Among the changes to Georgia’s workers’ comp. laws coming out of this past year’s legislative session was a provision that limits the employer/insurer’s responsibilities to pay for work injury medical care for more than 400 weeks 1.
Now, 400 weeks is equal to about 7 ½ years and may seem like a long time. However, I suspect that this 400 week cap on medical will negatively impact claimants when it comes to reaching a reasonable settlement of their claims.
One of my biggest takeaways from over 20 years of negotiating settlements is the importance of timing. Settle too soon and you may end up absorbing medical and lost wage costs that should be the responsibility of the employer. Wait too late and your case may get stale – if the insurance company can calculate with reasonable certainty its “worse case” then they will offer you less than fair value to resolve all claims.
The sweet spot for settlements is one where you assume some risk (that you will have future out of pocket medical costs and/or that you will not be able to return to work), and where the insurance company sheds risk. If their worst case includes tens of thousands of dollars in future medical costs or months of lost wage payments, it makes sense to conclude that risk with a lump sum offer.
If, however, the insurance company’s worst case scenario has been artificially reduced, then their risk goes down and they will offer less money. The 400 week cap on medical costs serves to artificially reduce the insurance company’s risk. They now know that they will not be on the hook for medical costs for more than 7 ½ years.
On the other hand, the insurance company cannot know how much their financial exposure may be during this 7 ½ years. We are also likely to find less pressure to allocate large portions of your settlement to a Medicare Set Aside. Finally, it is also possible that judges may be more receptive to designating selective cases as being catastrophic (where there is no cap on medical costs).
If knowing when to settle was more art than science before, that trend is even more pronounced with this 2013 change in the law. If you would like to discuss your case with me, I am happy to talk to you. Please use the contact form on this page or call me at 770-351-0801.
- This limitation on medical care only applies to cases involving injuries incurred on July 1, 2013 and thereafter and does not apply in cases deemed catastrophic. The affected Code section is 34-9-200(a) ↩