Does Surgery Increase Workers’ Comp Settlement?

If you’ve been injured on the job and are facing the prospect of surgery, you may be wondering how this will impact your workers’ compensation settlement. Generally, the answer to “Will surgery increase a workers’ comp settlement?” is yes. However, there are several factors to consider when navigating surgery and workers’ compensation claims, including the timing of the surgery and the type of settlement you pursue.

In this blog, we’ll break down how surgery affects workers’ compensation settlements in Florida, how the amount is determined, and what you need to know if you require surgery before or after settling your claim.

Navigating the workers’ compensation system can be challenging, but our Miami workers’ comp lawyers are here to help you get the fair settlement you deserve. Contact us today

How Are Workers’ Compensation Settlements Determined

Before understanding how surgery affects your workers comp settlement, it’s important to grasp how the settlement amount is determined. Workers’ compensation settlements typically cover medical expenses and lost wages.

Medical Benefits

A significant part of most workers’ compensation settlements go toward covering medical care. This includes hospital bills, doctor visits, prescriptions, physical therapy, and any other medical treatment deemed necessary by your treating physician. Surgery falls under this category, and the cost of undergoing surgery is one of the most significant expenses injured workers can face.

Disability Benefits

Workers’ compensation settlements also include compensation for lost wages and disability. These benefits are classified into two types:

Temporary Disability

Injured workers may be entitled to temporary total or partial disability benefits, depending on the extent to which they are unable to perform their job duties during recovery.

Permanent Disability

If your workplace injury results in a long-term or permanent disability, you may receive compensation for future earning capacity. This is often awarded when the injured worker reaches maximum medical improvement (MMI), the point at which your condition is not expected to improve further with additional medical treatment.

Surgery often leads to a higher settlement due to the complexity and costs of surgical procedures and their impact on your ability to return to work.

does surgery increase workers comp settlement in Florida

Will Surgery Increase Your Workers Comp Settlement?

Surgery can have a profound effect on the value of your workers’ compensation settlement, but several factors determine just how much it will influence the final settlement amount. Let’s explore the key considerations.

Surgery Costs and Type of Procedure

The average workers’ compensation settlement for surgery can vary greatly based on the type of procedure. More complex or invasive surgeries come with higher medical costs, which will be factored into the settlement.

In addition to the direct costs, surgeries often require longer recovery periods, leading to more lost wages and the potential for lasting work limitations. The average workers comp settlement can vary significantly depending on whether the injured worker is expected to make a full recovery or suffer from permanent limitations.

Type of Settlement Plan

In Florida, workers’ compensation settlements can be structured in two main ways:

  • Lump-Sum Payments: A one-time payment that covers all past and future medical costs, including the cost of surgery.
  • Structured Settlements: Payments are made over time, allowing for ongoing medical treatment, including surgeries and future medical expenses.

The type of settlement you choose will impact how surgery is accounted for. In a lump-sum payment, it’s essential to include the projected cost of surgery and any associated indirect expenses in the settlement. In contrast, a structured settlement may allow for future surgeries to be covered as they arise.

Timing of the Surgery

The timing of surgery can significantly affect your workers’ comp settlement. If you need surgery before you settle your workers’ compensation claim, you can include the cost of the surgery and related medical expenses in your settlement. However, if you realize you need surgery after settling your claim, your ability to have the procedure covered through workers’ comp may be limited.

surgery for a work injury

What If You Need Surgery Before Settling Your Workers’ Comp Claim?

If your doctor determines that surgery is necessary before you reach a settlement, you can include the medical costs associated with the surgery in your workers’ compensation claim. Surgery is often one of the most expensive medical treatments, so it can significantly increase the overall settlement value.

Additionally, undergoing surgery before settling your claim allows you and your attorney to account for any unexpected complications or additional treatments that may arise during recovery. If you are left with a permanent impairment after the surgery, you have the option to seek a higher settlement.

Surgery After Settling Your Workers’ Comp Claim

Once you settle your workers’ compensation case, it becomes much more complicated to recover additional funds for surgeries that were not anticipated. That’s why it’s critical to work with an experienced lawyer to ensure that all potential future medical costs are considered during settlement negotiations.

Including Surgery in Your Settlement Negotiations

If you know that surgery is required in the future when negotiating your settlement, your lawyer can request compensation to cover the projected costs of the procedure. This way, you can receive fair compensation upfront and won’t need approval from the workers’ comp insurance company to undergo the surgery.

No Recovery for Additional Costs After Settlement

Once you accept a lump-sum settlement, you generally won’t be able to recover compensation for unexpected expenses or complications that arise from surgery. This is why it’s essential to plan carefully and include any anticipated costs in your settlement amount.

Surgery Needed After Settlement

In some cases, a doctor may determine that surgery is necessary after a workers’ compensation claim has already been settled. Unfortunately, unless the surgery was already included in your negotiated settlement, the insurance company may refuse to cover the surgery. If you find yourself in this situation, you may have limited options to pursue additional compensation.

What If Surgery Is Denied?

Sometimes, the workers’ comp insurance company may deny your request for surgery, even if your medical provider recommends it. If this happens, you have options.

Seek Legal Guidance

An experienced workers’ compensation attorney can help challenge the denial of surgery. The attorney can work to prove that the surgery is medically necessary and directly related to your work injury.

Request a Hearing

If the insurance company continues to deny the surgery, your attorney can request a hearing before a workers’ compensation judge. During this hearing, both sides will present their case, and the judge will decide whether the surgery should be covered by the insurance company.

Consider Independent Medical Exams

In some cases, it may be necessary to undergo an independent medical exam (IME) by a doctor chosen by the insurance company. While these doctors may be biased, the findings of the IME could support your claim for surgery if they align with your treating physician’s recommendations.

Miami workers' compensation lawyer

Contact Our Experienced Miami Workers’ Comp Lawyers

In Florida, surgery often leads to a larger settlement in workers’ compensation cases due to the costs of medical care and the extended recovery times associated with surgical procedures. The cost of surgery, its timing, and the type of settlement plan you pursue all play crucial roles in determining the final workers’ compensation settlement amount.

If you’re facing surgery due to a work injury, it’s essential to work with an attorney who understands the complexities of workers’ compensation claims and can help you receive fair compensation for all medical expenses.

At Workers’ Compensation Lawyers Coalition in Miami, our experienced team can guide you through the claims process and ensure that you receive the maximum settlement for your case. Contact us today for a free consultation.

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