Let’s break down what really affects the value of a workers’ comp claim. You’ll get straight-to-the-point insights on what matters most and why—so you can feel more confident navigating your case.
Let’s kick things off with the biggest piece of the puzzle—your injury. The medical details set the tone for your whole case. They show what happened, how serious it is, and what kind of recovery (if any) you’re looking at. That’s what insurance companies, lawyers, and judges use to figure out how much your claim is worth.
How Bad Is the Injury?
The harsher the injury, the more your case is usually worth. A sprained ankle isn’t going to bring in the same money as a spinal fusion. But here’s the twist: sometimes really severe, clear-cut cases settle for less because the insurance company does what it’s supposed to and there’s nothing left to fight over.
Permanent vs. Temporary
If your injury is permanent, that’s a big deal—it usually means more money. Long-term damage means long-term costs, and that raises your case’s value compared to something that fully heals.
More Injuries, More Value
If you’ve hurt more than one body part—like a shoulder and a wrist—those can often be added together. Each one has value, especially in scheduled systems, and they stack up.
Your Disability Rating
This is a percentage that reflects how much ability you’ve lost. Higher rating = higher benefits. Whether it’s short-term or permanent, that number matters.
Future Medical Needs
Ongoing care like surgery, physical therapy, or medication boosts your settlement value. Even if treatment’s not locked in yet, the possibility of needing it gives your lawyer more to work with.
Timing Around MMI
Maximum Medical Improvement (MMI) is when your doctor says, “You’re not going to get much better than this.” Settlements usually happen around that time, but sometimes it’s smart to start negotiating before MMI—when there’s still uncertainty about future care and more value on the table.
Schedule vs. Non-Schedule Injuries
Some body parts (arms, legs, hands) are on a set chart—your payout is based on a % of loss. Others (like your neck or back) aren’t, and your benefits are tied to how much the injury affects your ability to work and earn.
After the medical stuff, the next big piece is your finances—basically, how much you were making before the injury and how that’s changed.
Your Average Weekly Wage (AWW)
This one’s a game-changer. Your AWW is what your benefits are based on, and the higher it is, the more money you get—both weekly and in your final settlement.
But figuring it out isn’t always simple. There are different ways to calculate it legally, and even a small mistake can cost you thousands over time. So yeah, it’s worth getting it right.
Lost Wages and Missed Time
If you’ve been out of work—or working fewer hours—that lost income adds value to your case. In non-schedule cases, more missed time usually means more money. But with schedule cases, going back to work early can actually lower your final payout.
Can’t Go Back to Work? Earning Less Now?
If your injury keeps you from working at all—or you can only go back in a limited role or for lower pay—that drop in earnings (called “reduced earnings”) can bump up your settlement value.
Future Medical Costs
This one overlaps with the medical side, but it matters financially too. If you’ll need ongoing care—like more surgeries or long-term therapy—that raises the stakes. Insurers don’t want to keep paying those bills, so that can give you leverage.
And if you’re on (or may be on) Medicare, a Medicare Set-Aside (MSA) might be required. That’s a formal estimate of your future medical costs that gets built into your settlement.
We’ve talked about your injury and your income—now let’s get into the legal stuff.
How Strong Is Your Case?
If your case is well-documented—with clean medical records, consistent treatment, and a solid timeline—you’ve got leverage. Insurance companies take strong cases seriously and are more likely to offer a better deal.
Even if your case isn’t perfect, don’t count it out. A sharp lawyer can turn a shaky case into a win if they know how to argue it right.
What Type of Settlement?
There are two main types:
How Insurers Play It
Some companies are quick to settle. Others make lowball offers just to see who bites. They know if a few people accept early, they save money overall.
Also, the longer your case stays open, the more it costs them—doctor bills, legal fees, court time—it all adds up. That cost can work in your favor if you’re willing to stick it out.
When to Settle
Timing matters. Most people settle right around Maximum Medical Improvement (MMI)—when doctors say you’ve recovered as much as you’re going to. That’s when the picture is clear, but before the insurance company has paid out too much.
Wait too long, and you might lose value. Jump too soon, and you might miss out on more money. There’s a sweet spot, and a good lawyer will help you find it.
Beyond the paperwork and pay stubs, there’s a personal side to every workers’ comp case—how you approach it, what you need, and how flexible you're willing to be.
Being Open to Negotiation
If you're totally rigid and won’t even consider offers, you could miss out on a solid deal. That doesn’t mean take whatever’s handed to you—but it does mean trusting your lawyer and staying open to options that make sense.
Don’t Jump at the First Offer
Insurers love starting low to see if you’ll bite. That first offer is rarely the best one, so don’t be afraid to push back.
Willing to Go to Court?
Sometimes, the only way forward is to fight it out. It can be stressful, sure—but showing you're not afraid to litigate can boost your leverage. Insurers want to avoid court costs, bad press, or setting a legal precedent, and they’ll often pay more to keep things quiet.
Need the Money Now?
If you're under pressure financially, that can change your strategy. It’s totally understandable—but if you can wait, you might walk away with more. It’s all about balancing your timeline with your long-term value.
Having the Right Lawyer
This might be the most important piece. A good workers' comp lawyer isn’t just filling out forms—they're digging for extra value in your case, spotting what others miss, and knowing when to push, settle, or go to court. It can be the difference between a check that helps and one that truly sets you up.
If you’re not sure where you stand, or you just want to talk it out with someone who does this every day, give me, Rex Zachfosky, a call at 212-406-8989. No pressure, no commitment—just a real conversation about your situation and your options.
.jpg)
