A surgery can increase your workers’ compensation settlement if it happens after the settlement agreement. If the surgery happens before the settlement is made, it would be covered by the insurance company as a part of your medical care.
Depending on the surgery, it can increase the settlement by tens of thousands of dollars or more. In the event the surgery makes things worse, your settlement could be even higher.
When would a surgery affect my workers’ compensation settlement?
A surgery will alter your workers’ compensation settlement amount if you still need the procedure. The settlement agreement would have to cover the costs of the surgical procedure, as well as its attendant medical expenses, like your:
- hospital stay,
- diagnostic exams and radiology (X-rays, etc.),
- anesthesia,
- physical therapy,
- occupational therapy,
- medication, including pain killers,
- assisted mobility device, such as a wheelchair, and
- home modifications.
How your workers’ compensation claim is settled will determine how your surgery payout will happen. Workers’ comp claims can be settled in two ways:
- compromise and release, or
- stipulation and award.
Compromise and release settlements
A compromise and release settlement agreement is the more common of the two. In it, the insurance company will hand you a lump sum of money to cover all of the workers’ compensation benefits that you would be entitled to receive in the future.
This includes any surgical procedures that you have not had yet.
You can accept the lump sum payment either:
- all at once, in an actual lump sum, or
- in a structured settlement that spreads smaller payments out over time.
Compromise and releases can be risky. If the payment does not end up covering all of your expenses, there is little you can do about it.
Stipulation and award settlements
If your workers’ comp claim settles with a stipulation and award, the insurance company will cover all future medical care needed for your workplace injury, as they arise. This is an ongoing agreement with the insurer that will last for the rest of your life. When the surgical procedure is performed, the medical bill will go to the insurance company.
Making sure that they pay it in full, however, is not always easy.
What if the surgery was performed before my workers’ comp settlement?
If your surgical procedure was performed before the workers’ compensation settlement was reached, then it would be covered as a part of your medical expenses.
Recall that workers’ comp benefits come in the form of:
- medical benefits,
- disability benefits, and
- death benefits, if the injury was fatal.
The disability benefits are meant to cover a portion of your lost wages from your time off work. They are split into:
- temporary benefits, which cover your wages while you recover, and
- permanent disability benefits, which cover the wages you stand to lose from disabilities or impairments that still exist after you reach maximum medical improvement (MMI).
In addition to these disability benefits, workers’ compensation laws require your employer’s insurer to cover your medical costs. That coverage continues up to the point that the case is settled in a compromise and release agreement.
How much would it affect my injury settlement?
It will depend on the type of surgery required and the other costs associated with it.
Obviously, more costly surgeries will increase the settlement amount more than minor ones will. Less obviously, though, where the surgery is performed can matter, as identical procedures in different states can cost surprisingly different amounts.
Here are a few common surgical procedures for workplace injuries and their average costs in the U.S.:
- spinal fusion surgeries for serious back injuries – $110,000,
- joint replacement surgeries – from $16,500 to $33,000, and
- surgeries related to a broken wrist – $8,000.1
Meanwhile, surgeries involving skull fractures, brain injuries, or other organ damage run into the tens of thousands of dollars if not more.
In addition to the surgery, there will also be the costs of all of the attendant medical expenses, like physical therapy. Just the costs of the hospital stay can be huge. The national average for a single-day hospital stay in the U.S. is $2,883, with the average hospital stay lasting for 4.6 days.2
These costs can fluctuate substantially depending on where the surgery is performed. For example, the average single-day hospital stay costs $1,305 in Mississippi, but $4,181 in California.3
Plus, one surgery can trigger continuing expenses. For instance, an amputation will require you to have a prosthetic for the rest of your life. One surgery can also cause serious scarring and disfigurement which can affect your mental health, appearance, and range of motion.
These and other medical costs can drastically increase the fair settlement amount of an average workers’ compensation case.
Can a surgery ever decrease my workers’ comp settlement?
Yes, if your surgery is extremely successful and you make a full recovery allowing you to return to work. So while your settlement should cover your surgery and related expenses, you settlement would not include future disability payments or medical bills.
How soon can I get my surgery?
In serious situations, the workers’ comp insurer should approve or deny your claim within days. In less urgent cases, the insurer can take weeks or longer to make its decision and may even require an independent medical examination.
How can a workers’ compensation attorney help my workers’ comp claim?
A workers’ compensation lawyer can maximize the amount you receive from your employer’s insurance company. The insurer will likely do everything that it can to either:
- deny coverage, and/or
- minimize its payout.
This is how workers’ compensation insurance companies make a profit.
By advocating for your rights, your lawyer can make sure that you get what you deserve. An attorney can also inform you when you are being offered a lower settlement amount than what your workers’ comp case is worth.
The experienced workers’ compensation attorneys and personal injury attorneys at our law firm are familiar with all of the ways that insurance companies try to reduce the settlement value. Our workers’ comp attorneys have found that workers’ comp insurance carriers frequently try to understate the costs of your future medical expenses. They also frequently dispute whether your medical treatment is for your work-related injury.
By establishing an attorney-client relationship with a workers’ comp lawyer, you can get their legal advice and try to get a higher settlement offer. If necessary, your attorney and the insurer can engage if mediation in attempt to achieve the most favorable resolution for you.
I was just injured at work. What do I do?
Report the injury to your employer as soon as possible.
If you wait too long, you may miss your opportunity to get a workers’ comp settlement. Even a mild carpal tunnel injury or puncture wound could reap a sizable settlement. (In some cases, independent contractors may be able to benefit from workers’ comp as well.)
Then contact a workers’ comp attorney to help you through the claims process and to ensure you make all your deadlines.
Legal References:
- Mary Elizabeth Dallas, “The 10 Most Common Surgeries in the U.S.,” Healthgrades (September 10, 2021); and Maureen Milliken, “Hospital and Surgery Costs,” Debt.org (June 22, 2023).
- Maureen Milliken, “Hospital and Surgery Costs,” Debt.org (June 22, 2023).
- Same.
