Case Study: $285,000 Construction Fall Settlement
This case study follows a construction worker -- we will call him Carlos -- who fell from scaffolding and recovered a total of $285,000 through a dual recovery strategy combining workers' compensation and a third-party negligence claim. We break down the accident, the multiple surgeries, the insurance company's tactics, and the legal strategy that maximized his total recovery.
The Accident
Carlos was a 42-year-old journeyman framer working for a subcontractor on a commercial building project in Orange County. On a Tuesday morning in June 2024, he was working on scaffolding at approximately 18 feet above ground level when the scaffolding platform gave way. A cross-brace had not been properly secured by the general contractor's crew, who had assembled the scaffolding the previous day.
Carlos fell 18 feet to the concrete floor below, landing on his left side. He suffered multiple serious injuries: a comminuted fracture of the left calcaneus (heel bone), a compression fracture at T12, and a torn rotator cuff in his left shoulder. He was transported by ambulance to the nearest trauma center, where emergency imaging confirmed the extent of his injuries.
The accident was witnessed by three coworkers, and a Cal/OSHA investigation later confirmed that the scaffolding had been improperly assembled in violation of Cal/OSHA Safety & Health fall protection standards. The general contractor was cited for the scaffolding deficiency.
Case Timeline
Carlos underwent emergency surgery to stabilize the calcaneus fracture with plates and screws. The T12 compression fracture was treated with a thoracolumbar brace. His workers' comp claim was filed under Labor Code §3600 and accepted by his employer's insurer. Simultaneously, we initiated the investigation for a third-party claim against the general contractor.
Carlos required a second surgery on his heel bone (subtalar fusion) after the initial repair did not achieve adequate alignment. He also underwent arthroscopic rotator cuff repair on his left shoulder. Between surgeries, he participated in physical therapy for both his foot and shoulder. Carlos was on temporary disability throughout this period, receiving $1,619 per week.
Carlos continued extensive physical therapy. On the third-party side, we obtained the Cal/OSHA investigation report, deposed the general contractor's site superintendent, and secured expert testimony from a scaffolding safety engineer who confirmed the assembly deficiencies. The general contractor's liability insurer attempted early settlement at $45,000, which we rejected.
Carlos reached MMI in August 2025. The QME evaluation resulted in a combined 32% permanent disability rating accounting for his heel, back, and shoulder injuries. We negotiated a workers' comp Stipulations settlement that kept future medical care open -- critical given the likelihood of future surgeries.
With the workers' comp case resolved, we focused on maximizing the third-party recovery. The general contractor's insurer ultimately settled for $160,000 after mediation, bringing the combined total recovery to $285,000. The workers' comp insurer's lien was negotiated down as part of the resolution.
The Dual Recovery Strategy
The key to maximizing Carlos's recovery was pursuing both workers' compensation and a third-party negligence claim simultaneously. This "dual track" approach is available in many construction injury cases but is often overlooked by workers who do not have experienced legal representation.
Workers' Compensation Track
The workers' comp claim provided immediate benefits under Labor Code §4660: full medical treatment coverage, temporary disability payments of $1,619 per week during recovery, and ultimately a permanent disability award based on Carlos's 32% combined PD rating. Workers' comp is a no-fault system, meaning Carlos was entitled to these benefits regardless of who caused the scaffolding failure.
Workers' Comp Recovery: $125,000
- $84,160 Permanent disability benefits (32% PD rating, very heavy occupation group)
- $34,840 Additional PD value negotiated above statutory minimums through Stipulations
- $6,000 SJDB voucher for retraining
- Open Future medical care kept open (lifetime value estimated at $150,000+)
Third-Party Negligence Track
The third-party claim was filed against the general contractor, whose crew had improperly assembled the scaffolding. Unlike workers' comp, a third-party civil claim allows recovery of damages that workers' comp does not cover -- most importantly, pain and suffering and full lost wages (workers' comp only pays two-thirds of wages).
