When you experience a workplace injury, you may have various treatment recommendations from your doctor. From different medications to physical therapy, you will likely have multiple recommendations. Commonly, you may also require surgery, depending on the injury. This can be a significant medical bill for many workers, so many wonder if workers’ compensation benefits cover surgery. Many employees in similar circumstances may find that their initial workers’ compensation offer is insufficient to cover surgery, which is when they might pursue a settlement.
The only problem is, how do you know if your surgery will change the amount? After all, many medical providers will pursue surgery in a last-ditch effort to treat your injury, and they may not recommend it initially when filing your workers’ compensation. In this article, we’ll evaluate how surgery may affect your settlement amount and how to ensure you can heal from your injury safely and securely.
Does Surgery Increase Your Workers’ Comp Settlement?
When a claim includes the surgery cost, these expenses are factored into the settlement calculations, often resulting in a higher payout to account for the required medical care. This includes the cost of the procedure and related expenses such as hospital stays, post-operative care, and ongoing rehabilitation.
The settlement will also factor in the costs caused by:
- The length of the surgery;
- The complexity of the surgery;
- Hospital stays required before and after the surgery;
- Medication used before, during, and after the surgery;
- Rehabilitation after the surgery.
Often, providers will need medical bills to calculate the total amount of the settlement. Because of this, you must keep track of any medical documents you receive before and after surgery to send to your employer and workers’ compensation insurance provider.
How Surgery Can Change Your Settlement Timeline
In addition to the total amount of your settlement, surgery can also affect the timeline for which you may receive compensation. Here’s how:
Extended Recovery Periods and Delayed Settlements
Since most surgeries require a recovery period, it can delay your settlement and negotiation process, as you won’t be able to receive a post-surgery evaluation. During this evaluation, medical providers will see if you need further treatment, such as physical therapy, and whether you’ve reached maximum medical improvement (MMI). This status dictates that you’ve recovered as much as possible, and no further treatment will improve your condition.
If your condition affects your ability to work and ability status, your settlement will likely be more extensive to compensate you for lost wages or provide career counseling you’ll need while transitioning careers. If you can’t receive an MMI evaluation due to your surgery recovery, it’ll take longer to negotiate an accurate settlement. However, doing so is imperative to ensure you receive the amount you deserve because of your injury.
Can Surgery Affect Eligibility for Permanent Disability Benefits?
Undergoing surgery can significantly impact your eligibility for permanent disability benefits and the rating assigned to your case. If surgery successfully restores functionality and reduces limitations, your disability rating might be lower, potentially decreasing the amount you are eligible for permanent disability benefits. For example, a back surgery that restores mobility may result in a less severe rating. Conversely, if the surgery leaves you with residual pain, restricted movement, or ongoing medical needs, your rating could increase. The higher your rating, the more it reflects the lasting impact of your injury and your need for permanent disability benefits and more settlement money.
That said, some surgeries will only render you with a temporary disability. A temporary disability simply means you won’t be able to complete typical working duties while you recover from surgery. During this time, you will need to receive compensation for lost wages, and you may need to seek an evaluation if you want to qualify for permanent disability benefits like Social Security Disability Insurance.
Repercussions of Permanent Impairment
While a permanent disability may provide a higher settlement, it can affect your life in the long term. For one, depending on the extent of the impairment, you may not be able to work in the same or any profession. You may also need to seek a new career to seek a different career that you’ll still be capable of doing with your injury. These hardships require the compensation that you deserve.
Common Mistakes to Avoid in Workers’ Comp Settlements After Surgery
Because surgery can impact your workers’ compensation settlement in varied ways, it’s essential to proceed through the process carefully to ensure you receive the total amount to cover any hardship you experience promptly. Here are a few mistakes that can interfere with that outcome:
- Filing a claim too late: If you don’t file a claim for your injury and the surgery needed within the statute of limitations, which can vary depending on the state you live in, your workers’ compensation insurance provider will not be liable to cover your surgery or other treatment.
- Lying to medical professionals: It’s essential to be completely transparent with medical professionals about the symptoms you experienced before and after the surgery.
