You are negotiating a workers compensation settlement blindfolded.
Your opponent – insurance companies such as Travelers, Liberty Mutual, and The Hartford, and third-party administrators such as Sedgwick CMS and Gallagher Bassett – has data from tens of thousands of claims. They know the average cost per claim depending on the body part injured, your age and education, and dozens of other variables.
To know if a settlement offer is good, you need access to the data insurers, claim adjusters, and defense attorneys use to determine average workers comp settlement amounts for cases with similar bodily injuries and factors. But you will not get it. At least not from the insurance carrier.
And the insurer uses this information mismatch when trying to settle a workers compensation case.
I wrote this article, and the others on this website, to counter the insurers’ advantage during litigation and negotiation.
The guidelines below, including the workers comp settlement chart for specific injuries and conditions, data on average payouts, and tips for calculating a fair figure, are the first point of reference for attorneys and claimants trying to figure out a case’s worth. I base them on results I have obtained for injured workers like you, reviews of reported settlements, and countless hours spent negotiating with insurers directly and in mediation.
Please use these recommendations to do the following:
You only get one shot at negotiating a payout that could have lifelong consequences.
If you have questions about workers comp laws in Virginia, complete our online contact form or call me at (804) 251-1620 or (757) 810-5614.
My law firm has negotiated millions of dollars in workers compensation settlements. And we want to get more for you.
A workers comp settlement is an agreement to end part or all of your claim for a lump sum of money and other terms.
You, your pre-injury employer, and the employer’s insurance carrier (or claim administrator) must be parties to the workers compensation settlement contract for it to have force.
Workers comp settlements fall within one of these categories:
The most common type of workers comp settlement is the “full and final” settlement.
A “full and final” settlement is an agreement to end all parts of your case (including claims for wage loss, compensation for permanent partial disability, and medical expenses) if you receive a cash payment.
The Medicare Secondary Payer Act (MSP) requires all parties in a workers comp case to protect Medicare’s interests when the settlement includes the cash buyout of future medical expenses.
The preferred method to protect Medicare’s interests is a Workers Compensation Medicare Set Aside (WCMSA).
A WCMSA is an agreement to allocate a portion of a workers compensation settlement to pay for future medical services related to the work injury or occupational disease. You must use these funds to pay for treatment related to the occupational injury or illness before Medicare steps in and covers your care.
This settlement type means the insurer will pay a lump sum of money plus fund a WCMSA.
The Centers for Medicare and Medicaid Services (CMS) review of the WCMSA amount may be necessary, depending on the settlement amount and your Medicare status.
The parties may agree to settle only the indemnity portion of the case, leaving the lifetime medical award intact.
This type of settlement is called an “open medical” settlement.
You give up your right to receive the following types of workers compensation benefits if you accept an “open medical” settlement:
But the insurer must continue to pay for reasonable and necessary medical treatment related to your work accident, which includes reimbursement for mileage expenses related to appointments.
A structured settlement is an alternative to a lump sum payment settlement for releasing the insurer from liability.
The insurer will buy an annuity from a structured settlement carrier if the parties use a structured settlement.
This structured settlement carrier will then make periodic payments to you based on the agreed schedule.
Several organizations provide data on average workers compensation settlement amounts.
For example:
In 2021, the Virginia Workers Compensation Commission approved 4,839 settlements with a total aggregate value of $253,600,035. Therefore, the average workers comp settlement payout in Virginia was $52,407.53.
For the accident years 2019-2020, the National Council on Compensation Insurance (NCCI) reported the average total incurred costs per claim were $41,353 ($22,377 in medical expenses and $18,976 in indemnity benefits).
In 2019, the Joint Legislative Audit and Review Commission (JLARC) released a report with its findings of available workers comp data.
JLARC analyzed claims involving compensable injuries and diseases in Virginia from 2014 to 2016.
It found the parties had settled 8,083 claims (19 percent) within the first two years after the date of injury.
