If you’ve suffered a job-related injury that required surgery and are pursuing a Pennsylvania workers’ comp settlement, you may be wondering, ‘Does surgery increase workers’ comp settlements?’
Here, our experienced workers’ compensation lawyers at Win Big Law provide valuable insights on how undergoing surgery may influence your settlement, ensuring you receive the maximum benefits you deserve.
Surgery May Increase Your Workers’ Compensation Settlement
In general, surgery or a potential surgery may increase the financial value of your workers’ comp settlement. Specifically, the timing, results, and type of surgery can affect the value of a claim. Before accepting a workers’ compensation settlement, it is essential to understand how surgery can affect your claim for your medical costs and lost wages.
Why Surgery Can Increase Your Workers’ Comp Settlement
Under Pennsylvania law (77 P.S. § 531), workers’ compensation insurance must pay for your medical expenses, including surgery. If your surgery is unsuccessful, the value of your claim will increase, as this means you are more likely to have a higher disability rating. Additionally, whether or not your surgery is successful, you will not be able to work while recovering from the surgery, which means your employer’s insurance company will have to continue paying your lost wages.
The Cost of Medical Treatment
The cost of medical treatment, including surgery, is a majorfactor insurance companies consider when calculating a workers’ comp settlement. Specifically, if you have not undergone surgery and your case has not been settled, your employer’s workers’ comp insurance carrier must factor the cost of future medical expenses into your workers’ comp settlement. Additionally, if the surgery is complex and highly invasive, the workers’ comp insurance company will have to factor in other costs, such as follow-up and rehabilitative care, which can increase the value of your claim.
Do Multiple Surgeries Affect a Settlement More?
Yes, multiple surgeries may increase the value of your workers’ compensation settlement. As explained by the Pennsylvania Supreme Court, injured workers cannot claim a specific permanent loss from an injury if surgery restores some or all the lost function. If your injury requires multiple surgeries, it is likely you will never fully recover and will be left with a permanent disability, which can increase the value of your workers’ comp settlement.
Does the Type of Surgery Play a Part in the Settlement Amount?
The type of surgery can significantly influence the settlement amount in a workers’ compensation claim. Complex surgeries that involve high-risk procedures, extensive rehabilitation, or a lengthy recovery period tend to increase the settlement value.
This is because such surgeries reflect the severity of the injury and the consequent impact on the worker’s life, potentially leading to higher compensation for medical expenses, lost wages, and long-term disability. Insurance companies assess the surgery’s intricacy, the necessity for future medical interventions, and the overall prognosis post-surgery.
Therefore, when negotiating workers’ comp settlements, the specific type of surgery, its associated risks, and the expected outcomes are crucial factors that can sway the compensation amount, reflecting the gravity of the worker’s condition and the anticipated costs for their optimal recovery and rehabilitation.
Does the Location of the Surgery Affect the Settlement
The location of the surgery, referring to the medical facility or the geographic location where the surgery is performed, can influence the workers’ compensation settlement, albeit indirectly. High-cost regions or specialized medical centers may incur higher charges for surgical procedures, which can, in turn, elevate the settlement amount to cover these increased costs.
If the surgery is performed in a facility known for its expertise in a particular type of medical procedure, the insurance company might recognize the necessity for higher compensation. Conversely, surgeries carried out in less specialized settings might not impact the settlement significantly, unless the case specifics demand consideration of such factors.
Unsuccessful Surgery & Workers’ Comp
Unsuccessful surgeries can have a profound impact on workers’ compensation claims, often leading to increased settlement amounts. When surgery does not yield the expected outcomes, it may indicate a more severe injury or a potential for long-term disability. Such situations may necessitate additional medical treatments, prolonged recovery periods with physical therapy, or even further surgeries, escalating the overall cost covered by the settlement.
Insurance companies typically consider the likelihood of ongoing medical issues and the possibility of increased disability and medical benefits when evaluating the claim’s worth post an unsuccessful surgery. Consequently, the acknowledgment of an unsuccessful surgery within a workers’ comp claim can substantially influence the settlement negotiations, emphasizing the need for adequate compensation to address the worker’s heightened medical and financial needs.
The Type of Workers’ Comp Settlement Plays a Part
Under Pennsylvania law (77 P.S. § 1000.5), workers’ compensation benefits are formally known as “compromise and release” agreements. You can negotiate to receive your workers’ compensation settlement in installments or one lump sum payment. If your injury is severe and you have not undergone surgery, you are more likely to receive a higher lump sum payment or installments to cover the cost of your surgery and compensate you for your permanent disability.
Surgery Before Vs. After Settlement
The timing of surgery, whether before or after reaching a settlement in a workers’ compensation case, can significantly influence the settlement’s terms and amount. Undergoing surgery before your workers’ comp settlement can provide a clearer picture of the injured worker’s medical needs, recovery trajectory, and potential long-term effects to determine the settlement value.
Getting surgery before allows the insurer to assess the actual costs of medical care, rehabilitation, and any necessary future treatments. Conversely, if the surgery occurs after the settlement, there may be uncertainties regarding the total cost of medical care and the possible need for additional treatments. This might lead to a workers’ comp settlement that doesn’t fully cover all medical expenses or adequately compensate for the worker’s injuries.
How Is Workers’ Comp Settlement Calculated?
Your workers’ compensation benefits are determined by a combination of factors: your average weekly wage, your disability rating, and the portion of your body that was injured. Additionally, the insurance company will also factor in the legal and factual strength of your workers’ compensation when considering and calculating a fair settlement.
Factors Affecting Your Settlement
Beyond surgery, several other factors can significantly impact your workers’ compensation settlement. Specifically, factors such as:
- Your prior medical history
- The severity of your injury
- The length of your recovery period
- Future medical expenses
- The strength of your doctor’s medical opinion
Additionally, your willingness to litigate your claim can affect your workers’ comp benefits, as your employer’s insurance company will have to factor in the cost of future litigation.
What to Do If Insurance Denies Your Claim
If your workers’ compensation claim is denied by the insurance company, it’s crucial to respond proactively to protect your rights. Initially, review the denial letter closely to understand the specific reasons for the rejection, as this will inform your next steps. It’s essential to file an appeal within the stipulated timeframe, as missing this deadline can jeopardize your chance to contest the decision.
Speaking with a seasoned workers’ compensation attorney can be pivotal; they can help navigate the appeals process, gather necessary evidence, and advocate on your behalf so you have the highest likelihood of maximum medical improvement. Additionally, preparation for a hearing may be required, where you can present medical records, witness testimony, and other pertinent documentation to challenge the insurer’s decision and seek favorable workers comp settlements.
Approval for Work-Related Injury Surgery
Securing approval for surgery as part of your workers’ comp claim can be a complex process. In short, injured workers need a doctor to provide an opinion stating that surgery is reasonable and necessary. If your employer’s insurance company refuses, you can request a hearing by filing a Petition to Review Medical Treatment.
Talk With an Experienced Workers’ Compensation Attorney About Your Work-Related Surgery
Employers and insurance companies only care about preserving their bottom line. If you suffered a job-related injury that requires surgery, it is essential to understand how your surgery can affect the monetary value of your claim, and an experienced workers’ compensation lawyer can help you navigate the issues arising from your claim.
Learn how the workers’ compensation lawyers at Win Big Law can maximize your settlement!