- Settling too early: If you settle before you understand the impact of your surgery or after you’ve reached MMI, you may not receive the total amount you’re entitled to, especially if you end up needing permanent disability compensation.
- Failing to document all surgery-related costs: If you don’t keep organized documentation of all medications, physical therapy, revision surgeries, or other out-of-pocket costs, insurance providers will not be liable to pay your full settlement amount.
- Accepting settlements without understanding the terms: Many workers accept settlement agreements before fully understanding them. Commonly, some may think lump sum settlement payments sound attractive, but they can wait for your right to future medical benefits if you run into unforeseen complications from your surgery. An attorney or other legal experts can highlight these hiccups and provide recommendations.
- Accepting settlements even if you are unhappy with the terms: If your insurance provider sends a counteroffer that you’re unhappy with, don’t feel the need to settle. Hiring a workers’ compensation attorney can help you find a solution that works for you, even if it takes longer.
Surgery is often a requirement in recovering from a workplace injury. As long as you know how it may affect the settlement process, you can seek all the necessary treatment without worrying about costs or your future. If you need more help in the settlement process, contact one of our legal experts at Request Legal Help! Our attorneys can guide you through the process and advocate for your rights, no matter what surgery you need.
FAQs About Surgery And Workers’ Comp
Does Having Surgery Mean a Higher Workers’ Comp Settlement?
Surgery can often increase the overall settlement amount due to the added medical expenses and the potential for longer recovery times. However, each case is unique, and the impact of surgery on a settlement will depend on factors like the type of surgery, recovery outcomes, and the extent of any resulting disability.
How Long Do I Need to Wait After Surgery to Settle My Workers’ Comp Claim?
Generally, you should wait until you reach Maximum Medical Improvement (MMI), which means your condition has stabilized, and medical professionals don’t expect further recovery, even with more treatment. Setting aside time before reaching MMI may lead to an incomplete assessment of your long-term needs, which could reduce your settlement.
Will Surgery Affect My Eligibility for Permanent Disability Benefits?
Surgery can impact your eligibility for permanent disability benefits, especially if it leads to lasting physical limitations. Your disability rating, which determines your eligibility, is typically evaluated after recovery and may be higher or lower depending on surgery outcomes.
Can I Be Required to Undergo Surgery to Receive Workers’ Comp Benefits?
Workers’ comp cannot usually force you to undergo surgery. However, declining surgery recommended by a doctor could impact your benefits, particularly if necessary for recovery. Consulting with a legal professional can help you understand your options.
How Does Workers’ Comp Handle Complications From Surgery?
If surgery related to your work injury causes complications, workers’ compensation should cover the additional medical expenses and any extended recovery time. Thoroughly documenting complications and consulting with a workers’ compensation attorney can help ensure providers factor in these additional costs.
What If I Can’t Return to Work After Surgery?
If you cannot return to work after surgery, you may qualify for additional benefits, such as permanent disability or vocational rehabilitation. Discuss this possibility with your healthcare provider if you want to include it in your settlement considerations.
Can My Workers’ Comp Settlement Be Reopened If My Condition Worsens After Surgery?
In some cases, you can reopen workers’ comp claims if there’s a significant change in your condition post-settlement. The rules for reopening a claim vary by state, so it’s essential to consult with a legal professional if your health declines after surgery.
Should I Consult a Lawyer Before Settling a Workers’ Comp Claim After Surgery?
Yes, consulting with a workers’ comp attorney can help you understand the full implications of surgery on your settlement, review settlement terms, and ensure you receive fair compensation for any long-term needs resulting from the surgery.
About the Author
Aaron is a professional legal writer with a B.S. in English Education from Southern Illinois University – Carbondale. He has written, published, and edited thousands of legal articles for RequestLegalHelp, which has connected over 5 million people to legal help in the United States.
With over five years of experience writing thousands of legal articles for law firms across the U.S. and Canada, Aaron specializes in covering federal, state, and city-level legal issues ranging from auto accidents to wrongful terminations.
