What result usually comes out of a workers comp appeal. The insurance company is appealing their loss.?

[eoforwic]

I have been injured many times in my life (27 broken bones and 2 back injuries) I was injured in a fall in front of my boss. I collapsed 2 disc in my lower back and herniated 2 in my neck and tore my rotator cuff. I was told that there are 4 scenarios that could happen in the appeal (a) a full trial where a jury decides the same issues as the WCC but are required to assume the WCC decision is correct (b) a settlement where a lump sum is paid out and the case is closed forever but the claimant receives additional compensation. (c) a mediation that results in a compromise or a settlement. (d) A dismissal of the appeal and the commission decision is approved.

What is the general outcome of these. There is no question of my injury and was watched happen by my boss. The insurance company is afraid that due to all my injuries prior that these surgeries could be very costly. Thanks for your help.

Prior injuries were from 30 years of cowboying. (breaking and training horses)

[chozai65]

Wow, I don't know of any states where a JURY makes the decision.

The issues are, how much of the new injury is causing your problems, vs, how much of the old injuries. And each state has their own guidelines, as far as how the settlements work. Generally, there is no "pain and suffering" with workers comp.

Workers comp is highly regulated by each state. The amount of payouts, also, are highly regulated by the state. It's really more of a matter of, "is this a covered workers comp claim, or something else" that the judge has to decide.

Having herniated discs, and collapsing discs, is a natural part of aging. I'd guess that the insurance company is accepting the torn rotator cuff, but not the back issues. If this is the case, it's probably going to be a judge, saying yes this is related to the fall, or no it's not related to the fall and you only discovered it AFTER the fall. That's all you're looking for. Once the judge decides, then the formulas for payment apply, and the money gets paid according to state law.

[hussein]

WC laws are state-specific, so it's hard for anyone here to say. I would expect that the employer's insurer will argue that PART of your injuries/condition is due to your (apparently extensive) history of other injuries - and therefore the current employer's liability should be restricted.