Does Surgery Increase Workers' Comp Settlements?
The short answer is: it can, but not always. The impact of surgery on a workers' compensation settlement is complex and depends on several factors. It's not simply a case of surgery automatically equating to a larger payout. Instead, the surgery's necessity, success, and resulting impact on the worker's ability to return to work are key determining factors.
Let's explore this in more detail.
How Surgery Can Increase a Workers' Comp Settlement
Surgery can lead to a larger settlement if it directly addresses the work-related injury and improves the worker's condition. Here's how:
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Increased Medical Expenses: Surgery is expensive. Workers' compensation typically covers medical expenses related to the injury, and a significant surgery adds substantially to these costs. This increased expense can be a factor in a higher settlement, especially if the surgery results in a significant improvement in the worker's condition.
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Greater Disability: If the injury is severe and requires surgery, it likely signifies a significant disability. The more extensive the surgery and recovery period, the greater the potential impact on the worker's ability to return to work, potentially leading to a higher settlement to compensate for lost wages and future earning capacity.
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Permanent Impairment: Surgery may not fully restore a worker's function, resulting in a permanent impairment rating. This rating quantifies the degree of permanent physical limitation caused by the injury, often translating into a larger settlement to compensate for the long-term impact on the worker's ability to work.
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Successful Surgery Leading to Improved Outcome: If the surgery is successful in alleviating pain and improving function, this might still lead to a higher settlement than if the surgery hadn't been performed. The worker may still have some limitations but achieving a positive outcome after surgery can strengthen a case.
How Surgery Might NOT Increase a Workers' Comp Settlement
Conversely, surgery doesn't guarantee a larger settlement. Several scenarios can negate or minimize the impact:
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Unnecessary Surgery: If the surgery is deemed unnecessary or experimental by the insurance company's medical reviewers, it may not be covered fully, and the settlement might not reflect the surgical costs.
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Unsuccessful Surgery: If the surgery doesn't improve the worker's condition or even worsens it, it could actually hurt the settlement amount. The insurance company might argue that the surgery was a failure and that the worker's condition is essentially unchanged.
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Pre-existing Conditions: Pre-existing conditions can complicate the claim. The insurance company might argue that the surgery's success, or even the need for it, is due to the pre-existing condition, not the work injury.
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Failure to Follow Medical Advice: If the worker fails to follow post-surgical instructions or attends necessary rehabilitation, the insurance company might argue that the worker is not doing everything possible to recover and could reduce their settlement offer.
What Factors Determine the Settlement Amount?
Beyond the surgery itself, several other factors influence the final settlement amount:
- The extent of the injury and its impact on the worker's ability to work.
- Medical expenses (including surgery costs).
- Lost wages.
- Future medical needs.
- Permanent impairment rating.
- Negotiation between the worker and the insurance company.
- State laws governing workers' compensation.
What if the Surgery is Recommended but not Yet Performed?
If surgery is recommended but hasn't been performed, the settlement negotiations will likely account for the projected costs and the potential impact of the surgery on the worker's recovery. The insurance company will want to understand the necessity and projected success of the procedure.
In Conclusion:
Surgery's impact on a workers' compensation settlement is not straightforward. While it can lead to a larger settlement due to increased medical costs and potential disability, its success and necessity are crucial factors. The ultimate settlement depends on various aspects of the case and is often the result of negotiation and compromise between the worker and the insurance company. Seeking legal counsel from a workers' compensation attorney is highly recommended to understand your rights and navigate the complexities of the process.
