Does Surgery Increase Workers' Comp Settlements?
The question of whether surgery increases workers' compensation settlements is complex and doesn't have a simple yes or no answer. The impact of surgery on a workers' compensation settlement depends on several crucial factors, and it's rarely the sole determinant of the final amount. Let's explore the key considerations.
What factors influence workers' compensation settlements?
Several factors contribute to the overall settlement amount in a workers' compensation case. These include:
- The extent of the injury: The severity of the injury is paramount. A more severe injury requiring extensive medical treatment, including surgery, will generally lead to a larger settlement than a minor injury.
- Lost wages: The amount of income lost due to the injury significantly impacts the settlement. Longer periods of lost work and reduced earning capacity justify higher settlements.
- Medical expenses: The total cost of medical care, including surgery, hospitalization, rehabilitation, and ongoing treatment, directly influences the settlement amount. Surgical procedures are expensive, and these costs are factored into the calculation.
- Permanent impairment: If the injury results in permanent physical limitations, this significantly increases the settlement value. A surgical procedure may improve the condition but might still leave some permanent impairment requiring ongoing care or impacting future earning potential.
- Pain and suffering: In some jurisdictions, compensation for pain and suffering is included in the settlement. The severity of pain experienced, both before and after surgery, can affect this component of the settlement.
- Legal representation: The skill and experience of a workers' compensation attorney can be crucial in negotiating a fair settlement. A strong legal advocate can ensure all damages, including those related to surgery, are properly accounted for.
- Jurisdictional laws: Workers' compensation laws vary significantly by state or province. These laws dictate what types of benefits are available, how they are calculated, and the process for resolving disputes.
Does the need for surgery automatically mean a larger settlement?
No, the need for surgery doesn't automatically guarantee a larger settlement. While surgery often indicates a more serious injury, the outcome of the surgery is just as important. A successful surgery that fully restores function might result in a lower settlement than a less successful surgery that leaves significant permanent impairment. The overall impact on the injured worker's ability to return to work and their long-term prognosis plays a significant role.
What if surgery doesn't fully resolve the injury?
If surgery doesn't fully resolve the injury or leads to complications, it can increase the settlement amount. This is because the ongoing medical expenses, pain and suffering, and reduced work capacity continue to accrue. The worker might require additional surgeries, physical therapy, or other forms of ongoing medical care.
How do insurance companies view surgery in workers' compensation cases?
Insurance companies carefully evaluate the necessity and success of surgeries. They may request independent medical examinations (IMEs) to verify the need for the surgery and assess its outcome. They will analyze the medical records, surgical reports, and the overall impact on the worker's ability to return to work. They may contest the necessity or success of a surgery if they believe it is not justified or if it does not significantly improve the worker's condition.
Can I negotiate a higher settlement if I need surgery?
Negotiating a higher settlement is always a possibility, especially if surgery is involved. However, simply needing surgery doesn't automatically entitle you to a higher amount. A skilled workers' compensation attorney can help build a strong case by presenting comprehensive medical evidence demonstrating the extent of the injury, the need for surgery, the costs incurred, the resulting limitations, and the potential for future expenses.
In conclusion, surgery can be a factor influencing the size of a workers' compensation settlement, but it's not the only factor. The overall impact of the injury, the success of the surgery, and various other legal and medical considerations all play significant roles. Seeking legal counsel from an experienced workers' compensation attorney is crucial to understand your rights and ensure you receive a fair settlement.
