Workers’ compensation is designed to give you the financial support you need to recover from a workplace injury or occupational disease as quickly as possible. That includes paying for your medical expenses. So if you require surgery for your workplace injury, you’ll generally see an increase in your workers’ comp settlement to cover the cost.

However, the extent to which surgery affects your payout depends on three main factors:

  • The level of surgery required
  • The type of settlement you receive
  • Whether your surgery is carried out before or after your settlement

In this blog, we explore how these factors influence your settlement amount and what steps you can take to receive your full medical benefits.

How does surgery affect your workplace injury settlement?

Some states allow you to choose your preferred healthcare provider following a workplace injury. But in states like Kansas and Missouri, your employer or their insurance company has the right to assign you a doctor they’ve approved.

These approved doctors are often chosen because they prioritize low-cost care such as occupational therapy, physical therapy, and pain medication. But if these treatments fail or it’s clear that they’re insufficient, your doctor will recommend more expensive options such as surgery. Injuries that can require surgery include:

  • Back or spine injuries
  • Brain injuries
  • Broken bones
  • Internal organ damage
  • Penetrating or puncture injuries
  • Skull fractures

The cost of surgical procedures will be reflected in your settlement as compensation for medical expenses. Minimally invasive minor surgeries typically cost less and have shorter recovery times, so the increase in your workers’ compensation settlement will be slight. But if you require major surgery such as organ replacement, your settlement could increase by tens of thousands of dollars.

Since the same surgical procedures cost different amounts depending on your state, it’s difficult to give specific figures for how much your settlement will increase. But research into the 10 most common surgeries in the US shows that the average medical costs for some common treatments include:

  • Spinal fusion procedures for serious back injuries – $110,000
  • Joint replacement surgeries – $16,500 to $33,000
  • Surgeries to fix a broken wrist – $8,000

However, your surgical procedure isn’t the only factor that influences your settlement amount. Because surgeries can result in additional medical expenses and changes in your situation, you might also be able to claim for:

  • The cost of your hospital stay, including your bed and meals
  • Diagnostic tests such as x-rays
  • Wages lost while you recover from your surgery
  • Physical therapy to recover from the procedure
  • The cost of anesthetics
  • Medication and medical supplies
  • The cost of any complications following the procedure
  • Additional hospital visits to monitor your recovery

Finally, if your workplace injury results in temporary or permanent disability even after surgery, you might be entitled to receive disability benefits. These will also increase your workers’ compensation settlement.

How your type of settlement affects a payout increase from surgery

Workers’ compensation claims are typically settled in one of two ways:

  • Stipulation and reward: The workers’ compensation insurance company agrees to pay for any and all future medical treatments you need relating to your workplace injury
  • Compromise and release: The insurer gives you a lump sum payment that includes the anticipated cost of future treatments and benefits. You can receive this as a single payment or as part of a structured settlement plan that pays out over time

If your surgery takes place before your settlement, your payout will increase regardless of which type of settlement you receive. Similarly, if your surgery takes place after a stipulation and reward settlement, your medical treatment will still be covered by the insurance company.

However, if your surgery is set to take place after a compromise and release settlement, you need to make sure the future costs are reflected in your payout. These should include:

  • The cost of future medical care, including surgeries
  • Anticipated costs of post-surgery complications
  • The indirect costs of your surgery, as detailed above
  • Future disability benefits

Be aware that if your condition gets worse after you’ve accepted a compromise and release settlement, you won’t be able to claim additional compensation for surgery. Therefore it’s vital that you take steps to ensure your settlement amount is suitable for your injuries and medical needs, such as hiring a local workers’ compensation lawyer.

Do I need to get approval for my surgery?

Even if your treating physician recommends surgery for your workplace injury, that doesn’t mean you’ll get it right away. Since your employer’s insurance company is required to cover your medical expenses, they need to approve your surgery first.

If your surgery is urgent, the insurance company will typically approve or deny the treatment within a few days. But if it’s non-urgent, it can take several weeks to receive a verdict. The insurance company might even request an independent medical examination to verify the need for surgery, which can add further time.

How to make sure you receive a suitable settlement

In most cases, a workplace injury that requires surgery will lead to an increase in your workers’ compensation settlement. But that doesn’t necessarily mean your employer’s insurance company has your best interests at heart.

As a for-profit business, the insurance company will do everything in its power to downplay your injuries, deny your need for surgery, and minimize your settlement. That means you can miss out on the financial support you need to make a full recovery. So it’s a good idea to hire an experienced workers’ compensation attorney who can defend you against their typical cost-saving tactics.

The expert trial lawyers at Phalen Law have over 50 years of experience in getting appropriate workers’ compensation settlements for injured workers across Kansas and Missouri. By anticipating the cost of your medical needs, we ensure you receive a substantial payout no matter what kind of settlement you receive. And if your employer or their insurance company appeals, we always stand our ground until you receive the medical benefits you’re entitled to.

So if you’ve sustained a workplace injury that might require surgery, contact us today to make sure your settlement reflects your treatment.

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William L. Phalen

For 30 years, Bill Phalen has been representing families and workers whose lives have been devastated by workplace injuries, reckless drivers and the negligence of others. When tragedy needlessly strikes – because of the irresponsible behavior of an employer, corporation or an insurance company – Bill Phalen is an advocate for the people, always representing David in the fight against Goliath. Bill’s strong convictions have led to successful cases at the Court of Appeals and Kansas Supreme Court.

21:34 06 Aug 23
It has been a long road of recovery, very thankful for all they have done on my behalf, Bill and Melissa thank you for having my back and helping me get through everthing i have gone through in the last few years.
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13:21 28 Mar 23
Very nice employees. William is an awesome attorney if it had an option for 10 stars I would give him 10. I highly recommend him to anyone in search of a great attorney
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05:32 25 May 21
I highly recommend Mr Phalen. He and his staff did a great job! I could not have won my case without them.
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14:42 18 Dec 20
I was hurt at work and Mr Phalen took my case on and worked on it for over a year and was able to successfully get me a settlement check for my injuries. Hire him if you’re ever injured on the job!
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21:06 01 Jul 19
If you need an excellent attorney around the Pittsburg area Bill Phalen is the guy to go to. Very knowledgeable and pleasant and the office staff is great. I wouldn't go to anyone else!
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16:14 01 Apr 19
I've worked here as a student intern since August, 2018 and I must say that this has been the most enjoyable job I've had to date. Mr. Phalen and the gals working here are a pleasure to be around and work with. They are patient with me every time I'm slow to get the hang of a new task, they are relaxed and easy going but know how to get the job done well. They each put extra effort into all of the work they do for each and every client. Several times they have come in early or stayed at the office late to make sure that they got every done that they needed to prepare someone's case.The people in this office have been a part of this community for a lifetime and working with them has helped me feel as if I was a part of this great community as well.
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16:52 27 Mar 19
Very Proud to call him my Attorney, very friendly staff, that always keeps me updated on my case and one phone call away to answer any questions. I have been using him for many, many years. I can't Thank him enough for what he has done and still doing for me and my family. But Thank you. Would highly recommend William Phalen.