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 authorized 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. However, 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.
AVERAGE WORKERS’ COMP SETTLEMENT FOR SURGERY
The average workers’ compensation settlement for surgery ranges between $2,000 and $30,000. But, it’s important to note that settlement amounts can vary based on factors. This includes the severity of the injury, the type of surgery, and individual circumstances.
The specific details of the case and jurisdictional laws also play a role in determining the final settlement amount.
It’s important to know that the laws about workers’ compensation are different depending on where you live. It’s a good idea to talk to a lawyer who knows the laws in your area to understand how your case might be affected.
HOW LONG DOES IT TAKE WORKERS’ COMP TO APPROVE SURGERY?
The time it takes for workers’ compensation to approve surgery can vary depending on various factors. This includes the complexity of the case and jurisdictional regulations. While there isn’t a fixed timeframe, there are some general guidelines.
Insurers typically aim to approve surgeries that are likely to help injured workers recover or allow them to return to suitable work. It is recommended to provide notice of proposed surgery to the insurer. Then within six weeks (42 days), the insurer’s medical consultant should provide their findings on the proposed surgery.
In some cases, workers’ comp claims administrators must make a decision on treatment authorization within 5 working days of receiving the request.
But, the entire process of getting surgery approved by workers’ compensation can take days, weeks, or even months, depending on the specific circumstances and the efficiency of the insurance company involved.
HOW LONG DOES IT TAKE TO GET A SETTLEMENT AFTER SURGERY?
Generally, it may take 30 days to 14 months or more to finalize a settlement after surgery. The time it takes to receive a settlement after surgery can vary depending on various factors, such as the case’s complexity, negotiations between the parties involved, and jurisdictional regulations.
DOES HAVING MULTIPLE SURGERIES INCREASE MY WORKERS’ COMP SETTLEMENT?
Having multiple surgeries can potentially increase a workers’ compensation settlement. The reason is that each surgery incurs additional medical expenses, which can indicate the seriousness and complexity of the injury.
The settlement amount may be adjusted to cover the costs of multiple surgeries, including the surgeries themselves, post-operative rehabilitation, and potential future medical expenses.
It’s important to note that the specific impact on a workers’ comp settlement may vary depending on various factors, such as the severity of the injuries, the necessity and relevance of each surgery, and the jurisdictional regulations.
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).
The type and seriousness of your injury can affect how much money you get in a settlement. You’re more likely to get a higher settlement if you need major surgery for a serious injury.
The cost of the surgery and any other medical expenses will also be considered. This includes things like medicine or therapy you might need after the surgery. These costs can make the settlement amount higher.
When you have surgery, it takes time to recover, which means you can’t work. This can lead to getting more money for lost wages. If the surgery is invasive or requires a lot of therapy, it may take longer to recover and impact how much compensation you receive.
If the surgery leaves you with a permanent disability or problem, it can also affect the settlement. This means your ability to do your job will be considered when deciding how much money you should get.
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.
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 authorized 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.
CAN I SETTLE MY CASE BEFORE SURGERY?
Yes, settling a personal injury case before surgery is possible. Whether or not you can settle your case before surgery depends on various factors, including the circumstances of your case, the severity of your injuries, and the negotiations between the parties involved. It is important to consult with a personal injury attorney who can guide you through the legal process and help determine the best course of action for your specific situation.
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.
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.