Does Having Surgery Increase Your Workers’ Comp Settlement?

When you need workers’ comp, it’s natural to have many questions about the benefits you can receive. One question that often arises is whether having surgery for your injury can increase your workers’ compensation settlement.

There can be a relationship between having surgery and the amount of a workers’ compensation settlement. However, since every case has unique circumstances, it isn’t the only factor.

Let’s take a look at whether undergoing a surgical procedure can impact compensation and, if so, under what circumstances. You can work through the workers’ compensation process with greater clarity with help from an Atlanta workers’ compensation lawyer.

What Workers’ Compensation Is Meant to Cover

Workers’ compensation is designed to provide financial support and medical benefits to employees who have been injured on the job. This includes coverage for medical treatment, rehabilitation, lost wages, and disability payments.

The purpose of a settlement in a workers’ compensation case is to provide a lump sum payment that represents a fair and reasonable amount to compensate the injured worker.

Factors that can impact the settlement include the nature and severity of the injury, the necessity of surgery, the cost of the procedure, and the associated medical expenses. You can learn more about the value of your potential settlement by working with an Atlanta personal injury lawyer.

The Role of Surgery in Workers’ Compensation Settlements

Surgical intervention can significantly influence a workers’ compensation settlement, depending on the type of surgery, extent of disabilities, and potential long-term effects. Common surgeries like hip replacements or procedures for broken bones can lead to higher comp payouts due to surgical costs, hospital stays, and post-surgery complications.

The impact of surgery on a workers’ comp claim includes both anticipated costs (such as recovery periods and rehabilitation) and indirect costs like loss of income during downtime. Workers may also require subsequent surgeries or ongoing treatments, increasing the influence on the impairment rating.

Did the Surgery Happen Yet?

Whether a recommended surgery increases a workers’ compensation settlement depends on whether it has occurred. If only recommended, the insurance company will review the proposed treatment plan and determine if the surgery is necessary or if alternative options exist.

In this case, a recommended operation may have little effect on the settlement. However, if the surgery has already taken place, it is more likely to influence the amount. Undergoing surgery often leads to higher medical costs in the short and long term for bills, rehabilitation, and health impacts.

This provides a factual basis for greater lost wages and disability claims. However, it’s important to note that a surgery that has already been performed and paid for is a past expense that has already been covered by workers’ comp benefits, so the surgery costs will not be included in the settlement.

Does the Type of Surgery Matter?

The type of surgery matters when it comes to workers’ compensation cases because workers’ comp insurance companies take into account the future long-term rehabilitation costs or permanent disability benefits.

The type of surgery can determine the likelihood of a full recovery or permanent work restrictions. Certain surgeries have a high success rate and offer patients a full recovery with no lingering physical limitations.

Other surgeries, even if initially successful, may result in permanent work-related restrictions due to the nature of the medical procedure or underlying conditions. These restrictions may restrict the ability to perform certain tasks or limit their work capacity permanently.

Common Surgery Types in Workers’ Comp Cases

Some injuries frequently lead to surgeries in workers’ comp claims, such as:

• Spinal Surgeries: For herniated discs or fractures
• Knee or Shoulder Repairs: For ligament tears or joint injuries
• Carpal Tunnel Surgery: For repetitive stress injuries

The type of surgery can impact settlement amounts based on recovery time, success rate, and likelihood of permanent restrictions.

Am I Sure to Be Approved to Get the Needed Surgery?

Simply because your treating physician recommends surgery does not guarantee immediate authorization. This is because workers’ compensation insurance companies are required to cover medical care, but have the responsibility of evaluating the necessity and cost-effectiveness of certain procedures.

In cases where the surgery is deemed urgent, the insurance company will review and approve or deny the treatment within a few days. However, if the surgery is non-urgent, it can take several weeks to receive a verdict. During this time, the insurance company might also request an independent medical examination.

This can further prolong the approval process and add even more time before you can move forward with your surgical treatment. It’s important to work with an experienced workers’ comp lawyer to advocate for your rights and help expedite your access to additional medical treatments.

Main Factors That Help Determine a Workers’ Compensation Settlement Amount

Several factors influence the final amount of a workers’ compensation settlement, all of which depend on the unique circumstances of the injured worker’s case. Here’s a closer look at the key considerations:

• Nature and Severity of the Workplace Injury/Illness: Serious injuries, such as the loss of a limb, traumatic brain injuries, or chronic illnesses resulting from workplace conditions, often lead to higher settlements. The more severe and life-altering the injury, the greater the compensation required to cover the worker’s needs.
• Extent of Disability: Settlements increase with the degree of disability, whether it’s temporary or permanent. Partial disability typically results in lower compensation than full permanent disability, as the latter often hinders the worker from ever returning to their job.
• Lost Wages: Settlements account for both past income lost during recovery and future earnings lost due to reduced work capacity. For example, permanent disability often warrants compensation to cover lost earning potential over the worker’s remaining career.
• Medical Costs: All medical expenses related to the injury—such as surgeries, physical therapy, prescription medications, and assistive devices—are factored into the settlement amount.
• Age: Younger workers often receive higher settlements because they have more years of potential work ahead, which increases the impact of long-term disability on their earnings.
• Vocational Limitations: If the injury prevents the worker from performing their previous job duties, settlements may include funds for vocational rehabilitation or training for a new career.
• Pre–Existing Conditions: While pre-existing health issues may complicate recovery, they are also considered when calculating compensation, particularly if the workplace injury exacerbated these conditions.

Permanent Disability Ratings and Workers’ Compensation Settlements

A permanent disability rating determines the extent of an injured worker’s long-term impairment and plays a crucial role in calculating workers’ compensation settlements. This rating, expressed as a percentage, reflects the severity of the injury and its impact on the worker’s ability to perform job duties.

Disability ratings are typically assigned by a treating physician or through an Independent Medical Examination (IME). Higher ratings indicate more significant impairments, resulting in larger settlements to account for lost earning capacity, ongoing medical care, and vocational limitations.

For example, a worker with a 50% disability rating due to permanent back injuries may receive a higher settlement than someone with a 10% rating for a minor injury.

Because these ratings directly influence settlement amounts, working with an experienced workers’ compensation lawyer ensures the rating accurately reflects the injury’s true impact.

Contact a Workers’ Compensation Law Firm for a Free Consultation

While surgery may increase the value of your workers’ compensation settlement, there are many factors that must be considered on a case-by-case basis. At John Foy & Associates, our experienced Atlanta workers’ comp attorneys understand how complex these cases can be.

Our legal team is dedicated to thoroughly evaluating each unique circumstance and advocating strongly on your behalf. Our team works to build the strongest workers’ compensation claim possible. We know what it takes to achieve the maximum settlement.

Schedule a free consultation today.

Contact us for a free consultation. We are here to answer your questions and assess the merits of your case. With our experienced lawyers on your side, you can focus entirely on your recovery, knowing your rights and potential compensation benefits are in good hands.