When you suffer a work-related injury, you may qualify for workers’ compensation benefits, including medical coverage. But what happens when you reach a point where ongoing medical care is uncertain?
You might have the option to settle for a workers’ comp future medical buyout—a lump sum payment in exchange for closing your medical benefits.
If you’re wondering how much that buyout might be, you won’t find a simple workers’ future comp medical buyout calculator because every case is unique. Instead, understanding how future medical costs are calculated can help you make an informed decision.
What Is a Workers’ Compensation Future Medical Buyout?
A future medical buyout is when an injured worker agrees to a lump sum payment instead of continuing to receive ongoing medical coverage through their employer’s insurance. This option gives you control over your medical care, but it also means you will be responsible for all future treatment costs related to your injury.
Many injured workers consider this route because they no longer want to deal with the workers’ comp system or they prefer to choose their own doctors. However, accepting a buyout means taking on the risk that your settlement amount may not fully cover your future medical expenses. This is why understanding the calculation process is critical before making any decisions.
How Is a Workers’ Comp Future Medical Buyout Calculated?
There’s no universal workers’ comp buyout calculator, but several key factors impact your settlement amount. Each plays a role in estimating your future medical expenses and how much the insurance company may be willing to offer.
Severity of Your Injury
The more severe your injury, the higher your potential settlement. A minor back strain will not result in the same buyout amount as a spinal cord injury requiring surgery and ongoing therapy. Insurance companies carefully assess medical reports to determine how much treatment you will need in the future.
Estimated Future Medical Costs
Insurance companies look at your medical records and consult with doctors to estimate how much your future care will cost. This includes doctor visits, prescription medications, physical therapy, surgeries, assistive devices, and potential home modifications.
These calculations must be as accurate as possible because once you accept a settlement, you cannot request additional funds for medical care.
North Carolina Medical Fee Schedules
Each state has a medical fee schedule that sets standard rates for medical services. In North Carolina, insurers use these rates to calculate the cost of future treatment.
This means your settlement is based on what workers’ comp typically pays, not what private insurance or cash-pay patients might pay. Understanding these fee schedules can help ensure you receive a fair settlement.
Age and Life Expectancy
Younger workers with longer life expectancies may receive higher settlements since they are likely to need treatment for a longer period. Insurance companies use actuarial tables to determine an injured worker’s estimated lifespan and factor that into the settlement calculation.
Ongoing Medical Needs and Risk of Complications
Conditions expected to worsen over time could increase the value of your buyout. However, insurance companies may try to argue that you will require less care than expected to lower their payout. This is why it is important to have medical professionals document any potential long-term complications.
Legal Representation and Negotiation
Having an attorney negotiate on your behalf can significantly impact the amount you receive. Insurers aim to settle for the lowest amount possible, but an experienced lawyer can push for a higher settlement based on strong medical evidence and future care projections. Without legal guidance, many workers accept settlements far lower than they truly need for future care.
Pros and Cons of Accepting a Workers’ Comp Future Medical Buyout
A workers’ comp buyout calculator won’t give you a one-size-fits-all answer. That’s because accepting a medical buyout comes with both advantages and risks. Carefully considering your options will help you determine if a buyout is right for you.
Advantages of a Future Medical Buyout
One of the biggest advantages of a buyout is the ability to control your medical treatment. You will no longer be required to see doctors chosen by the workers’ compensation insurance company, and you can seek alternative treatments that may not have been covered under workers’ comp.
Additionally, a lump sum payment can provide financial flexibility, allowing you to invest in your future healthcare needs on your own terms. Many workers also appreciate the ability to avoid delays and restrictions imposed by the workers’ compensation system.
Risks of Accepting a Buyout
The biggest downside of a buyout is that you are responsible for all future medical expenses. If your condition worsens, you cannot request additional compensation from your employer’s insurance company.
There is also the risk of underestimating how much your future medical needs will cost. Without proper planning, some injured workers run out of money before they have completed their treatment, leaving them in a difficult financial position.
Relying on a workers’ comp future medical buyout calculator might seem like an easy way to determine your settlement, but every case is different. Without legal guidance, you risk accepting an amount that doesn’t fully cover your needs.
Get Help Understanding Your Workers’ Comp Buyout Options in North Carolina
A workers’ comp future medical buyout can provide financial freedom, but it’s not the right choice for everyone. Before making a decision, speak with an experienced North Carolina workers’ compensation attorney.
At Mehta & McConnell, PLLC, we can help you understand your options, negotiate a fair settlement, and ensure your future medical needs are fully accounted for. Contact us today to schedule a consultation and take the next step in securing your financial future.
Jason McConnell
Jason McConnell is the managing attorney of Mehta & McConnell Injury Lawyers, a Charlotte, North Carolina Workers’ Compensation law firm. In his free time he enjoys playing golf, cooking, traveling and following the UNC Tar Heels and Carolina Panthers.
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