The optimal outcome for a workers’ compensation claim is the injured worker returning to his pre-injury employment. Fortunately, that outcome is achieved in most of the claims that we receive at AEU. These positive results are realized when:
Some disputes cannot be resolved absent a full claim settlement. Due to the inherent nature of a settlement, it’s nearly impossible for all parties to be 100% satisfied with the outcome. It’s been said (and disputed as to the origin) that a good compromise is when the parties are equally unhappy.
So, what happens if either of the parties is so unhappy with a potential resolution that they are unwilling to enter into a settlement agreement? There are two options.
For example, let’s say an injured worker has an accepted knee injury and is claiming that his back is also injured. The employer and carrier could accept the back as compensable, but with that comes an unknown amount of additional exposures: additional temporary compensation, additional medical benefits including surgery, and possible permanent restrictions.
While this second option may seem attractive, it’s important to remember some key issues when trying a longshore claim in court.
There are claims that are clearly worth seeing through the litigation process. If an employer and its insurance carrier plan to try a longshore workers’ compensation claim, they need to understand the costs and the risks involved. Above all, it’s important to realize that the Longshore Act is designed and liberally construed to protect injured workers, not employers and carriers.
ABOUT THE AUTHOR
Will Scheffler joined The American Equity Underwriters, Inc. in 1998 and serves as Senior Vice President, Director of Claims. His insurance experience began in 1993 with FARA and continued with the ALMA branch (now AEU) in 1998. He has been a speaker at Loyola Law School’s Annual Longshore Conference, U.S. Department of Labor seminars, and ALMA conferences. Will is licensed as an adjuster in Maine, Alabama, and Louisiana and is a licensed Qualified Manager in California. He serves on the Advisory Board for Loyola’s Annual Longshore Conference. Will received his bachelor’s degree from Louisiana State University and earned the CPCU and AIC designations from The Institutes.