The average workers comp settlement amount was $32,093, with a median payout of $13,253 (meaning half of all the settlements were below this).
JLARC’s analysis did not include contested (denied and disputed) claims resolved before a judge heard the evidence. Nor does the average amount reflect claims settled more than two years after the injury date
But these average settlement figures mean little.
Indeed, workers comp settlement payouts vary because so many factors affect value.
This article explains some of these factors after the charts with average settlement amounts by body part and injury type.
| Type of Injury | Examples | Average Total Claim Cost per the NSC and the NCCI(a) | Average Settlement Amounts |
| Abdomen | Hematoma rupture, intra-abdominal abscess, bowel obstruction, hepatic injury, splenic injury, etc. | $16,933 for Medical; $10,208 in Indemnity | |
| Altitude Disease | Acute or chronic mountain sickness, high-altitude cerebral edema, high-altitude pulmonary edema, etc. | - | |
| Ankle | Amputation, Achilles tendon tear, ankle sprain, tarsal tunnel/nerve compression, fracture, etc. | $17,534 in Medical; $14,360 in Indemnity | |
| Bites and Stings | Dog bites, bee stings, human bites, snakebites, tick bites, Lyme disease, tick paralysis, etc. | - | |
| Back and Lumbar Spine | Degenerative disc disease, dislocation, fracture (vertebral compression or burst), lumbago, radiculopathy, herniated disc, spondylolysis, spondylolisthesis, stenosis, sciatica, etc. | For the low back - $17,486 in Medical; $20,480 in Indemnity. For the upper back - $17,799 in Medical; $18,955 in Indemnity. | Lower back: $45,000 to $500,000 or more, depending on whether you need spinal fusion. Upper back: $35,000 to $175,000 or more. Failed back syndrome, $650,000 or more. |
| Burns | Radiation burns, chemical burns, electrical burns, smoke inhalation, etc. | $34,753 in Medical; $13,918 in Indemnity | First-degree burns: $5,000 to $35,000. Second-degree burns $35,000 to $150,000. Third-degree burns: $150,000 to $275,000 or more. |
| Cardiovascular Disorders | Atherosclerosis, cardiomyopathy, hypertension, heart failure, coronary artery disease, aortic aneurysms, myocardial infarction (heart attack), peripheral arterial disease, atrial fibrillation, cerebrovascular accident (CVA), stroke, etc. | - | |
| Chronic Regional Pain Syndrome (CRPS) | CRPS, Reflex Sympathetic Dystrophy (RSD), causalgia | - | $70,000 to $150,000 |
| Cold Injury | Frostbite, hypothermia, chilblains, etc. | - | |
| Diving or Working in Compressed Air | Barotrauma, drowning, arterial gas embolism, immersion pulmonary edema, decompression sickness, gas toxicity, etc. | - | |
| Elbow | Arthritis, cubital tunnel syndrome, dislocation, fracture, lateral epicondylitis, medial epicondylitis, etc. | See the data for Shoulder and Arm injuries | |
| Electrical and Lightning Injuries | Electric shock (electrocution), lightning injuries, etc. | - | |
| Eye | Ocular burns, corneal abrasions from foreign bodies, corneal ulcers, blindness, eye contusions, eye lacerations, retinal detachment, posttraumatic iridocyclitis, vision loss, etc. | See the data for Facial Trauma | $65,000 to $105,000 |
| Facial Trauma | External ear trauma, nose fracture, jaw fracture, temporal bone fracture, broken teeth, etc. | $18,435 in Medical; $14,464 in Indemnity. This data includes injuries to the teeth, mouth, and eyes. | |
| Foot and Toes | Amputation, crush injury, dislocation, fracture (calcaneal, toe, 5th metatarsal, or fracture-dislocation of the midfoot), plantar fasciitis, etc. | $15,264 for Medical; $12,629 in Indemnity | $25,000 to $80,000 |
