If you need surgery as part of your medical treatment through your workers’ compensation insurance company, you might wonder, “does surgery increase a workers’ comp settlement?” Because workers’ comp pays for medical care if you are an injured worker who suffered an injury on the job, workers’ comp should pay for your surgery if you need it due to work-related injuries.
An experienced workers’ compensation attorney in NYC from Pyrros & Serres LLP answers frequently asked questions about paying for surgery through workers’ compensation. Other questions include what other medical care workers’ comp covers and additional workers’ compensation benefits that could be available to you as an injured worker.
What Does Workers’ Comp Normally Cover for Medical Treatment?
Workers’ comp is a no-fault system to get medical care and loss of income benefits for your injuries sustained at work. All for-profit businesses and most non-profit organizations must carry workers’ compensation insurance. According to the State of New York, your employer’s workers’ comp insurance company covers:
- All medical care necessary to treat your work-related injuries
- Up to two-thirds of your weekly average paycheck before the injury up to the maximum allowance
- Expenses for travel for your medical treatment
Injured employees do not need to live in New York; they just need to work in a job that is based in New York.
When Does Surgery Increase a Workers’ Comp Settlement?
Surgery is expensive, with common procedures like a knee replacement or hip replacement costing approximately $40,000, and heart or spine surgery starting at six figures, according to debt.org. If you need surgery to treat a work-related injury, your workers’ comp settlement may include funds to cover the surgery, depending on when you undergo surgery.
If you have the surgery before reaching a settlement agreement, the workers’ compensation insurance company will pay for it as part of your medical treatment costs. If you may require the surgery after the settlement agreement, the settlement medical set aside will increase to include the cost of the surgery, anticipated associated costs, and costs for potential complications.
So does surgery increase a workers’ comp settlement? Yes, and if you need the surgery after reaching a settlement agreement with the workers’ comp insurance company, the insurance company may settle in two different ways.
- In a stipulation and award settlement where you may be classified as being permanently disabled, the insurance company agrees to cover all medical costs associated with the injury for the rest of your life per the terms of workers’ compensation medical treatment guidelines.
- In a compromise and section 32 release settlement, the insurance company pays a lump sum or structured settlement to cover the current and future costs of your medical care associated with the injury. This may include future surgery, associated surgery costs, and potential complications from the surgery.
After a work accident, a workers’ compensation lawyer in New York City can represent you in your workers’ comp claim against the insurance company. The insurance adjuster may try to reduce the value of your claim to settle for less than the actual costs of your claim.
Will My Settlement Cover Physical Therapy or Complications from Surgery?
Yes, your settlement calculation should include the value of additional surgical costs, post-surgical rehabilitation, and costs from prospective complications. According to Healthgrades, even common surgeries like broken bone repair, hip or knee replacements, and gallbladder removal can still have severe complications.
Additional surgery costs and complications can include:
- Extended and overnight hospitalization
- Lost wages due to surgery, hospitalization, physical therapy, and rehabilitation
- Anesthesia and operating room hourly rates
- Surgeon fees and pre-surgery consultations
- Follow-up appointments
- Anti-rejection meds
- Outside expenses, such as travel costs, lodging for family members, and childcare
- Disability or reduced function of certain body systems
- Permanent disfigurement or scarring
- Negative reactions to anesthesia
Your settlement agreement with the workers’ comp insurance company should predict these costs for you to reach the maximum medical improvement (MMI), which is the point where you either fully recover or recover as much as you are able and are not likely to continue to improve.
What If I’m Still Disabled After Surgery?
According to the New York State Workers’ Compensation Board, your workers’ comp benefits include disability benefits for different levels of disability, including:
- Temporary Total Disability. For a short period of time, you are unable to work or earn an income from work.
- Temporary Partial Disability. For a short period of time, you are able to perform limited work and can earn a reduced income.
- Permanent Total Disability. You can no longer work and earn a livable income. In limited circumstances, you may occasionally be able to work and supplement your benefits up to the state maximum income for disabled earners.
- Permanent Partial Disability. You can no longer work full time and earn the same income you once earned. You may collect disability benefits on either a schedule loss of use (SLU) or non-schedule loss basis.
You may qualify for temporary benefits until you reach maximum medical improvement (MMI), at which point your approved claim physicians will determine your disability rating, which workers’ comp will use to decide if you qualify for permanent disability benefits and how much.
How to Find an Experienced Workers’ Comp Lawyer in NYC
Workers’ compensation cases are complex, often requiring years of experience to be effective against the insurance company’s insurance adjusters and legal team. If you suffered an injury on the job in New York City, you need a knowledgeable New York workers’ compensation attorney to manage your case.
Your attorney should have experience with workers’ compensation claims cases. If you work in construction, in an office, near chemicals, or at a grocery store, as a driver in a hospital, etc. make sure any lawyer you consider has experience representing clients in your field.
Contact Pyrros & Serres LLP for a New York Workers’ Compensation Attorney
Does surgery increase a workers’ comp settlement? It can if it is contemplated that your surgery may place after the settlement date. If your surgery occurs before the settlement, the insurance company should cover it as part of your medical expenses. Visit our blog to learn more about the role of a workers’ compensation lawyer for your case.