Does Surgery Increase Workers’ Comp Settlement?

Dawn Pinnisi

August 28, 2024

Employees who suffer serious injuries at work may require surgery to repair the damage. Many employees have questions about potential workers’ compensation benefits, such as whether benefits will cover surgery or if having surgery for their injury will increase their settlement. Let’s see if does surgery increase workers’ comp settlement or not.

There is a relationship between undergoing surgery and the potential compensation amount. However, this depends on many factors surrounding the case. At Varcadipane & Pinnisi, P.C., we highly advise injured workers to focus mainly on making the best decision for their health when it comes to treatment and always hire a workers’ compensation attorney to work toward securing a fair settlement while they focus on recovery.

What Can Workers’ Compensation Cover?

Workers’ compensation is a no-fault insurance that benefits workers who suffer work-related injuries or illnesses. It generally covers medical expenses, lost wages, and rehabilitation costs.

Medical expenses can be extensive, including necessary surgeries. Where a work-related injury results in death, workers’ compensation may also provide death benefits to the deceased worker’s dependents.

Workers’ compensation aims to ensure that injured workers receive the necessary treatment to recover and return to work or reach maximum medical improvement (MMI).

Will My Surgery Be Covered by Workers’ Comp?

If your surgery is deemed medically necessary and directly related to your work injury, it is typically covered by workers’ compensation. However, the process often requires approval from the workers’ compensation insurance company. This involves the review of medical records and recommendations from healthcare providers.

Insurance companies often seek a second opinion or an independent medical examination (IME) to confirm the necessity of the surgery. This can sometimes delay the process, but if your attorneys notice unnecessary delays, they can take steps to keep the claim process on track.

Can Surgery Increase My Workers’ Comp Settlement?

Surgery can increase a workers’ compensation settlement, as it often reflects the severity of the injury and the associated medical costs. Surgery often indicates a greater impact on the worker’s ability to earn a living, which should be reflected in the settlement offer.

The settlement amount may be influenced by:

• The overall cost of the surgery
• The extent of rehabilitation required
• The expected duration of recovery
• If surgery results in a permanent disability or partial impairment

Additionally, the timing of surgery can affect workers’ compensation settlements. If surgery is recommended but not yet performed, initial settlement offers may be higher, as they should cover the surgical costs. However, if surgery improves the worker’s condition before the settlement is finalized, the compensation may decrease since fewer ongoing medical needs or lost wages are anticipated.

Importantly, complications from surgery could increase the settlement due to additional medical needs and impacts on work capacity. Therefore, your lawyer will pay attention to the timing and surgical outcomes of surgery to help negotiate for an appropriate final settlement amount.

Does the Type of Surgery Affect the Claim?

The type of surgery can significantly influence a workers’ compensation claim. This is because different procedures lead to varying recovery times and potential outcomes. For example, a minor outpatient procedure may not substantially affect a settlement, whereas major surgeries like spinal or joint surgeries often have significant implications.

Complex surgeries also involve more extensive recovery periods, rehabilitation, and possibly long-term effects, such as chronic pain or reduced mobility. These factors are key considerations when calculating the settlement, as they impact the injured worker’s immediate and future financial needs.

The necessity and urgency of the surgery also play a role. Emergency surgeries following a work accident may be covered differently from elective surgeries recommended after initial treatments. The latter may require more rigorous justification to be covered under workers’ comp.

What Factors Can Determine a Work Compensation Settlement?

Your workers’ compensation claim will depend on several factors that will determine the final settlement. Each case is unique and features different circumstances, which in turn lead to different settlement amounts.

The primary considerations include:

• All treatment expenses linked to the injury, such as surgeries, therapy, hospital stays, and medications.
• If the injury leads to loss of earnings because of inability to work.
• Lasting impairment may lead to additional compensation based on the severity and impact on the worker’s life.
• Some settlements may consider chronic pain or emotional distress if the injury severely impacts the worker’s daily life.

While the settlement amount for a workers’ comp claim depends on several factors, it is possible to obtain adequate compensation for your suffering. However, you need to anticipate challenges seeking to deny the claim. Luckily, your workers’ compensation attorney may appeal with the Department of Labor and Workforce Development to ensure you receive timely and sufficient compensation to cover your work injury-related losses.

Consult a New Jersey Workers’ Comp Attorney Now

Our legal team at Varcadipane & Pinnisi, P.C. represents injured workers with serious injuries. Please contact us for your free consultation today.

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