| Hand and Fingers | Amputation, arthritis, degenerative joint disease, metacarpal neck fracture, fingertip fracture, nerve laceration, tendon laceration, trigger finger, etc. | $14,669 in Medical; $11,235 in Indemnity | $15,000 to $35,000 if released to full duty. $55,000 to $85,000 if you have permanent restrictions. |
| Hearing Loss | Deafness, tinnitus, etc. | - | |
| Heat Illness | Heat exhaustion, heat stroke, malignant hypothermia, etc. | - | |
| Hernia | Inguinal hernia, umbilical hernia, hiatal hernia, femoral hernia, incisional hernia, etc. | ||
| Hip/Thigh/Pelvis | Amputation, degenerative joint disorder, dislocation, femoral neuritis, fracture with pseudoarthritis, necrosis, piriformis, tendinitis/bursitis, pelvic fracture, femoral shaft fracture, etc. | $36,553 in Medical; $23,205 in Indemnity | |
| Knee | Amputation, degenerative joint disease, dislocation, patellar fracture, ligament injury (ACL/PCL/MCL), torn meniscus, patelllofemoral dysfunction (chondromalacia), tendinitis, etc. | $18,293 in Medical; $16,638 in Indemnity | $35,000 to $215,000 |
| Leg | Broken leg, compression syndrome, etc. | $38,049 in Medical; $21,699 in Indemnity | |
| Neck and Cervical Spine | Degenerative disc disease, cervical radiculopathy, whiplash, broken neck, stenosis, etc. | $30,404 in Medical; $28,987 in Indemnity | $30,000 to $300,000 |
| Paralysis | Spinal cord injury, cauda equina injury, monoplegia, hemiplegia, paraplegia, quadriplegia (tetraplegia), etc. | See the data for Traumatic Brain Injury (Head and Central Nervous System) | $400,000 to $1,000,000 or more |
| Poisoning | Carbon monoxide poisoning, caustic ingestion, lead poisoning, iron poisoning, hydrocarbon poisoning, chemical ingestion, toxic inhalation, etc. | - | |
| Pulmonary Disorders (Lung Disorders) | Occupational asthma, chronic obstructive pulmonary disorder (COPD), interstitial lung disease, pulmonary embolism, sarcoidosis, pulmonary hypertension, lung cancer, inhalation injury, silicosis, asbestos, black lung disease, hypersensitivity pneumonitis, occupational bronchitis, sick building syndrome, etc. | - | |
| Psychiatric Conditions | Post traumatic stress disorder (PTSD), depression, anxiety, acute stress reaction, etc. | - | $50,000 to $95,000 if PTSD is the only injury or condition. |
| Radiation Exposure | Contamination, ionizing radiation injury, acute radiation sickness, radiation cataracts, etc. | - | |
| Shoulder and Arm (Upper Extremity) | rotator cuff tear | $26,088 in Medical; $23,028 in Indemnity | $25,000 to $175,000 |
| Thoracic Trauma | Blunt cardiac injury, rib fracture, pulmonary contusion, thoracic spine herniation, etc. | For the chest and organs - $11,045 in Medical; $10,294 in Indemnity | |
| Traumatic Brain Injury (Including Head Trauma and Concussion) | Concussion, skull fracture, head injury, brain contusion, chronic subdural hematoma, diffuse axonal injury, epidural hematoma, subarachnoid hemorrhage, etc. | For the head and central nervous system - $60,875 for Medical; $33,067 in Indemnity | $75,000 to $205,000 |
| Wrist | Amputation, arthritis, carpal tunnel syndrome, De Quervain's, finger dislocation, ligament sprain, tendinitis, scaphoid fracture, distal radius fracture, perilunate and lunate dislocations, etc. | See the data for the Hand and Fingers |
The data in the third column comes from the National Council on Compensation Insurance’s (NCCI) Workers Compensation Statistical Plan database. You can find this information on the National Safety Council’s (NSC) website.
