What is the highest workers comp settlement in the US?
What is the highest workers comp settlement in the US? | Insurance Business America
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What is the highest workers comp settlement in the US?
The highest workers comp settlement payouts can reach millions of dollars
Workers comp settlements in the US range between $2,000 and $40,000, with recent data estimating the average amount to be at $20,000. At first glance, this seems to be a relatively modest figure, but one important factor to consider is that many workplace accidents result only in minor injuries without long-term effects on workers’ lives.
However, even with all the necessary safety precautions in place, catastrophic incidents still occur, and these can leave employees with injuries that can adversely alter the rest of their lives. Such accidents also have serious financial ramifications and among these are the settlements that can reach millions of dollars.
There are currently no official rankings of the highest workers comp settlement payouts in the US, and in this article, Insurance Business will instead list down what we consider are the most notable multimillion-dollar cases, not just because of the huge settlement amount but also because of the unique circumstances behind each case.
1. $13.2 million workers comp settlement for ironworker struck by a car (California)
Wanting a better life for his family, 30-year-old San Diego resident Rafael Pineda agreed to relocate more than 200 miles away from his wife and three kids to work as an ironworker for an industrial project in Long Beach. But in December 2017, while riding his motorcycle to work, he was hit by a speeding car. The accident caused irreparable damage to his brain and spine, requiring him to receive care for the rest of his life.
Pineda’s claim was denied by his company’s insurer and his case was turned down by four law firms, citing the “coming and going rule,” which states that coming to work and leaving for home from work are not considered work-related, and therefore, not covered under workers’ compensation insurance.
The case was eventually handled by a San Diego law firm, which said the insurer’s lawyer initially offered $10,000 to settle the entire case. What followed was a lengthy trial, ending with the insurer being ordered to pay a total of $13.2 million in compensation – the highest workers comp settlement in the state to date – covering almost four years of past disability payments and other medical benefits, including two caregivers to provide round-the-clock care.
2. $12 million workers comp settlement for a nursing home worker with carpal tunnel syndrome (South Dakota)
In 1999, Alice Torres, who worked as a cook in a nursing home in Rapid City, underwent surgery for carpal tunnel syndrome. In the compensation report sent to her employer, her doctor noted that her condition was “aggravated” by her work. Torres then sought around $8,000 in compensation for physical impairment, medical expenses, and lost time. Her claim was denied, with the insurer citing a lack of proof that her health issues were caused by her job.
A suit was then filed in 2001. Torres’ lawyers found that the company’s insurer offered employees bonuses if they can reduce overall payouts from one year to the next. The lawyers argued that this created an improper conflict of interest for claims adjusters, who were supposed to be motivated by fairness and not cost control. In the end, Torres was awarded over $12 million in compensation, although 45% of the amount was paid to the law firm.
3. $12 million workers comp settlement for employee injured by a state trooper (New York)
In 2021, George Cole, along with four coworkers, was riding a minivan on the New York State Thruway, when the rear of their vehicle was struck by a New York State Trooper’s car. Cole suffered severe injuries, which left him paralyzed from the waist down.
During the investigation, it was found that the state trooper was sending and receiving text messages while driving and even opened a Facebook page moments before the impact. The trooper was also not responding to an emergency at the time of the crash. The case was due to go to trial but a few days before it began, Cole received a settlement agreement worth $12 million.
4. $11.3 million workers comp settlement for an injured nanny (California)
In 2018, a 29-year-old woman working as a nanny in Los Angeles suffered a catastrophic brain injury while accompanying her employers on a ski trip in Colorado to take care of their five-year-old son. The woman was a passenger in her employers’ car when it was struck by a bus. Investigations revealed that her employer ran a stop sign and was likely using his phone, leading to the collision. The accident left the woman confined to a wheelchair and needing round-the-clock care.
The insurance company initially denied liability for the claim. But the woman’s lawyer was able to prove that the injuries were sustained during the course of her job. The insurer agreed to settle for $11.3 million – one of the highest workers comp settlement payouts in the state’s history – and pay for past medical expenses related to the injury.
5. $10 million workers comp settlement in an exception to the “coming and going rule” (California)
In another case related to the “coming and going rule,” a woman who veered off the road while driving home from work, sustaining a traumatic brain injury in the process, was awarded $10 million in a settlement because of an exception to the rule.
According to the woman’s lawyer, while commutes from work to home and vice versa are often not covered, the rule has certain exceptions. In the woman’s case, she was driving home from work in “special circumstances,” with 2:30 a.m. not considered normal commuting hours.
6. $8.9 million workers comp settlement for a painter who fell from scaffolding (California)
In 2004, 18-year-old painter Antonio Enriquez fell 20-feet from a scaffold as he was going about his job. He sustained severe brain damage due to the accident, leading to a range of mental health issues, including anxiety, depression, and psychosis.
