If you suffered a workplace injury that requires surgery, you may be wondering if undergoing surgery can increase your workers’ compensation settlement. Surgery often leads to higher settlement amounts, but the impact depends on various factors. Here’s what you need to know about how surgery can affect your workers’ comp settlement.

What is a Workers’ Comp Settlement?

A Workers’ Comp Settlement is a legally binding agreement between an injured worker and the employer’s compensation insurance. This agreement relieves the employer and their insurance company of future medical and disability benefits in exchange for a lump sum payment or a structured settlement to the injured worker.

Can Surgery Increase a Workers Comp Settlement?

Yes, surgery can potentially increase a workers’ comp settlement. This is because the cost of the surgery and the future medical care required can increase the overall medical expenses. If the surgery leads to an increased disability, it can also increase the compensation for lost wages based on the injured worker’s average weekly wage.

However, it’s important to note that the success of the surgery could affect the settlement negotiations. If the surgery is successful and the injury improves before the settlement negotiations, it might result in a lower settlement.

How Does Surgery Affect a Workers’ Comp Claim?

Surgery typically increases the value of a workers’ comp settlement for several reasons:

Surgery Increases Medical Expenses

The cost of surgery, from the procedure itself to medications and physical therapy, boosts the medical expenses part of your claim. Things like surgery costs, hospital stays, anesthesia, and follow-up appointments are all included in your medical benefits. The more these expenses add up, the higher your potential settlement value becomes.

Surgery May Lead to More Lost Wages

Being out of work for surgery (and recovery) increases your disability period and lost income benefits. The longer you are unable to work due to an injury, the more the insurance company will likely have to pay in wage replacement.

Surgery Can Worsen the Disability Rating

If surgery worsens your permanent disability, your impairment rating will be higher. This increases the payout for your permanent partial disability. The more severe your disability, the more the insurer will pay in disability benefits.

Surgery Shows Serious Injury

Needing surgery demonstrates the severity of the injury. Surgery proves the injury is serious enough to warrant major medical treatment. This helps justify a larger payout.

How the Type of Surgery Impacts Your Settlement

Not all surgeries have the same effect on your workers’ comp settlement. Here are some factors to consider:

  • Invasive surgery – More complex surgeries like reconstructive surgery or spinal fusion tend to increase settlements more than minor outpatient procedures.
  • Number of surgeries – Multiple surgeries drive up medical costs and time off work, likely boosting your payout.
  • Success of surgery – If surgery significantly improves your condition, it may lower the settlement value. But if you still have a permanent impairment, the impact is higher.
  • Surgery delays – When surgery is postponed, it extends time off work and pushes back your maximum medical improvement date. This can increase lost wage awards.
  • Settlement timing – If surgery occurs before settlement negotiations, the impact is greater than the surgery promised after a settlement.

How Much Can Surgery Increase a Settlement in NY?

The exact amount surgery increases your workers’ comp settlement depends on your situation. However, surgery can typically increase the value from 20% to 50%.

In some cases, surgery more than doubles the potential value. It all depends on factors like:

  • Type and number of surgeries
  • Medical costs
  • Length of disability period
  • Change in impairment rating
  • Complications from surgery
  • Your age and wages

The cost of a single surgery often ranges from $20,000 to $50,000. Multiple surgeries will boost the value even more. The longer you are out of work, the more lost wages you incur.

For a serious injury requiring multiple surgeries, you could potentially get 100% or more over a nonsurgical settlement. But every case is unique, so consider speaking to an experienced personal injury attorney like the team at O’Connor Law PLLC.

Does the Timing of Surgery Matter for Your Settlement?

When your surgery occurs in relation to settlement, negotiations can impact the payout. Here’s how:

  • Before Settlement: If surgery happens before negotiations, the insurer knows the full costs. This makes calculating a fair settlement easier.
  • After Settlement: If you settle and then need surgery later, you may have to reopen the claim for more benefits. This can be difficult.
  • During Negotiations: Upcoming surgery during settlement talks makes estimates more complicated. The insurer may offer less, hoping to avoid paying the surgical costs later.

Ideally, have the surgery before starting settlement talks. This reduces guesswork and gets you the maximum payout upfront.

How Can You Increase Your Settlement if Surgery is Needed?

If you need surgery for your workers’ comp injury in New York, here are some tips to get the best settlement:

  • Get All Recommended Treatment: Follow medical advice to fix the injury, including surgery if prescribed. Insurers can deny benefits if you refuse reasonable treatment.
  • Talk to Your Doctor: Ask about how surgery may improve your injury, disability rating, recovery time, and return to work. Provide this information to your attorney.
  • Keep Good Records: Save all medical records, costs, disability notes, and anything else related to your injury. This evidence helps get a higher settlement.
  • Hire an Attorney: An experienced NY workers’ comp lawyer can estimate how the surgery will impact your claim value. They can negotiate the maximum settlement for your situation.
  • Time Settlement Carefully: If possible, have the surgery before settlement talks start. This prevents the insurer from lowballing you pre-surgery to avoid paying the surgical benefits later.

What If The Insurer Denies Surgery Approval?

Workers’ compensation insurance providers must approve any recommended surgeries. However, they may deny approval if they don’t think surgery is necessary.

If surgery is denied, your workers’ comp attorney can fight the denial and prove medical necessity. Getting surgery approved is crucial to receive those settlement benefits later.

Consult With a Workers’ Comp Attorney About Your Surgery

The decision to undergo surgery is an important one. Be sure to discuss risks, benefits, alternatives, and settlement impact with your doctor.

It’s also smart to consult with an experienced workers’ compensation attorney before surgery. An attorney can provide legal advice on:

  • Getting your surgery approved
  • Calculating the potential increase to your settlement
  • Ensuring you receive the compensation you deserve
  • Identifying if settlement before or after surgery is best
  • Negotiating a fair settlement amount

Don’t undergo surgery before exploring how it might affect your claim and speaking with a knowledgeable lawyer. With proper representation, surgery can often lead to higher settlement awards. Discuss your options with an attorney at O’Connor Law in NY who is experienced in obtaining top settlements for injured workers.