In addition, you can discover more information about average payouts for your specific bodily injury by clicking on the hyperlinks in the chart and elsewhere in this article.
Sample ranges for workers comp settlements by body part and injury type help.
But detailed information on average payouts for injured workers in similar occupations is better.
Below is a chart with workers comp settlement results I have negotiated for injured employees like you.
But first, I have to include this disclaimer:
THE VIRGINIA STATE BAR RULES OF PROFESSIONAL CONDUCT REQUIRE ALL ATTORNEYS TO MAKE THE FOLLOWING STATEMENT AND DISCLAIMER TO THEIR CASE RESULTS: VIRGINIA WORKERS COMPENSATION SETTLEMENTS AND VERDICTS IN ALL CASES DEPEND ON VARIOUS FACTORS AND CIRCUMSTANCES WHICH ARE UNIQUE TO EACH CASE. THEREFORE, PAST RESULTS IN CASES ARE NOT A GUARANTEE OR PREDICTION OF SIMILAR RESULTS IN FUTURE CASES THAT I MAY UNDERTAKE.
No two cases are the same.
But the factors to consider when calculating a fair workers comp settlement payout remain the same from claim to claim.
Here are items to consider when deciding a reasonable range to settle for the body parts you injured:
You are more likely to receive a reasonable settlement offer if the insurer agrees that your injury or occupational disease is compensable (in other words, an event covered by the Workers Compensation Act).
And if you have received a Workers Compensation Award Letter memorializing this acceptance.
The Award Order gives you leverage to negotiate a higher settlement amount because the insurer will have to jump through evidentiary and procedural hoops to stop your benefits.
If the insurer has denied your claim, you must evaluate the evidence to determine the likelihood you will succeed at a workers comp hearing.
Similarly, you must assess the evidence to determine your chance of defeating an employer’s application for a hearing to stop benefits.
The insurance company’s settlement offers may reflect the strength (or weakness) of its defenses.
How much workers comp pays in wage loss and permanent partial disability benefits depends on your pre-injury average weekly wage (AWW).
A higher AWW increases the insurer’s potential financial exposure for indemnity benefits, which affects the settlement payout.
Your workers comp settlement payout should reflect who will pay for medical bills to date.
Generally, you can negotiate a higher settlement if the claim settles on a denied and disputed basis with no medical bills paid. Otherwise, the insurer can deduct these amounts from its claim evaluation as already paid.
But this is only a smart option if you have other ways to pay outstanding medical bills, such as private health insurance or Medicaid.
Examples of medical treatment the average workers comp settlement accounts for include the following:
Calculating how much your workers comp settlement should include for future medical expenses can be challenging. In addition to considering your current medical status, you must also try to predict your life expectancy and how much healthcare costs may rise over the next several decades.
Instead of estimating this amount alone, I recommend working with a life care planner to determine an appropriate amount.
Having private health insurance can make settling your workers comp case more attractive.
Your attorney can include provisions in the settlement contract that trigger the anti-subrogation statute in the Code of Virginia. And other states may have similar anti-subrogation laws.
These terms allow you to (i) avoid reimbursing your health insurer for payments it made for treatment related to the occupational injury and (ii) continue using the private insurance for medical care after the settlement.
Eventually, your physician (usually the orthopedic surgeon, pain management doctor, or neurologist) will declare that you have reached maximum medical improvement (MMI) for the work injury.
Then your physician will do one of the following:
The average workers comp settlement amount is higher for workers who cannot return to their pre-injury work after reaching MMI because it allows the employee to seek and collect additional wage loss benefits.
The estimated time it will take to find a job, given your permanent restrictions (residual functional capacity), age, education, geographic location, and work experience, has a role in your final workers comp settlement payout.