Our investigation established liability through multiple channels:
- Cal/OSHA citation: The general contractor was cited for failing to ensure scaffolding was erected in accordance with manufacturer specifications and OSHA standards
- Witness testimony: Three coworkers confirmed the scaffolding had been assembled by the general contractor's laborers the day before the accident
- Expert analysis: A scaffolding safety engineer identified the specific cross-brace failure and documented that proper inspection would have caught the deficiency
- Prior violations: The general contractor had received two previous Cal/OSHA citations for scaffolding deficiencies on other projects
Third-Party Recovery: $160,000
- $160,000 Gross settlement from general contractor's liability carrier
- -$38,400 Workers' comp lien (negotiated down from $62,000)
- -$53,333 Attorney fees (one-third contingency on third-party)
- $68,267 Net to Carlos from third-party claim
Insurance Company Tactics We Overcame
Both the workers' comp insurer and the general contractor's liability carrier deployed aggressive tactics to minimize their exposure. Here is what we faced and how we responded.
Tactic 1: Delayed Surgery Authorization
The workers' comp insurer delayed authorization for the second heel surgery (subtalar fusion) for two months through Utilization Review, arguing the first surgery's results should be given more time. Meanwhile, Carlos was in pain and unable to bear weight. We filed for expedited IMR and contacted the insurer's attorney directly, threatening penalties under Labor Code §5814 for unreasonable delay. The surgery was authorized within two weeks.
Tactic 2: Surveillance
The general contractor's insurer hired a private investigator to conduct surveillance on Carlos, hoping to catch him performing physical activities inconsistent with his claimed injuries. Surveillance is legal in California, but in this case, the footage actually helped our case -- it showed Carlos using a walking boot, struggling with stairs, and unable to carry groceries with his injured arm. We used the surveillance footage as evidence of his ongoing limitations.
Tactic 3: Lowball Third-Party Offer
The general contractor's insurer made an initial settlement offer of $45,000 for the third-party claim -- less than one-third of the eventual settlement. Their argument was that Carlos bore some fault for working on the scaffolding without inspecting it himself. We countered that California law places the duty to provide safe scaffolding on the contractor who erects it, not on the workers who use it. The Cal/OSHA citation eliminated any serious comparative fault argument.
Multiple Body Parts: How Combined Injuries Increase Value
One of the most important aspects of Carlos's case was that he injured multiple body parts -- his heel, his spine, and his shoulder. Under California workers' comp law, injuries to multiple body parts can result in a "combined" PD rating that is significantly higher than any single injury rating alone.
Carlos's individual PD ratings were:
- Left Foot/Ankle 16% PD (calcaneus fracture with subtalar fusion, permanent limp, cannot work on uneven surfaces)
- Thoracic Spine 12% PD (T12 compression fracture, healed with kyphotic deformity, chronic pain)
- Left Shoulder 9% PD (rotator cuff repair, reduced range of motion, cannot work overhead)
- Combined 32% PD (using the combined values chart -- not simple addition)
The combined 32% rating was critical to the settlement value. At this level, each additional percentage point of PD is worth substantially more than at lower levels, and the overall settlement calculates to a much larger number than three small separate claims would yield.
Key Lessons from This Case
- Always investigate third-party liability. In construction, someone other than your employer is often responsible for the unsafe condition that caused your injury. Third-party claims can double or triple your total recovery compared to workers' comp alone.
- Cal/OSHA citations are powerful evidence. A safety citation against the responsible party is near-conclusive proof of negligence in a third-party claim. If Cal/OSHA investigates your accident, cooperate fully and obtain a copy of the report.
- Multiple body parts multiply value. Falls often cause injuries to several areas of the body. Make sure every injury is documented, treated, and rated separately. The combined PD rating is always higher than any single injury alone.
- Negotiate the workers' comp lien. When you recover money from a third party, your workers' comp insurer has a lien on that recovery. But the lien amount is negotiable. In Carlos's case, we reduced the lien from $62,000 to $38,400 -- saving him $23,600.
