Does Having Surgery Increase Your Workers’ Comp Settlement?

Navigating the Path to Recovery: How Surgery Impacts Your Workers’ Comp Settlement

A workplace injury can be a life-altering event, leaving you with physical pain, emotional distress, and lost wages. Workers’ compensation insurance aims to provide financial assistance for medical bills, lost income, and other related expenses. If surgery is recommended as part of your recovery plan, it can significantly impact your workers’ compensation settlement. This article explores how surgery can influence your settlement amount, addressing the timing of surgery, the type of procedure, and factors affecting surgery approval.

Does Having Surgery Increase My Workers’ Compensation Settlement?

In many cases, undergoing surgery related to your work injury can lead to a higher workers’ compensation settlement. Here’s why:

Increased Medical Costs: Surgery often involves significant medical expenses, including surgeon fees, anesthesia costs, hospital stay, and rehabilitation. Workers’ compensation covers these costs, but they also contribute to the overall value of your claim.
Long-Term Impact on Earning Capacity: If the surgery aims to improve your ability to work, but has a longer recovery period or potential complications that limit your future earning potential, the settlement can reflect this loss of earning capacity.
Pain and Suffering: Surgery can be a painful and invasive procedure. The settlement may take into account the additional pain and suffering you’ve endured due to the surgery.

However, it’s important to note that having surgery doesn’t guarantee a higher settlement. Several factors influence the outcome, including:

Severity of Your Injury: The seriousness of your injury and the impact it has on your daily life will significantly influence the settlement amount. Surgery for a minor injury might not significantly increase the settlement compared to a major surgery for a debilitating injury.
Success of the Surgery: A successful surgery that improves your overall health and ability to work can lead to a higher settlement. Conversely, an unsuccessful surgery with complications might not significantly impact the settlement if your overall condition remains unchanged.
Pre-Existing Conditions: If you had pre-existing medical conditions that contributed to your need for surgery, the settlement might be adjusted to reflect the proportion of the surgery’s impact related to the work injury.

Did the Surgery Happen Yet?

The timing of your surgery can affect your workers’ compensation settlement in two ways:

Settlement Before Surgery: If you haven’t undergone surgery yet, the settlement might be based on estimated future medical costs for the recommended procedure. This estimation can be inaccurate, and the final settlement might be adjusted after the surgery to reflect the actual costs incurred.
Settlement After Surgery: If you’ve already undergone surgery when the settlement negotiations occur, the documented medical bills associated with the surgery become concrete evidence of the additional medical expenses you’ve incurred. This can strengthen your case for a higher settlement.

Does the Type of Surgery Matter?

Yes, the type of surgery can influence the settlement amount. Here’s how:

Major vs. Minor Surgery: Major surgeries with longer recovery times and higher costs will likely have a more significant impact on the settlement compared to minor outpatient procedures.
Impact on Earning Capacity: Surgeries that aim to restore your ability to work and minimize long-term limitations will be viewed more favorably in settlement negotiations compared to procedures that might not significantly improve your work capacity.
Risk of Complications: Surgeries with a high risk of complications can influence the settlement in two ways. A successful surgery with no complications can strengthen your case for a higher settlement due to the additional pain and risk endured. However, if complications arise, the settlement might be adjusted to reflect the worsening of your condition and any additional medical costs associated with the complications.

Am I Sure To Be Approved To Get Needed Surgery?

Worker’s compensation insurance companies have the right to approve or deny recommended surgeries. Here’s what can influence their decision:

Medical Necessity: The surgery must be deemed medically necessary to treat your work injury and improve your condition. The doctor’s recommendation and supporting medical records are crucial for obtaining approval.
Alternative Treatments: The insurance company might consider whether there are less invasive or expensive alternative treatments available before approving surgery. However, if these alternatives haven’t shown effectiveness, surgery might be approved.
Second Opinion: The insurance company might request a second medical opinion to verify the necessity of the surgery. Having a qualified doctor who can clearly communicate the need for the surgery is essential.

Frequently Asked Questions

Q: What should I do if my workers’ compensation insurance company denies my request for surgery?

Here’s what you can do if your workers’ compensation insurance company denies your request for surgery:

Appeal the Decision: Most states have a process for appealing a denied workers’ compensation claim. This typically involves filing a formal appeal with the workers’ compensation board or a designated appeals body.
Consult with an Attorney: An experienced workers’ compensation lawyer can guide you through the appeals process, gather necessary medical documentation to support your case, and represent you at any hearings.
Gather Medical Evidence: Obtain detailed reports from your doctor outlining the medical necessity of the surgery, the potential consequences of not undergoing the surgery, and how the surgery can improve your condition and ability to work.
Consider Independent Medical Examination (IME): In some cases, you might request an independent medical examination (IME) by a doctor chosen by the workers’ compensation board. This doctor will review your medical records and conduct an evaluation to provide an unbiased opinion on the necessity of the surgery.

Q: How long does it take to settle a workers’ compensation claim after surgery?

The timeframe for settlement after surgery can vary depending on several factors, including:

Complexity of the Case: Straightforward cases with clear evidence and minimal disputes might settle faster than complex cases involving multiple surgeries, pre-existing conditions, or contested claims.
Negotiation Process: Reaching an agreement with the insurance company can take time, especially if there are disagreements about the settlement amount. Having a lawyer represent you can expedite the negotiation process.
Your Recovery Progress: If your recovery from surgery takes longer than expected, the settlement might be delayed until your doctors can provide a clearer picture of your long-term prognosis and earning capacity.

In general, you can expect the settlement process to take anywhere from a few weeks to several months after surgery.

Q: Can I return to work after surgery?

The possibility of returning to work after surgery depends on the type of surgery, your recovery progress, and any restrictions your doctor might impose. It’s crucial to follow your doctor’s orders for rehabilitation and physical therapy to maximize your recovery and potential return to work.

Workers’ compensation benefits, including temporary disability payments, might be available to help you financially while you’re unable to work due to your injury and recovery from surgery. Consulting with your doctor and workers’ compensation representative can provide more specific guidance regarding your return to work timeline.

Conclusion: Partnering for Recovery

A work injury and the need for surgery can be a stressful experience. Understanding how surgery can impact your workers’ compensation settlement empowers you to make informed decisions. Remember, the following steps can maximize your chances of receiving a fair settlement that reflects the full impact of your work injury and necessary surgery:

Seek Medical Attention: Prioritize your health and well-being by getting the medical care you need, including recommended surgery if necessary.
Document Everything: Keep detailed records of all medical bills, doctor’s reports, and communication with the insurance company regarding your surgery request and claim.
Consider Legal Representation: An experienced workers’ compensation lawyer can advocate for your rights, negotiate a fair settlement, and guide you through the appeals process if your surgery request is denied.

By working with your doctor, keeping thorough records, and potentially seeking legal guidance, you can navigate the workers’ compensation process effectively and secure the compensation you deserve to facilitate your recovery and move forward after your work injury and surgery.