For example, you will likely have more difficulty finding a job if you –
The longer it takes to find a new job, the longer you may qualify for wage loss benefits through workers comp. And this factor affects the settlement amount.
You may qualify for other disability benefits (such as Social Security disability insurance (SSDI), Supplemental Security Income (SSI), VRS, or long-term disability)) while receiving workers comp benefits.
The relationship between these different systems is complex, with numerous regulations and laws determining how a workers comp settlement affects your right to the other benefits.
Your settlement payout should reflect how closing the workers comp case helps or hurts your right to seek and get benefits from these other systems.
The body part injured in the work accident determines whether you qualify for compensation for permanent loss of use.
In Virginia, for example, your occupational injury must affect one of the body parts listed in Code Section 65.2-503 to recover benefits for partial disability.
Other states have similar laws that may pay for whole-body impairment from work injuries.
Your permanent impairment rating determines how much compensation you will receive for the permanent loss or loss of use of a scheduled body part.
A low rating will decrease the settlement amount.
So, make sure you get a second opinion if the rating seems off.
Workers compensation provides disability benefits and medical care for injuries and conditions due to the overuse of the non-injured body part because of the compensable work injury. This rule is called the compensable consequence doctrine.
For example, I have represented many injured workers who required left knee surgery due to overuse caused by a compensable right knee injury such as a torn ACL.
Your workers comp settlement amount should include monies for body parts you may add to the claim.
In Virginia, most workers comp cases are limited to 500 weeks of indemnity benefits.
Therefore, the insurance company’s financial exposure decreases as it continues to pay weekly wage loss benefits.
And the number of weeks potentially remaining affects the settlement amount in your workers comp case.
You may have a civil action against the third party that caused your work injury. This claim is called a third-party action under tort law.
For example, suppose you suffered injuries in a work-related motor vehicle crash caused by a driver you have never met.
In that case, you can recover workers comp benefits through your employer’s insurance while filing a personal injury lawsuit against the negligent driver.
The workers comp insurer, however, has a lien against the proceeds from any auto accident settlement or verdict.
Therefore, your workers comp settlement amount may reflect the insurer’s agreement to waive any lien it has against the third-party action.
Generally, this means your workers comp settlement payout is lower.
But you will get more money because you do not have to repay a workers compensation lien from the proceeds of the third-party action.
Personalities matter in all aspects of life, including negotiating workers comp settlements.
Some insurers are pragmatic and practical and evaluate workers comp settlements fairly.
But other insurers, employers, and claim administrators are litigious, which affects the settlement payout offers.
An experienced attorney will know what you can expect from the claim adjuster or defense lawyer in your case.
Insurance carriers use a concept called “present value” to justify offering lower settlement amounts.
But you can use the yearly cost of living adjustments (COLAs) allowed under the Workers Compensation Act to counter this argument.
Present value (also called the time value of money) is the idea that a dollar in your pocket today is worth more than a dollar promised in the future. That is because you can invest the money you have and earn interest.
The present value concept applies to workers comp settlements because the insurer pays income replacement benefits weekly and medical expenses as needed, but a lump sum settlement payment upfront.
Insurance carriers, therefore, will argue you should accept a lower settlement payout by telling you that you are better off getting the lump sum now rather than hoping to get weekly checks or medical benefits.
I agree – to an extent. There is a reason for the old saying: “A bird in the hand is worth two in the bush.”
But do not give the insurer an excessive discount on the settlement value of your case.
Instead, point out that healthcare costs have increased more than most other areas of the economy. And you may be entitled to more indemnity benefits if the Workers Compensation Commission finds you eligible for a cost-of-living adjustment.
You can try to negotiate a workers comp settlement alone, taking on the insurance company and its team of attorneys, claim adjusters, and doctors with data on thousands of past claims.
Or you can call my firm at (804) 251-1620 or (757) 810-5614 or complete the online contact form and let us do it for you.
We help you hold the insurance company accountable for your life-changing injury.