Does Having Surgery Increase Your Workers’ Comp Settlement?

Yes, surgery often does increase workers’ compensation settlements. However, surgical procedures are just one factor among many that determine your final workers’ compensation settlement amount. The average settlement takes into account the type of surgery, your recovery, and your ability to return to work.  These elements all play important roles in your case value.

At Munley Law, our Pennsylvania workers’ compensation attorneys have helped countless injured workers through the complicated process of receiving fair compensation after a work-related injury that required surgery. Call the Munley workers’ compensation lawyers today for a free consultation.

Key Factors That Determine Settlement Increase

Type and Complexity of Surgery

Different procedures affect settlement values differently. A simple arthroscopic knee procedure might add several thousand dollars to a settlement, while multiple-level spinal fusion surgery could increase the value by tens of thousands of dollars.

Permanent Impairment Rating

After surgery, doctors assign impairment ratings as percentages based on American Medical Association guidelines. Higher impairment ratings directly correlate to higher settlement amounts.

Work Restrictions and Future Earning Capacity

Permanent restrictions like “no lifting over 20 pounds” or “no climbing ladders” limit job options. If these restrictions prevent you from returning to your previous position, your settlement should reflect this reduced earning capacity over your lifetime.

Future Medical Needs

Ongoing medical care must be calculated into your settlement, including:

• Follow-up surgeries or procedures
• Physical therapy and rehabilitation
• Medical equipment and assistive devices
• Pain management treatment
• Regular monitoring and doctor visits

Recovery Timeline and Complications

Settlement negotiations typically begin after reaching Maximum Medical Improvement (MMI) – when your doctor determines you’ve recovered as much as possible. Surgical complications, infections, or slow healing can extend this timeline and increase settlement value.

Pre-existing Conditions and Surgical Outcomes in Pennsylvania

Many workers worry that having a pre-existing condition will prevent them from receiving fair compensation when surgery is needed. While pre-existing conditions can complicate workers’ comp claims, they don’t automatically disqualify you from benefits.

Pennsylvania workers’ compensation law recognizes the “aggravation principle.” This means if your work injury worsened a pre-existing condition to the point where surgery became necessary, you may still qualify for full benefits. For example, if you had mild arthritis in your knee but a workplace fall made it severe enough to require knee replacement, workers’ comp should cover the surgery.

Getting Surgery Approved Through Workers’ Compensation

Before your surgery can increase your workers’ comp settlement, you first need to get it approved by the insurance company. In Pennsylvania, all medical treatments for work injuries must go through a utilization review process. This process provides an impartial review of the reasonableness or necessity of medical treatment rendered to, or proposed for, work-related injuries and illnesses.

A Munley workers’ comp attorney can significantly improve your chances of getting surgical approval by gathering strong medical evidence that supports your need for surgery. We will prepare you for independent medical examinations and negotiate directly with the insurance adjuster to overcome any objections to the procedure. Call today for a free consultation.

What is an independent medical examination?

When surgery is recommended for your work injury, the insurance company will likely schedule an Independent Medical Examination (IME). Despite its name, an IME is conducted by a doctor hired by the insurance company, not a truly independent physician.

During an IME, the doctor will review your medical records, ask about your symptoms, and perform a physical examination. In Pennsylvania, you must attend an IME if requested, or risk your benefits being suspended.

Workers’ Rights During Surgical Recovery

At Munley Law, we believe knowledge is power. The more you know about your rights, the easier it is to protect them. Here are your rights while you’re recovering from surgery after a workplace injury:

• If your doctor releases you for light or modified duty work, your employer may offer you a position within your restrictions. You must make a good-faith attempt to perform this work, but you can’t be forced to exceed your medical restrictions.
• It is illegal for your employer to retaliate against you for having surgery or filing a workers’ compensation claim. You cannot be fired, demoted, or otherwise punished for exercising your rights.
• For the first 90 days after your claim begins, you may need to see doctors from your employer’s approved provider list. After this period, you can choose your own physician. You always have the right to a second opinion, though you might need to pay for it yourself if it’s not authorized.

Calculating a Fair Settlement After Surgery

A fair settlement should account for:

Past and Future Medical Expenses: All surgery-related costs, ongoing treatments, medications, and future medical needs.

Lost Wages: Both past missed work and future earning limitations due to permanent restrictions or reduced capacity.

Permanent Impairment Benefits: Compensation based on your impairment rating percentage for lasting physical limitations.

Vocational Rehabilitation: Costs for retraining if you cannot return to your previous occupation.

Working with an experienced workers’ compensation attorney at Munley Law is extremely important to ensure all these factors are properly calculated to arrive at a truly fair settlement figure.

Common Settlement Mistakes to Avoid

Many injured workers make costly mistakes when settling their workers’ compensation cases after surgery. Here’s what you should be aware of to protect your financial future:

• The most common error is settling your case too soon, before reaching maximum medical improvement. If you accept a settlement before understanding your long-term prognosis, you might receive far less than your case is worth, especially if complications develop later.
• Another frequent mistake is underestimating future medical needs. Surgery often leads to ongoing treatments, medication requirements, or even additional procedures that should be accounted for in your settlement.
• Many injured workers fail to consider all available benefits. Beyond medical expenses and lost wages, you may be entitled to compensation for permanent impairment, vocational rehabilitation, or transportation costs to medical appointments.

Call the Munley Attorneys to Help Maximize Your Workers’ Comp Settlement

Perhaps the most significant mistake is attempting to negotiate directly with insurance companies without the benefit of legal representation. Insurance adjusters handle thousands of claims and know how to minimize settlements.

At Munley Law, our workers’ compensation lawyers deeply understand insurance adjusters’ tactics and can protect your rights throughout the claims process. Our award-winning team works on a contingency fee basis, meaning you pay nothing unless we win. Call Munley Law today for your free consultation at 844-385-9333.