Does Surgery Increase Workers Comp Settlement?

The short answer is, yes, surgery does increase a workers comp settlement amount. But it still depends on the kind of surgery you’ll have.

Minor surgeries that are minimally invasive typically cost less and have shorter recovery periods. So if they increase your settlement amount, it won’t be that noticeable. But major surgeries like organ replacement or heart bypass are more expensive. So they may increase your settlement amount significantly.

If you’re wondering how much additional settlement you can get after your surgery, here’s a quick guide for you.

How is Workers Comp Settlement Calculated?

Your workers comp settlement will typically include two types of workers comp benefits:

  • lost wages compensation
  • medical benefits

Lost wages are calculated based on your average weekly wage and how long you need to be off work. Your average weekly wage, in turn, will be based on your average earnings from before you got injured.

While medical benefits will cover all the medical expenses necessary for you to get better. This includes emergency treatment, medications, medical supplies, surgeries, and rehabilitative therapy.

Note, however, that your medical benefits will be paid directly to your treatment provider. Workers comp laws require that treating doctors should be accredited by the insurance carrier. Most of these doctors are also employed by the insurance company.

So unless it’s a reimbursement, you won’t receive cash for your medical benefits. Though it will be included in your settlement computation.

Your settlement will either be released in a lump sum or structured payments. If you opt for a lump sum settlement, you get a one-time cashout but you may not be able to get anything more even if your condition worsens.

Structured payments, on the other hand, typically last until you return to work or have reached maximum medical improvement (MMI).

Before agreeing to a settlement amount, make sure to consult with your workers comp lawyer first. Insurance companies are notorious for paying as little benefit as they can legally get away with.

If you’re not familiar with your state’s workers comp laws, you’ll most likely be offered a settlement that’s much lower than what you’re really entitled to. And that’s the last thing you want to happen.

HOw Will Surgery Affect My Workers Comp Settlement?

Getting surgery for a work-related injury can affect both your medical benefits and lost wages compensation.

Obviously, your medical benefits will now include the cost of the surgery, any medications, and rehabilitative therapy (if necessary).

Some types of surgeries, particularly invasive ones, also require long recovery periods. This can extend your absence from work which, in turn, will increase your lost wages benefits.

But, as I’ve mentioned, this will still depend on the type of surgery you need.

Cases involving amputation, for instance, received an average settlement of $25,000 up to $110,000. While those who suffered from vision loss and have likely needed an eye surgery only received $6,000 up to $36,000. These data are based on the Florida claims database from 2012 to 2022.

An injured worker holding on to his walking crutches.

Who Pays for the Surgery if My Case Hasn’t Been Settled?

If your surgery happened in the middle of your workers comp claim, the payment for it will form part of your medical benefits.

As I’ve said, in a workers comp case, your treating doctor should be accredited by your insurance carrier. They will then send all the medical billing to your insurance provider. And if your claim is approved, the insurance company will pay for all the costs related to the surgery including post-operative care.

What If I Had the Surgery After the Case Is Settled?

If you already received a settlement for your claim and your doctor found that you need surgery, getting an additional settlement can be tricky.

As mentioned, if you opt for a lump sum settlement, you may not be able to demand additional benefits in case your condition worsens. 

However, if your settlement doesn’t include a waiver for future medical benefits, you may still file a claim for the surgery. This is usually the case for structured settlement payments.

Whichever the case is for you, an experienced workers comp lawyer like Victor Malca can help you get the benefits you rightfully deserve. He has already helped thousands of injured workers in Florida fight for their rights. He can help you too. Contact us now for a free consultation.

(Related: How to Track Your Workers Comp Check: A Quick Guide)

VICTOR MALCA – Florida Workers Compensation & Social Security Disability Attorney

Victor Malca P.A. has over 27 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. His experience and continued success when fighting for his clients puts him among the most trusted workers’ compensation attorney’s in Florida. He specializes in representing injured workers on compensation benefit cases and disabled individuals claiming lost social security disability benefits.

Book a free consultation today. Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida.

About The Author

Judy Ponio is a writer and editor for the Victor Malca Law P.A. website and blog. She enjoys helping people in need with questions about social security disability and workers compensation law. She has a passion for helping those in need and the elderly with accurate legal information that can make a positive difference in their lives.