If you’ve sustained a serious injury in the workplace, you’re dealing with two complicated situations at once: getting medical care to recover and applying for workers’ compensation.
As part of your care, it’s possible that a doctor might offer surgery as a treatment option. Such an important choice leaves a lot to consider. If you’re wondering how surgery would impact your workers' comp benefits, you’re not alone.
Surgery can increase, or decrease, your workers' comp settlement amount depending on the surgery type and surgery timing. Let’s dig into how surgery may impact your claim and how workers’ compensation benefits are calculated.
Will surgery increase my workers' comp benefits?
Undergoing surgery has very real physical and emotional impacts. Above all, we recommend making the right choice for your health — not for the possible increase in payout.
While surgery can in some cases increase your benefits, it’s not guaranteed, and you would never want to put yourself in a position of making a major medical choice on a gamble.
The reality is, workers’ comp payments differ depending on the surgery, the timing, and the result. Here are three key factors to consider:
Timing of surgery. Typically, workers’ comp settlement offers are low before there is a diagnosis or recommendation for further treatment — including surgery. If a medical professional makes a recommendation for surgery, this will almost always increase the initial settlement amount.
However, if you have a successful surgery and your injury improves before settlement negotiations are completed, it could lower the overall settlement value. While workers’ compensation should cover the cost of your surgery — 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, less compensation would be required (but you’d also be healthier!).
Surgical results. On the other hand, you may have a surgery that’s less successful. If this occurs before the settlement negotiations end, and the surgery worsens your injury or causes further complications, it might increase the settlement. But it will certainly be worse for your long-term health.
Type of surgery. Due to their severity and perceived impact on your ability to work, some types of surgeries will merit a higher or lower settlement. For example, a carpal tunnel surgery will yield lower settlement value than a lower back I5-S1 injury.
All of this points toward carefully weighing the pros and cons of surgery with your medical doctor. You can’t count on surgery as a tactic to increase benefits. More than anything, take this time to get aligned with your doctor, follow their instructions, and build an ally for your case.
What exactly determines a workers' comp settlement?
To understand your workers' comp settlement, it’s important to understand there are two phases of workers' comp when you can receive payments:
Active phase: This is when you’re out of work and receiving treatment to improve your injury. If your claim is accepted, you’ll receive wage replacement at this time, a percentage of your previous wages, and an additional amount for treatment costs.
“Maximum Medical Improvement”: At this stage, a doctor determines you’ve reached a plateau in your recovery and may not keep improving. If your injury leaves with a lingering medical impact, you may be entitled to additional payments. The duration of these payments varies by state, and they're designed to cover continued medical costs and, potentially, financial damages due to lost wages from your continued inability to work.
How are benefit payments calculated?
Your benefits will be calculated based on a variety of factors, such as injury type, severity, medical care, and your ability to return to work. The diagnosis you receive from your doctor often has the biggest impact on these payments.
Much of these calculations are negotiable. A lawyer can negotiate your “medical rating” (which comes from your doctors’ diagnosis) — which is directly correlated to your payment amount. They can also negotiate whether you’re receiving adequate care at any stage of the process.
The best thing you can do to maximize payment: Get a lawyer on your side.
Workers’ comp is complex and it varies wildly by state. How your doctor diagnoses you and how you frame your case make a major impact on benefits. Hiring a lawyer who understands the system ensures the best possible care and support for your future.
At Atticus, we’re here to help. We’ll start by hearing your story and offering free legal guidance — if you wish to connect with a lawyer, we’ll connect you with one from our trusted network.
Victoria Muñoz is an attorney on Atticus’s Workers' Compensation team. She’s a licensed attorney, a graduate of Stanford Law School, and has counseled hundreds of people seeking workers' compensation. In her free time, she enjoys hiking and spending time with her pup.
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