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Does Surgery Increase a Workers Comp Settlement? Yes

Wondering whether surgery increases a workers compensation settlement? The answer is yes, usually. We answer that and everything else you need to know in this article.

evident Editorial Team
January 2, 2024
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Workers' compensation is a lifeline for those suffering from workplace injuries, providing vital benefits to help manage medical expenses and lost wages. But the landscape of workers' comp claims can be complex and confusing, especially when a serious injury requires surgery. 

This article will provide an overview of workers' compensation, seeking to answer a pivotal question: does surgery increase a workers' comp settlement?

By exploring the fundamentals of workers' comp, settlement calculation factors, the impact of surgery, and the nuances of different state laws, we'll provide a basis for injured workers to understand their rights and options.

Key Takeaways

What is a Workers Comp Settlement?

Workers Compensation Basics

Workers' compensation is a form of state-mandated insurance provided by employers to protect employees who suffer work-related injuries or illnesses. In essence, it's a safety net designed to cover medical expenses and a portion of lost wages when an employee cannot work due to their injury. And because it is state-mandated, the details vary from state to state.

Workers' compensation also provides disability benefits to those who have a permanent inability to work due to their injuries. Importantly, accepting workers' comp benefits usually means relinquishing the right to sue your employer for negligence related to the injury.

Understanding Settlements

A workers' comp settlement is an agreement between the injured worker and the employer's insurance company. The settlement essentially finalizes the claim and can take the form of a lump sum payment or structured payments over time. 

The objective is to provide financial assistance that adequately covers medical care costs, physical therapy, future medical expenses, and lost wages. The specific amount can vary significantly from case to case, though, depending on several factors we'll explore in greater detail below. 

It's important to note that accepting a settlement generally closes the workers' compensation claim, which means you may not be eligible for further workers' compensation benefits related to the injury.

How Are Workers Comp Settlements Calculated?

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Factors Influencing Settlement Amount

Calculating a workers' comp settlement is a complex process that involves numerous factors. For starters, the nature and severity of the work-related injury play a substantial role. 

Simple injuries with short recovery periods may result in lower settlements, while more severe injuries or those causing permanent disability may lead to more significant compensation.

Lost wages are another crucial factor. Workers' compensation settlements typically include compensation for both past and projected future wages that the injured worker cannot earn due to the injury. This can depend on the individual's salary at the time of injury and the length of time they have been or will be unable to work.

Medical expenses are also integral to a workers’ comp settlement calculation. The costs of emergency care, surgery, medication, physical therapy, and any ongoing medical treatment are tallied and factored into the settlement.

Finally, a key consideration is the concept of “maximum medical improvement” (MMI). MMI is the stage when the injured worker has recovered as fully as they are expected to. Once MMI is reached, any remaining disabilities are evaluated, and additional disability benefits may be included in the settlement. This can significantly influence the final settlement amount.

The Impact of Surgery on Workers Comp Settlements

Medical Treatment and Costs

When assessing a workers' comp claim, the insurance company will often scrutinize the associated medical expenses. These expenses encompass a wide range of treatments, from initial emergency care to follow-up appointments, rehabilitation, and medications. Among these costs, surgeries often represent a significant portion. 

Surgery costs are not limited to the operation itself but also include pre-operative evaluations and post-operative care. Post-operative care can involve extensive physical therapy, which is crucial for an injured worker's recovery and return to work. 

Surgery Increase and Settlements

Now, to the crux of our question: does surgery increase your workers' comp settlement? In most cases, the answer is yes. More serious injuries that require surgery often lead to higher workers' comp settlements. This is mainly due to the increased medical expenses and the often-lengthy recovery periods associated with surgical procedures.

Surgery frequently indicates a severe injury or one that didn't respond to less invasive treatments. Thus, it often translates into prolonged periods off work, increasing the amount of lost wages that the settlement may cover. Additionally, there is a higher likelihood of a worker reaching MMI with a remaining disability after surgery, which could result in permanent disability benefits, further increasing the settlement amount.

It's important to remember that while surgery can increase a settlement, each case is unique. Several factors come into play, such as the specific circumstances of the injury, the type of surgery, the worker's job, and their wages. The negotiation skills of the involved parties also significantly affect the final settlement.

For instance, some insurance companies may argue that the surgery was unnecessary or overly expensive, pushing to reduce the settlement. On the other hand, an experienced workers' compensation attorney can help an injured worker document all related costs accurately, negotiate effectively, and advocate for a fair settlement. 

