Does Surgery Increase a Workers Comp Settlement?

Workers’ compensation is a crucial aspect of employment law, providing essential benefits to employees who suffer injuries while performing their job duties. A common question that arises is whether undergoing surgery can influence the amount of workers’ compensation settlements in Florida.

Our Florida workers’ compensation lawyers at Work Injury Rights have over 45 years of experience. Contact us today for help with your claim.

A Closer Look at Florida Workers’ Compensation

To fully comprehend the potential impact of surgery on workers’ compensation settlements, it’s necessary first to understand the fundamentals of workers’ compensation.

In Florida, employers who have four or more employees, whether full-time or part-time, must carry workers’ compensation insurance. This insurance is designed to cover medical expenses, lost wages, and other costs an employee might incur due to a workplace injury.

Surgery and Workers’ Compensation

If surgery is deemed necessary to treat a work-related injury or illness, it is generally covered by workers’ compensation.

The treating physician usually requests authorization for surgery from the workers’ compensation insurance carrier. The carrier reviews the request and decides whether to approve or deny the surgery.

The workers’ compensation insurance provider might request an IME to evaluate the necessity of the surgery. If there are disputes regarding the necessity of the surgery, the approval process, or benefits, it’s important to seek help from a workers’ compensation attorney.

How Does Surgery Affect Workers’ Compensation Settlements in Florida?

Medical expenses constitute a significant portion of workers’ compensation settlements. Consequently, if an injured worker requires surgery, the cost associated with that surgery could potentially increase the settlement amount.

The type of surgery required can significantly influence the total payout of a settlement amount. This is determined by various factors including the cost of the surgery (encompassing both surgical and non-surgical costs), any indirect expenses incurred, and the severity of the injury.

Given these variables, the settlement amount can greatly vary and is assessed on an individual basis. Therefore, it’s highly recommended to consult with a lawyer who specializes in workers’ compensation laws to ensure you receive all the benefits you’re entitled to.

workers comp will cover surgery costs for a workplace injury

Key Factors That Influence Settlement Amounts

While the cost of medical care, including surgery, plays a role in determining settlement amounts, it’s not the sole determinant. Other factors that are taken into account include:

  • The severity of the injury: Injuries that are more severe typically result in higher settlement amounts due to increased medical costs and potential long-term effects on the worker’s ability to earn income.
  • Impairment rating: This is a rating assigned by a doctor that indicates the degree of impairment caused by the injury. A higher impairment rating can lead to a larger settlement.
  • Ability to work: If the injury affects the employee’s capacity to work, either temporarily or permanently, this can also influence the settlement amount.

What If I Require Surgery Before My Case Is Settled? 

The timing of settlements is crucial, especially when medical care is involved. Your physical health can change rapidly and dramatically. If you find yourself needing surgery while your claim is still being processed, don’t worry.

Including your surgery in your claim is one of the quickest and simplest ways to have your procedure covered, provided your claim is approved. Your medical provider will send all relevant billing documents to the insurance company, which will then cover the costs included.

What If I Need Surgery After My Case Is Settled? 

Once a case has been settled and you’ve received a settlement, claiming additional costs can become complex and depends on several factors. Lump-sum payments are typically inflexible as they often include a waiver for future medical benefits.

Therefore, if your doctor determines that surgery is necessary after your case has been settled, any requests for additional funds will likely be denied. The benefit of structured payment plans is that they often don’t include such a waiver, providing more security through adaptable coverage.

Let Our Florida Workers Comp Lawyers Help You

While surgery can increase the cost of medical care and potentially influence the amount of a workers’ compensation settlement, it’s just one factor among many that are considered.

It’s imperative for injured workers to consult with their healthcare providers and legal counsel to make informed decisions about their treatment and workers’ compensation claims. Contact Work Injury Rights at 954-833-5226 to schedule a free consultation today.