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.