- Keep future medical care open when possible. Carlos chose Stipulations for the workers' comp settlement specifically because his heel and back may require additional surgery in the future. The lifetime value of open medical care for multiple surgical sites can easily exceed the lump-sum buyout an insurer would offer.
Carlos's Outcome
The $285,000 combined recovery -- $125,000 from workers' comp and $160,000 from the third-party claim -- gave Carlos the financial foundation to rebuild his career. He can no longer work in construction framing due to his permanent restrictions: no climbing, no working at heights, no heavy lifting, limited use of his left arm overhead, and chronic foot pain on uneven surfaces.
Carlos used his SJDB voucher to begin training as a construction estimator, leveraging his 15 years of field experience in a desk-based role. His workers' comp future medical care remains open, ensuring that any future surgeries or treatment for his heel, back, or shoulder will be covered for life.
For more information about construction fall injuries, see our construction fall injury guide. For back injury specifics, visit our back injury workers' comp page. To estimate your own case value, try our free settlement calculator.
Frequently Asked Questions
What is a third-party claim in a construction injury case?
A third-party claim is a separate civil lawsuit filed against someone other than your employer who was responsible for your injury. In construction, this often includes the general contractor (if you work for a subcontractor), a property owner, an equipment manufacturer, or another subcontractor whose negligence caused the accident. Third-party claims allow you to recover damages beyond workers' comp -- including pain and suffering, which workers' comp does not cover.
Can I file both workers' comp and a third-party lawsuit?
Yes. Under California law, workers' comp and third-party claims are separate legal proceedings. Your workers' comp claim covers medical treatment, temporary disability, and permanent disability regardless of fault. A third-party claim against a negligent party can recover additional damages including pain and suffering, loss of consortium, and full lost wages (not just the two-thirds covered by workers' comp). However, the workers' comp insurer has a lien on the third-party recovery to recoup benefits already paid.
How long do construction injury cases take to settle?
Construction injury cases with both workers' comp and third-party claims typically take 2-4 years to fully resolve. The workers' comp portion may settle in 18-30 months once the injured worker reaches MMI and obtains a PD rating. The third-party civil lawsuit often takes longer due to discovery, depositions, and potential trial scheduling. In this case study, the total process took approximately 28 months from injury to final resolution of both claims.
What is a typical construction fall settlement in California?
Construction fall settlements vary widely based on the height of the fall, the severity of injuries, and whether a third-party claim is available. Workers' comp-only settlements for fall injuries typically range from $60,000 to $200,000+ depending on the PD rating. When a viable third-party claim exists, total recoveries of $200,000 to $500,000+ are common for serious injuries. Falls from significant heights with multiple injuries and surgeries can result in recoveries exceeding $1 million.
Who pays for my medical bills after a construction fall?
Your employer's workers' compensation insurance pays for all reasonably necessary medical treatment related to your fall injury, regardless of who was at fault. This coverage begins immediately and continues throughout your treatment. If you also file a third-party claim, the third-party's liability insurance does not directly pay medical bills -- instead, medical costs are factored into the overall civil settlement or judgment. The workers' comp insurer's lien must be resolved as part of the third-party settlement.
Injured in a Construction Accident?
If you were hurt on a construction site, you may have both a workers' comp claim and a third-party negligence claim. Most workers only pursue workers' comp and leave significant money on the table. Our free consultation will evaluate whether a dual recovery strategy could maximize your total compensation, just as it did for Carlos.
Legal Disclaimer: This case study is based on a real client's case with identifying details changed to protect privacy. The settlement amount and case details are specific to this individual's circumstances. Past results do not guarantee future outcomes. Every workers' compensation and personal injury case is unique, and your recovery may be higher or lower depending on the specific facts of your accident, the severity of your injuries, and other factors. Contact our office for a free evaluation of your specific situation.
David Lamonica (State Bar #165205) has extensive experience representing construction workers injured on job sites throughout California. He specializes in dual recovery strategies that combine workers' comp claims with third-party negligence actions to maximize total compensation.