Does Surgery Increase Workers’ Comp Settlement?

When workers are injured on the job, they often turn to workers’ compensation to cover their medical expenses and lost wages.

Each year, millions of workers in the U.S. suffer work-related injuries. According to labor statistics, private employers reported 2.8 million injury and illness cases in 2022 [1].

Many of these cases involve serious injuries that require surgery, leading to questions about how surgery can affect a workers’ compensation settlement.

Understanding whether surgery increases a worker’s settlement amount is critical for injured workers seeking fair compensation. Our workers’ compensation attorneys can help you understand the factors influencing compensation settlement amounts and the role surgery plays in determining the outcome.

Factors Affecting Workers’ Compensation Settlement Amounts

Workers compensation settlements vary widely from case to case, depending on several key factors. Each workers’ compensation claim is unique, and the settlement amount hinges on numerous elements related to the injury and recovery process.

These include the nature and severity of the injury, related medical expenses, lost wages, pain and suffering, and future medical care.

The Nature and Severity of the Injury

The extent of the injury is one of the most significant factors in determining the amount of compensation a worker receives in a settlement.

The severity of the injury can affect a person’s ability to return to work, influencing medical costs and future wage loss. More severe injuries that require surgery or cause disability lead to higher settlement amounts.

Medical Expenses

The cost of medical treatment plays a critical role in calculating the average workers’ comp settlement. This bill includes hospital stays, medications, physical therapy, and, if necessary, surgery.

Workers who undergo surgery will likely face more significant medical bills, which increases the overall settlement value. Future medical costs related to recovery or ongoing care are also considered.

Lost Wages

If the injury prevents the employee from working for an extended period, lost wages can significantly increase the settlement. Workers who require surgery often have longer recovery periods, resulting in substantial wage loss. The settlement negotiations must account for these lost earnings, especially if the surgery leads to a temporary or permanent inability to work.

Pain and Suffering

While workers’ compensation laws primarily focus on economic damages, in some cases, pain and suffering may be considered. The physical and emotional toll of a work injury can influence the settlement, particularly if the injury leads to long-term disability.

Future Medical Bills

In cases where the injured worker may require additional medical care after surgery—such as follow-up treatments, future surgeries, or long-term rehabilitation—these future medical treatments will be factored into the medical benefits element of a workers’ compensation settlement.

The average workers’ compensation settlement should reflect the costs already incurred and projected future care, especially if the worker has yet to reach maximum medical improvement (MMI). MMI is the point at which the worker’s condition has stabilized, and no more significant improvement is expected, directly impacting the calculation of ongoing care costs.

The Role of Surgery in Workers’ Comp Settlements

Surgery is often necessary for more severe work-related injuries, and it can profoundly impact the average workers’ comp settlement.

When a treating physician recommends surgery, it signals that the work-related injury is significant enough to require an invasive procedure for recovery. This recommendation can influence how the employer’s insurance company views the severity of the injury and the overall settlement value.

Surgical procedures often lead to higher medical costs, extended recovery times, and a potential need for ongoing care, all of which must be factored into the final workers’ comp settlement. Let’s delve into the specific ways surgery influences compensation.

Medical Necessity

To increase a workers’ compensation settlement, claimants must prove that the surgery is medically necessary, meaning it is essential for the worker’s recovery and directly related to the workplace injury.

The workers’ compensation claim could be jeopardized if there is any question about whether the surgery is necessary or related to the work injury. Medical documentation and expert testimony are critical in establishing the need for surgery and ensuring that workers’ compensation benefits cover it.

Impact on Recovery

Surgery can drastically affect an employee’s recovery timeline and overall ability to return to work. In some cases, surgery improves workers’ condition and allows them to return to work sooner.

However, surgery may also lead to a longer recovery period or result in complications that impair the worker’s long-term earning potential. The outcome of the surgery can significantly influence the workers’ comp settlement, especially if the surgery leads to partial or permanent disability.

Increased Damages

If the surgery leads to a permanent disability, the overall settlement amount will likely increase. Permanent disability means the worker will never fully recover from the injury and will face long-term or lifelong limitations. In such cases, the settlement must account for the worker’s inability to earn the same wages as before and ongoing medical needs.

