By Charles W. O’Donnell · Virginia workers’ compensation attorney
You have already won your workers’ compensation case. An award is in place, and you are receiving weekly benefits. But living with the claim is very frustrating and wearing you down.
Your doctor recommends treatment, and you wait again for the adjuster’s approval. A prescription becomes another telephone call. Someone wants you to return to a “light-duty” job, but you are concerned that you cannot safely do what the job actually requires. You would like to spend your time getting better and rebuilding your life rather than struggling every week with a claims adjuster over delays in your care or benefits.
It is understandable to start thinking: Can I just settle this case and move on? Answer: Yes—if the parties agree and the Commission approves.
A full and final settlement may offer that opportunity. But before you exchange your existing benefits for a lump sum settlement, you need to understand what you are giving up, what those rights may be worth, and how you will take care of yourself afterward.
Being tired of the process is a reason to explore your options. It should not determine the price of your future.
Understand what you are giving up
An existing award can provide valuable protections. Depending on your award and circumstances, those protections may include continuing wage-loss benefits and medical treatment for your work injury. A full and final settlement can close those rights, leaving you responsible for selecting your care and managing your future expenses that the workers’ compensation carrier would otherwise have been required to cover. The settlement documents matter. You need to know exactly which obligations are ending and which, if any, remain. Virginia Workers’ Compensation Commission’s explanation of compromise settlements.
Settlement also requires agreement. You cannot simply require the carrier to buy out your claim, and the carrier cannot require you to accept its (frequently low) offer. A Virginia workers’ compensation settlement must receive Commission approval, including a determination that it is in the injured worker’s best interests. That review is important, but the Commission does not negotiate your settlement for you. Commission settlement guidance, settlement FAQs.
An adjuster’s offer is not an independent valuation
For you, this may be your first experience with workers’ compensation. For the insurance company, evaluating claims and negotiating settlements is part of its everyday business. Its adjusters have claims experience, access to defense attorneys, and a responsibility to protect the carrier’s interests—not yours.
You deserve an attorney concentrating on your rights and benefits.
An adjuster may tell you, “This is the absolute highest amount we can offer.” That statement does not establish the fair settlement value of your case. It tells you what the adjuster is offering at that point in the negotiations. Whether the offer is reasonable requires an independent examination of the evidence, the benefits at stake, and the risks on both sides.
A search or AI estimate cannot value your particular case
A quick Google search cannot supply that examination. Neither can asking an AI program to put a dollar value on your injury.
AI may help organize information or suggest questions. But a confident answer can still be based on incomplete records, the wrong assumptions, or rules from another state. It cannot replace an experienced Virginia workers’ compensation attorney’s responsibility to examine your particular case, identify missing evidence, and explain the benefits and consequences of the proposed agreement.
Virginia workers’ compensation settlements are highly dependent on the facts of each person’s case. Even two people with the same diagnosis can have very different settlement considerations.
What an experienced settlement review should cover
Before discussing a demand, we need answers to questions such as:
- What does your existing award cover, and is your weekly compensation rate correct?
- What benefits have already been paid, and what additional benefits may remain available?
- What treatment does your doctor reasonably anticipate, including surgery, medication, therapy, or replacement equipment?
- What are your actual work restrictions, and what do they mean for your ability to earn a living?
- Are there unpaid medical bills, reimbursement claims, or other obligations that must be resolved?
- What evidence could strengthen your claim, and what evidence might the carrier use to challenge it?
Those questions guide the work needed to prepare a meaningful settlement demand. Sometimes that means obtaining a clearer medical opinion. Sometimes it means reviewing the physical requirements of a proposed job, obtaining an appropriate evaluation, or documenting future treatment costs.
For example, a job described as “light duty” may still involve prolonged sitting, repeated use of an injured hand, standing, bending, or lifting. The actual duties need to be compared with your medical restrictions. An unresolved disagreement about that work can affect both your benefits and settlement negotiations. Get advice before refusing an offered position: an unjustified refusal of suitable employment can jeopardize wage-loss benefits under Virginia law. Virginia Code § 65.2-510.
Plan for future treatment and benefit eligibility
The medical side deserves just as much attention.
A settlement amount may look substantial until you consider what future treatment could cost. If the agreement closes your medical benefits, who will pay for the next procedure? What about prescriptions, therapy, or another surgery several years from now?
Do not assume that Medicare will simply take over those bills. Medicare’s interests must be considered where applicable, and a Medicare Set-Aside may be part of the planning. Money allocated for that purpose is intended for qualifying injury-related medical expenses; it is not ordinary spending money. Whether a set-aside is appropriate, how it should be funded, and whether CMS review is available require individual analysis. CMS guidance on workers’ compensation settlements.
Medicaid requires a separate review. Its eligibility rules differ by coverage category, so a settlement’s effect cannot be answered with a blanket statement that you will either keep or lose coverage. Virginia Medicaid eligibility guidance. If you receive Social Security disability benefits, a workers’ compensation lump-sum settlement can also affect those payments. Social Security Administration guidance.
These issues belong in the discussion before you agree to settle.
Workers’ compensation attorney fees are different
Concern about attorney fees is understandable. But attorney fees in Virginia workers’ compensation settlements are generally significantly lower, as a percentage of the recovery, than the contingency fees commonly charged in personal injury and motor-vehicle accident cases. For perspective, the Commission’s own sample settlement fee agreement uses 20%, although that example is not a mandatory rate or a guarantee of the fee in your case. Commission sample fee agreement.
All attorney fees for representing an injured worker are subject to the Virginia Workers’ Compensation Commission’s approval and award. The Commission evaluates the services performed and the results obtained; the attorney does not have the final say over the fee. Commission guidance on attorney fees.
Experienced representation is not beyond your reach. We can help. Ask us to explain the proposed fee, any separate expenses, and what you would actually receive from a settlement. Then consider the value of having someone identify overlooked benefits, develop the evidence, negotiate on your behalf, and help protect your future before you sign away your award.
Experienced representation can strengthen your negotiating position. No attorney can honestly promise a particular settlement or guarantee that every offer will increase. You should expect a clear explanation of the potential benefit of representation, the costs, and the uncertainties.
The right settlement at the right time
You should also expect an honest answer about timing.
Sometimes the right advice is to pursue settlement now. Sometimes it is to obtain additional medical information first. And sometimes the best advice is to keep the award in place because the proposed settlement does not adequately protect you.
Get help before signing away your benefits
At the Law Offices of Charles W. O’Donnell, P.C., we help injured workers examine those choices carefully. With more than 30 years of legal experience, I understand how much can be riding on this decision—for you and for the family members who depend on you.
We also look beyond the signing of the agreement. What income will you have when weekly checks stop? How will you obtain treatment? What money must remain available for medical care? Would a structured payment arrangement deserve consideration? When appropriate, we help coordinate the additional benefits or financial planning advice needed to make an informed decision.
You have every reason to want this accident behind you. Give yourself the benefit of experienced advice before making a decision that may affect the rest of your life.
Already receiving Virginia workers’ compensation benefits and considering settlement? Call 703-917-4115 or send us a text. We can help you understand your options, evaluate an offer, and decide whether the time is right to settle.
Call 703-917-4115Text 703-917-4115
You can also request a consultation. Family members helping an injured worker are welcome to contact us.
Related reading: Your rights after a new work accident when you have a prior injury.