Introduction:
When an employee suffers a workplace injury, they may be entitled to workers’ compensation benefits. A common question that arises is whether undergoing surgery for the injury impacts the compensation settlement. This article explores various aspects of Workers’ Compensation Settlement, particularly focusing on how surgery can influence the settlement amount.
Compromise and Release Settlements:
Definition:
- One-Time Payment: A ‘Compromise and Release’ settlement is an agreement that concludes a workers’ compensation claim through a single lump sum payment.
- Full Resolution: This settlement type typically resolves all aspects of the claim, including medical expenses, lost wages, and any other compensable damages.
Surgery Impact:
- Higher Settlement Amounts: In instances where surgery is necessary due to a work-related injury, the settlement amount in a compromise and release agreement may be adjusted upwards.
- Covering Additional Costs: The increase is to accommodate the added medical expenses and the potentially longer period of recovery associated with surgical procedures.
Stipulation and Award Settlements:
Definition:
- Ongoing Benefits: Unlike the lump sum approach of compromise and release, this settlement type involves agreeing to ongoing benefits over a period of time.
- Includes Medical Treatment: These settlements often cover the costs of medical treatment required due to the work-related injury.
Surgery and Ongoing Care:
- Future Medical Expenses: If surgery has already been performed or is anticipated, stipulated settlements may specifically include provisions for future medical expenses related to the surgery.
- Care and Rehabilitation: Additionally, these settlements can cover the cost of ongoing care, rehabilitation, and any other long-term treatment needs that arise from the surgical intervention.
What if the Surgery was Performed Before the Workers’ Comp Settlement?
Pre-Settlement Surgery:
- Inclusion in Settlement Negotiations: When surgery has been completed prior to the settlement of a workers’ comp claim, its costs and consequences are factored into the negotiation process.
- Impact on Settlement: The fact that surgery has already occurred can significantly influence the settlement amount due to the incurred medical expenses and the impact on the worker’s health and capabilities.
Evidence of Costs:
- Critical Documentation: To accurately account for the surgery in the settlement, comprehensive documentation is necessary. This includes all medical bills, surgical reports, and any related treatment expenses.
- Recovery Period: Records of the recovery period, including any time off work and rehabilitation, are also important for validating the claim and justifying the settlement amount.
How Much Would it Affect the Injury Settlement?
Increased Costs:
- Higher Medical Expenses: Surgery typically results in higher overall medical costs due to the procedure itself, hospitalization, medication, and follow-up care. These increased expenses generally lead to a larger settlement demand.
- Comprehensive Settlement Amounts: The settlement amount aims to cover all these costs, ensuring that the injured worker is not financially burdened by the consequences of a work-related injury.
Consideration of Disability:
- Assessment of Recovery and Disability: The degree of recovery following the surgery and any resultant disability or impairment are crucial factors in determining the settlement amount.
- Long-Term Impact: Settlements not only address immediate medical costs but also consider the long-term impact on the worker’s health, ability to work, and quality of life.
How Can a Workers’ Compensation Attorney Help My Workers’ Comp Claim?
Expertise in Negotiation:
- Skillful Advocacy: A workers’ compensation attorney brings expertise in negotiating with insurance companies, which is crucial for securing a fair settlement.
- Understanding Complexities: They are well-versed in the complexities of workers’ comp laws and can effectively argue for a settlement that reflects the true cost of your injury.
Legal Representation:
- Representation in Disputes: In cases where your claim is disputed or you face challenges from the employer or their insurance company, an attorney acts as a powerful advocate on your behalf.
- Courtroom Experience: If the claim proceeds to a hearing or trial, having an attorney ensures you have a knowledgeable professional to represent and guide you through the legal process.
Maximizing Settlement:
- Accurate Damage Assessment: An attorney will assess all aspects of your claim, including medical expenses, lost wages, and the impact of the injury on your future earning capacity.
- Future Considerations: They also take into account future medical care and potential long-term disability, ensuring these are reflected in the settlement amount.
Conclusion:
Undergoing surgery can significantly impact a workers’ compensation settlement. The type of settlement, whether it’s a compromise and release or stipulation and award, along with the timing of the surgery, play critical roles in determining the settlement amount. To ensure that you receive fair compensation that covers all your medical and rehabilitation costs, consider consulting a workers’ compensation attorney who can guide you through the complexities of your claim and advocate on your behalf.
