The short answer is yes, surgery can increase a workers’ compensation settlement.
However, surgery is just one factor that can affect the final settlement amount.
Undergoing surgery has very real physical and emotional impacts.
Above all, when considering whether to undergo surgery, it’s important to make the right choice for your health—not for the possible increase in payout.
How Do I Get a Workers’ Compensation Settlement?
After a workplace injury, employees may be eligible for workers’ compensation benefits.
These benefits support the employee’s unexpected medical expenses, lost wages, and other related costs. To receive benefits, an injured employee must first file a claim.
The employer’s insurance company will investigate the claim and determine whether the employee is eligible for benefits.
Sometimes, the employer’s insurance company may offer a settlement to the injured employee.
A settlement is a lump sum payment to cover all future medical expenses and lost wages related to the work-related injury or illness.
The employee agrees to waive the right to future workers’ compensation benefits related to the injury or illness in exchange for the settlement.
In Missouri, for example, workers’ compensation settlements depend on the nature and extent of an injury, the employee’s average weekly wage, and the amount of time they will be off work.
These factors are assessed by a workers’ compensation judge or administrative law judge, who will consider the medical evidence presented by the employee and the employer’s insurance company.
It is important to note that the workers’ compensation system will benefit injured workers regardless of fault.
So even if an employee’s actions caused the injury, they might still be entitled to workers’ compensation benefits, including a settlement covering the surgery cost.
When an employee may require surgery to treat their injury, this raises the question, Does having surgery increase a workers’ comp settlement?
Does Surgery Increase a Workers’ Comp Settlement?
While surgery could potentially increase your benefits, it’s not guaranteed. In other words, you can’t count on surgery as a tactic to increase benefits.
To receive compensation for surgery, an injured worker must first demonstrate that surgery is medically necessary and related to the workplace injury.
Then, the worker must prove that the injury and surgery will have a long-term impact on their ability to work or quality of life.
When an injured worker requires surgery, it typically means that their injuries require specialized medical care.
Specialized care could mean visits to a specialist, like an orthopedic surgeon, who is generally more expensive than a general practitioner.
Additionally, if the employee requires multiple surgeries, the costs can quickly add up, resulting in a higher settlement amount.
Further, when surgery is necessary, a settlement may need to cover the cost of post-operative care, including rehabilitation and physical therapy.
If the surgery requires the employee to take time off work for recovery, this can result in higher wage loss benefits as well.
On the other hand, if you have a successful surgery and your injury improves before settlement negotiations, it could lower the overall settlement value.
Your successful surgery may demonstrate that you now need less medical care or you are able to return to work without additional lost wages.
In this case, you will be healthier, but less compensation would be required.
Does Workers Comp Pay for Surgery?
Generally, workers’ compensation benefits will cover the surgery cost if it is reasonable and necessary to treat a workplace injury. However, workers’ comp does not automatically cover all surgeries.
When an injury is considered pre-existing or unrelated to the employee’s work duties, the insurance company may not cover the surgery related to that injury.
The employee may need to pay for the surgery or seek coverage from their personal health insurance.
Keeping detailed records of all medical treatment and working closely with the workers’ comp doctors will help you accurately document your medical needs.
If the insurance company denies coverage, you may need this evidence to appeal or dispute their findings.
Can Surgery Increase Your Workers’ Compensation Settlement?
It’s important for injured workers to seek legal guidance to ensure that they receive the compensation they deserve for their injuries.
Wes Cottrell of the Cottrell Law Office has over 32 years of experience helping the injured in Arkansas, Missouri, Oklahoma, and Kansas.
His firm specializes in personal injury, workers’ compensation, and social security disability cases.
If you or a loved one has been injured and are seeking workers’ compensation benefits, do not hesitate to contact our law office today.