Jul 30, 2024
Does Surgery Increase Your Worker’s Comp Settlement?
Nate Hansford
When you get hurt at work, you can file a workers’ compensation claim to obtain your workers’ compensation benefits. The nature of your workplace injury along with other factors will affect how much you receive for your workers’ compensation settlement.
If your injuries require you to undergo surgery, you may be wondering if this will increase your workers’ comp settlement. A workers’ compensation attorney can help you to better understand whether your particular surgical procedure will make an impact on your workers’ comp benefits.
Hansford McDaniel – Workers’ Compensation Attorneys represent the injured in workers’ compensation cases. Advocating for justice on behalf of our clients, we fight to achieve the maximum settlement. In this informative article, we discuss how a workers’ compensation settlement may be affected by surgery.
What Does Workers’ Compensation Cover for Workplace Injuries?
Employers are required to carry workers’ comp insurance if any part-time or full-time employee becomes injured on the job. It does not apply to independent contractors. The workers’ compensation process requires that employers file workers’ compensation claims on behalf of an injured worker.
The benefits you receive are provided as a means of financial support and to cover medical treatments. These can include lost wages, rehabilitation, and disability benefits. A workers’ compensation settlement is typically paid as a compromise and release settlement in a lump sum payment rather than a structured settlement plan. Since this can vary by the unique factors in each case, it’s difficult to determine the average workers’ comp settlement. Experienced lawyers in these matters can help you to calculate a fair settlement based on your workers’ compensation case.
Does Surgery Increase Workers’ Comp Settlement Amounts?
Can surgery increase your workers’ comp claim? It is certainly possible, but it varies case by case. The biggest factor involving surgery and its impacts on your case is whether it has already occurred or if you’re at the stage where the treating physician recommends surgery.
If the surgery has only been recommended, your employer’s insurance company will review the proposed treatment and determine whether it is necessary or if there are other options to help you recover. However, any work-related injury that requires undergoing life-saving or immediate surgical procedures may be easier to include in the claims process. For issues that aren’t life-threatening, the insurer will conduct an independent medical examination to determine if it is necessary.
In short, surgery affects some cases and the settlement value, but not always. If you are undergoing surgery and worry about the medical expenses relative to your workers’ comp and medical benefits, it is wise to speak with an attorney to ensure fair compensation.
How Surgery and Other Factors Can Impact a Workers’ Compensation Settlement in Georgia
Many things can affect the settlement amount that you receive for workers’ comp through your employer’s insurance company. Here is a look at what could potentially provide a high or low settlement or require the need to claim additional compensation in your settlement negotiations.
Whether the Surgery Happened Already or Is Recommended
When can surgery affect what you receive? It will depend on whether or not you have already had to undergo surgery for your workplace injury or if the medical treatment is only recommended. If other alternatives exist, you may be denied by the insurance company to receive a higher settlement amount for the associated medical costs of the surgery.
If post-surgery complications arise or there is a need for future medical treatments, an attorney negotiate may be the best way to get your surgery costs covered through the insurance company.
Type of Surgery
Serious back injuries may not be life-threatening, but in some cases, they cannot be remedied with physical therapy. Your doctor may have exhausted all possibilities before recommending surgery for this injury, though it still may be a struggle to get this covered. Injured workers who must undergo immediate surgery typically find this increases their settlements.
Your future costs for rehabilitation, permanent disability benefits, and future disability benefits are taken into account as well. Surgery may mean that you make a full recovery, or it could mean that you will require future medical care, resulting in future medical expenses. If you are more likely to have permanent work restrictions, you may be put on permanent disability for your workplace injury.
Medical Expenses
Your medical bills will impact your settlement amount, and often include compensation for doctors’ visits, prescriptions, and medical devices. These can also include surgeries, though the type of surgery and extent of your injuries will impact that decision.
Nature and Severity of Injuries or Illness
If your injuries are serious, permanent, or both, you can expect that the settlement you are awarded by your employer’s insurer will be much higher. Future treatments required may also be a factor in this determination.
Extent of Disability
Your disability rating will depend on what it takes to reach maximum medical improvement. You may only need temporary disability or you may need permanent benefits.
Lost Wages
Your disability level will be used to calculate past and future earnings, which can increase the benefits you receive.
Professional Limitations Due to Injuries
There may be a need to undergo occupational therapy or find an alternative to your work duties if you are no longer capable of performing your job in your previous capacity.
Age
Settlements are affected by your age, particularly if you are young and will have a longer disability period ahead.
It is easy to see how so many different factors, including surgery and beyond, can affect the settlement you receive for workers’ comp. Given this information, it is essential to work with a workers’ comp attorney who can help you navigate the legal process and get you the money you deserve for your injuries.
Common Reasons That Surgery Is Denied in Georgia Workers’ Comp Claims
Since workers’ comp is offered to employees from their first day of hire, many workers assume that the treatments they need will be covered without a hassle. Unfortunately, this is not always the case, and the insurer may cause you added stress by denying your surgery in a settlement.
There are many reasons why they may issue a denial. Most commonly, the surgery the doctor recommends may be denied because it doesn’t provide medical benefits that could help you improve. If surgery won’t alleviate your pain or restore lost mobility, the insurer sees it as a waste.
Additionally, if you have already reached maximum medical improvement, surgery will not be expected to improve your condition. It will most likely be rejected from your settlement coverage based on these grounds.
Other issues can create red tape that may be difficult to get around. The insurer may reject your claim if the doctor isn’t on your employer’s list of approved physicians. You can also be rejected if you don’t follow the treatment plan that your doctor has provided, leading to worsened injuries.
Pre-existing conditions can often gum up the works, especially with back-related injuries. If you have degenerative disc disease, your insurer may claim that your surgery is due to this condition rather than the injury you sustained while on the job. When an injury isn’t deemed work-related, workers’ comp will refuse to pay for the procedure.
Paperwork issues may also be to blame, especially if you didn’t report the accident in the proper amount of time or file your claim by the deadline. In some cases, the employer drops the ball and does not file the workers’ comp claim as they are required to do. With the help of an attorney, you can get the resolution you need to get your coverage.
How to Get Your Surgery Approved by Workers’ Comp
It may be possible for you to speak to the insurance adjuster to get approval for your surgery after your work injury. When there are minor errors on claim reports, it could be a simple misunderstanding that needs clarification.
However, keep in mind that insurance companies are always looking out for their bottom line, which may result in them continuing to refuse approval for your surgery in your settlement. If this is your current situation, it is essential to consult a law firm with experience representing clients for workers’ compensation claims.
Surgery that is performed to save your life after enduring a serious injury while you were doing your job should not be denied. Recommended surgery should be approved if it is going to make a difference in your ability to work and the quality of your life. When a denial is issued on this part of your settlement, you can request a hearing followed by filing an appeal. However, having an attorney that understands all the nuances of this area of the law will make it a smoother process.
Trying to deal with the insurer, the paperwork, and the red tape after enduring a serious injury can make it more difficult for you to heal. The added stress can hinder your recovery, and without full knowledge of these laws, the insurer may take advantage of you.
Navigate the legal process with Hansford McDaniel – Workers’ Compensation Attorneys. Our firm is committed to assisting clients who require surgery and standing up to the insurance companies who needlessly deny claims. When you have issues with getting approval for necessary surgery that has already taken place or needs to be performed, or you have other issues with your workers’ comp benefits, reach out to our team for a free consultation.