Needing care for the rest of his life, his father initially took on the responsibility of looking after him at night while working during the day, during which Enriquez was placed in a rehabilitation facility. He was eventually placed permanently in a rehab facility after his father struggled to juggle both.
The lawyer who took the case won an $8.9 million workers comp settlement for Enriquez to cover for the care he needed in his lifetime.
7. $6.2 million workers comp settlement for a construction worker struck in the head (Virginia)
An 18-year-old construction worker suffered a traumatic brain injury after being struck by a heavy piece of equipment on the job. He was unable to return to work after the accident and was eventually placed in a rehab facility.
His employer’s workers’ compensation insurance provider then agreed to place him in permanent and total disability if he agreed to a settlement negotiation. In the end, his disability benefits and treatments not covered by Medicare were paid by the insurer in cash for $6 million. He also received a Medicare Set-Aside worth about $235,000, which was placed in a special needs trust. The amount is considered the highest workers comp settlement in the state.
8. $4.5 million workers comp settlement for an undocumented construction worker (Connecticut)
In 2007, Estuardo Ceballos, an 18-year-old undocumented construction worker, fell from an 18-foot ladder while doing roof work at a job site in Stratford. He sustained a crushed spine, leaving him quadriplegic. Investigations at the construction site later revealed multiple safety violations.
The company agreed to a settlement, with the insurer awarding Ceballos $4.5 million, the highest work comp settlement in the state. The insurer also agreed to purchase a house for Ceballos in his native country in Central America, and modify it to fit his care needs, and provide him with a specially outfitted vehicle.
9. $3.5 million workers comp settlement for construction worker who slipped during icy weather (Illinois)
Kevin Montgomery, 62, worked as a construction worker in a condominium complex in Chicago in 2007. One snowy day, he and two other coworkers were moving carts of plywood to a temporary balcony when he stepped on a patch of ice, slipped, and twisted his back. The injury forced him to undergo two lumbar fusions in the next two years. It also caused inflammation of his spinal nerves, resulting in constant pain. Because the injury could not be completely treated, Montgomery was unable to work.
Montgomery filed a suit arguing that the company should have made adjustments or stopped work that day given the wintry conditions. The lawsuit added that the company allowed ice and snow to pile up and failed to inspect the site. It also claimed that the workers were carrying almost 3,000 pounds of plywood without sufficient protection.
In the end, Montgomery received $3.5 million in workers comp settlement and a workers comp lien waiver amounting to more than $1 million.
10. $3.2 million workers comp settlement for a technician injured on the way to a seminar (Pennsylvania)
In 2016, a 21-year-old automotive technician was left paraplegic after sustaining a cervical fracture in a car accident while on his way to a training seminar. After initially denying his claim, the insurer agreed to a $3.2-million settlement.
The technician’s lawyers said that part of the funds would be used for stem cell therapy to treat his spinal cord injuries, which would hopefully help him regain the use of his legs.
Almost all states require businesses with a certain number of employees to take out workers’ compensation insurance. This covers the cost of medical care and a portion of the lost wages of staff who get injured or sick on the job. It also protects companies from the financial liability of having to pay for these expenses out of pocket.
Once a work-related injury occurs, employers must report the incident to their workers comp insurers, which will then pay for the medical expenses and salaries for lost time at work. In the event a worker deems the payouts inadequate and unacceptable, that is when workers comp settlement negotiations begin. This provides a venue to help workers receive the compensation they deserve.
Once the worker and the employer’s insurer agree on an amount – meaning the workers comp case is settled – the insurer will then pay the employee either as a lump sum or through structured payments. Once all the funds have been paid, the worker can no longer reopen their claims in the future.
Each state has their own rules on what types of compensation injured workers are entitled to. Generally, you should make sure that the settlement amount is sufficient to cover for:
Previous and future medical expenses you incur because of the work-related injury
Past and future loss of income due to the injury
If you want to find out how workers’ compensation laws in your state work, our comprehensive small businesses guide to workers’ compensation contains the links to your state’s workers comp website.
Our Best in Insurance Special Reports page is the place to go if you’re searching for the best insurance companies that provide quality workers’ compensation coverage. The insurers featured in our special reports were handpicked by their peers and vetted by our panel of experts as dependable and respected leaders of the industry.
Among these are our five-star awardees for the Top Workers’ Compensation Insurance Companies in the USA. To come up with the list, the Insurance Business research team conducted one-on-one interviews and surveyed hundreds of specialist brokers to find out what they are looking for in a workers’ comp insurance provider. The poll results and the complete roster of winners can be viewed by clicking the link above.
Do you think workers comp settlements serve the best interest of the workers? How do these benefit the insurers and the employers? We’d love to see your comments below.
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