when resolving a claim involving future medical expenses. A Workers’ Compensation Medicare Set-Aside Arrangement may allocate part of a settlement for future injury-related care that Medicare would otherwise cover. Discuss whether one is appropriate, how it would be funded and administered, and how any Medicare conditional payments for past care will be addressed. CMS review criteria are not a blanket exemption from Medicare obligations for smaller settlements.
A lump-sum workers’ compensation settlement can also affect Social Security disability payments. Ask how the proposal may affect your payments and what you must report to Social Security. Language in the agreement cannot, by itself, guarantee that those benefits will stay the same.
Know What the Approval Hearing Does
A Pennsylvania Workers’ Compensation Judge must approve a Compromise and Release Agreement and determine that you understand its full legal significance. Read the agreement and all attachments before the hearing. If a term is unclear, discuss it with your attorney beforehand rather than arriving with an unanswered question about what you are giving up.
Before the hearing, you should be able to explain:
- Which claims and benefits am I giving up, and what remains open?
- How much will I receive after fees, costs, and other deductions?
- Who will pay outstanding bills and future treatment expenses?
- What employment documents or benefit-coordination obligations are involved?
- When will payment occur, and do the written terms match what I was told?
Do not agree on the assumption that you can reopen the claim if your condition gets worse or the money runs out. Approval can close rights you will not be able to recover simply because the settlement no longer meets your needs.
Review Your Proposed Settlement with Badey, Sloan and DiGenova
Bring us the full proposal, including any employment release, along with your claim notices and recent medical information. Badey, Sloan & DiGenova, P.C. can review what would end, what would remain payable, and which questions still need answers. We will also explain fees and possible costs before you decide about representation.
Call (215) 790-1000 or contact our Philadelphia office to request a free consultation about your Pennsylvania workers’ compensation settlement.