Understanding Virginia Workers’ Compensation Future Medical Buyouts

When an employee has been awarded workers’ compensation medical benefits, they may soon get a “buyout” offer from the insurance company. Usually, the offer is a lump sum payment intended to close out the case including future medical benefits. While this lump sum can be an attractive amount of money, there are important implications that the worker should consider before accepting the offer.

What is a Medical Buyout?

In Virginia, a worker who got injured on the job may be awarded “lifetime medical benefits,” meaning they are entitled to medical coverage for as long as they need it for the work injury. A medical “buyout” is when the workers’ comp insurer pays the worker a larger sum of money instead of waiting to cover their future medical expenses. If the worker accepts this payment, they are closing their lifetime benefits and cannot receive any additional payments in the future.

Do I Need to Accept a Medical Buyout Offer?

No, Virginia law does not require workers to accept any buyouts or lump sum offers from workers’ comp insurance. Employers also cannot force their employees to do so. A worker can freely choose to keep their lifetime medical benefits open so that they can continue to have coverage for injury-related costs down the road.

For some workers, accepting a medical buyout may seem preferable. Insurance companies typically offer a lump-sum, one-time payment that looks to be a significant amount of money. Alternatively, they may offer a combination of one lump sum amount plus a limited number of “lifetime” payments.

Either way, once the worker accepts it, they are essentially opting out of their remaining workers’ comp medical coverages for that particular injury. They can choose their own doctors and treatments without going through the worker’s compensation insurance system.

Despite this potential advantage, workers must consider some important downsides of accepting medical buyouts, which we discuss below.

Disadvantages of Accepting a Medical Buyout Offer

The main drawback with accepting a buyout is that the worker would no longer be covered for their future medical needs related to their work injury. If further treatment is needed, or if the injury develops complications, the worker would have to look to other insurance policies or even pay out of pocket. In many cases, workers unfortunately find that while their lump-sum payment was substantial, they still have trouble paying for new necessary costs.

Additionally, agreeing to a buyout and closing one’s lifetime benefits can have these effects:

• The worker would not be protected from rising healthcare costs in the future.
• The worker would not be protected from major unexpected medical expenses. It is common for job injuries to incur new costs after some time. For example, a back injury may require a spinal fusion surgery with updated hardware after several years.
• Other insurance policies, such as health insurance, may deny coverage for the particular work injury if they assert that worker’s comp should have covered it.
• The insurer would no longer cover the worker’s transportation costs to and from the doctor. These costs are actually covered under the workers’ comp system.

How Much Can I Get in a Workers’ Comp Medical Buyout?

There is no easy medical buyout calculator, as computing the buyout payment requires meticulous assessment of the injury and its projected medical costs.

The risk here is that the insurance company could misguide the injured worker regarding what is a fair amount to pay. Remember that this payment will waive all future medical benefits related to the injury, hence the worker should get a careful, thorough, and honest evaluation. Having a lawyer is crucial for the worker to determine their deserved buyout payment.

However, before even agreeing to a buyout, it is vital for an injured worker to consult with a workers’ compensation attorney. Deciding whether or not to accept the offer is a big decision that will impact the future of their medical care. An experienced lawyer can provide case-specific assessments and guidance on the pros and cons of a medical buyout.

Talk to a Trusted Virginia Workers’ Comp Lawyer

If you have received a workers’ compensation buyout offer in Virginia, or if you are dealing with a workers’ comp insurer, get the help of Attorney Jaleh K. Slominski. She has earned the trust of Virginia workers for her experienced counsel and fearless representation, which have led to favorable workers’ comp benefits for many clients.

Talk to Attorney Slominski about your buyout questions and concerns. Contact us by email, or call (434) 384-9400 (in Lynchburg) or (540) 554-3762 (in Roanoke).