In cases where future surgeries or ongoing treatment are anticipated, a well-negotiated settlement should account for these costs. Such scenarios are complex, and a workers' compensation lawyer can provide valuable guidance, ensuring that the settlement adequately covers both current and future medical benefits.

Thus, while surgery often increases workers' comp settlements, it's not guaranteed. What's crucial is that injured workers are fully aware of their rights, understand the nuances of the process, and receive professional guidance to navigate their claims effectively.

Does having multiple surgeries increase workers’ comp settlement?

We’ve discussed whether surgery increases a workers’ compensation settlement, but what if you have more than one surgery? Does having multiple surgeries increase a workers’ comp settlement?

For the same reasons discussed above, having multiple surgeries can increase a workers’ comp settlement through higher medical expenses and related costs. But the answer can vary depending on several factors, including the timing of your settlement. 

Remember, accepting a settlement generally closes your workers' comp claim and may make it difficult to obtain further benefits related to your work injury.  

This is part of why an experienced workers’ compensation attorney can be such a valuable resource for injured workers who are faced with tough decisions about how to navigate workers’ comp claims and whether to accept a proposed settlement offer. 

Importance of Legal Assistance in Workers Comp Settlements

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Role of a Workers' Compensation Attorney

Navigating the complicated maze of a workers' comp claim can be daunting, especially when recovering from a serious injury that necessitates surgery. This is where a workers' compensation attorney comes in. 

Workers’ comp attorneys have experience handling the complicated elements of workers' compensation frameworks. They can help document injuries, represent the injured worker during proceedings, negotiate with the insurance company, and ensure all paperwork is accurately completed and filed on time.

The Value of a Workers' Compensation Lawyer

The benefit of an experienced workers' compensation lawyer can be substantial. Their expertise can be instrumental in securing a fair workers’ comp settlement, particularly when surgery is involved. 

An experienced workers’ comp lawyer can help clarify whether the proposed settlement covers all relevant medical expenses - past, present, and future - and adequately compensates for lost wages and any permanent disability. 

An experienced lawyer can also assist in cases where the insurance company disputes the necessity or cost of surgery. They can leverage medical records, expert testimony, and a comprehensive understanding of workers' compensation law to advocate for an injured worker’s best interests. 

Ultimately, a workers' compensation attorney's role is to advocate for the injured worker and their rights, ensuring they receive the settlement they deserve. (If you are considering whether to hire a workers’ comp attorney, it’s important to understand how much a workers’ compensation lawyer costs). 

Workers’ Comp FAQs

How long do most workers comp settlements take?

The timeline for a workers' comp settlement process can vary widely, typically ranging from a few months to multiple years. This duration depends on the complexity of the case, the severity of the injury, the negotiation process, and whether litigation is required. 

The time it takes the injured worker to recover from their injury  also affects the process, as reaching a point of Maximum Medical Improvement is often necessary before finalizing a settlement.

Does Surgery Increase Workers Comp Settlement in NY?

In New York, the impact of surgery on a workers' comp settlement can vary. Generally, though, more serious injuries requiring surgical intervention often lead to higher settlements. 

The New York Workers' Compensation Board ensures that all reasonable and necessary medical care, including surgeries, is covered under workers' compensation insurance.

That said, every case is different and settlement amounts can depend on multiple factors, including the worker's degree of disability and average weekly wage.

State laws can be complex and have various interpretations, so consulting with a local, experienced workers' compensation attorney can be helpful. 

Does Surgery Increase Workers Comp Settlement in Oklahoma?

In Oklahoma, workers' compensation laws indicate that an injury requiring surgery could result in a higher settlement. Like other states, Oklahoma mandates that workers' comp insurance cover necessary medical care, which includes surgery. 

Additionally, the state's Permanent Partial Disability (PPD) benefits may apply if a worker is permanently, but not totally, disabled due to the injury or surgery, potentially increasing the overall settlement.

 Yet, just like in New York, the specific amount can vary based on many factors unique to the case. 

How is a workers comp settlement calculated in Tennessee?

In Tennessee, a workers' comp settlement calculation considers several factors, including the severity of the injury, the cost of medical treatment (including surgeries), lost wages, and whether the worker has reached Maximum Medical Improvement. If the injury leads to permanent impairment, a multiplier based on the body part affected and the extent of the disability is applied to the worker's compensation rate to calculate the settlement.