Whether the surgery improves the worker’s condition or leaves them with a permanent disability is crucial in determining compensation.

Other Factors Affecting Settlement Amounts

Additional factors beyond surgery influence workers’ comp benefits. Understanding these factors is vital to navigating the claims process effectively.

Severity of the Injury

The more severe the injury, the greater the likelihood of a higher compensation settlement for the worker. A serious injury that affects vital body functions or causes long-term impairments will increase the settlement amount.

Injuries that lead to permanent disability, such as loss of a limb or chronic pain, or that lead to a need for surgical procedures will drastically impact the settlement.

Lost Wages

The amount of lost pay due to time off work directly affects the settlement. Workers who undergo surgery need extended recovery periods, during which they cannot work.

The compensation settlement for the worker should include compensation for the income lost during this time. If the injury results in permanent disability, the settlement must also cover future wage losses.

Pain and Suffering

While pain and suffering are not always included in compensation settlements for workers, this factor may come into play in cases involving severe workplace injuries. If the surgery leads to chronic pain, emotional distress, or a significantly reduced quality of life, compensation for pain and suffering may be warranted.

Future Medical Expenses

If the worker requires future surgical procedures, physical therapy, ongoing rehabilitation, or long-term care following the surgery, these future costs must be factored into the comp settlement. Planning for future treatments ensures the injured worker receives adequate compensation for their ongoing medical needs.

Legal Considerations

Workers’ compensation claims are complex, and several legal considerations must be kept in mind when seeking compensation after surgery.

Burden of Proof

The injured employee has the burden of proving that their injury occurred during the course of their employment and that it required surgery. This step means gathering strong evidence to demonstrate that the injury is work-related and that the surgery was necessary for recovery.

Medical records, witness statements, and documentation from the employer can all support the workers’ compensation claim.

Medical Evidence

Medical evidence is essential in supporting workers’ compensation claims. For a successful settlement, documentation must show that the surgery was medically necessary and directly related to the work injury. Medical professionals may need to testify or provide written statements to corroborate this.

The insurance company may request an independent medical examination to confirm the worker’s condition.

Expert Testimony

Expert testimony can strengthen a workers’ compensation claim, especially when surgery is involved. Medical experts can testify about the severity of the injury, the necessity of the surgery, and the long-term implications for the worker’s health and ability to work. This expert testimony is often crucial in obtaining maximum settlement.

Why You Need a Workers’ Compensation Attorney

Navigating the complexities of a workers’ compensation claim process, especially when surgery is involved, can be overwhelming. This process is where legal support becomes invaluable.

Legal Expertise

A specialized attorney understands the intricacies of workers’ compensation laws and how to secure maximum benefits for injured workers. Experienced lawyers can provide guidance on gathering evidence, filing a claim, and handling disputes with the employer’s insurance company.

Negotiation Skills

A skilled lawyer brings strong negotiation skills to the table. Many settlements are negotiated between the worker’s attorney and the employer’s insurance company. Workers’ compensation attorneys can deal with the insurance company to ensure you receive a settlement that fully compensates you for your medical expenses, lost pay, and long-term needs.

Advocacy

Above all, a lawyer acts as your advocate. They will fight for your rights, ensure you are treated fairly, and work to maximize your compensation. Whether negotiating with a third party or their insurance company, they will have your best interests in mind at every stage.

Without legal representation, it’s easy to feel pressured into accepting a low settlement offer that doesn’t fully cover your losses.

Secure Expert Legal Representation!

If you’ve been injured on the job and required surgery, it’s essential to understand your rights and pursue the compensation you deserve. Navigating a worker’s compensation claim can be challenging, but you don’t have to do it alone. Rosenfeld Injury Lawyers are here to help you through the entire process, from gathering medical evidence to negotiating a fair settlement.

Contact us today at (888) 424-5757 for a free consultation with a Chicago workers’ comp lawyer from our team, or complete our contact form.

References: [1] BLS

All content undergoes thorough legal review by experienced attorneys, including Jonathan Rosenfeld. With 25 years of experience in personal injury law and over 100 years of combined legal expertise within our team, we ensure that every article is legally accurate, compliant, and reflects current legal standards.