Many people have questions about what factors go into a workers compensation settlement. Understanding the different factors that affect a settlement amount is important. If you do not understand them, you will likely make a mistake if and when you settle your workers compensation case with the insurance company.
One question that often comes up is whether surgery will increase the amount of a workers compensation settlement. Several other associated questions must be considered in answering this question:
- Has the surgery just been recommended or actually taken place?
- What type of surgery?
- If the surgery took place, was it successful?
- If the surgery has not taken place, how much will it cost?
- Does the workers compensation insurance company dispute their responsibility for the surgery?
The answers to these five questions above can certainly affect what the workers compensation insurance company will offer to settle a workers compensation case.
Why does it matter whether the workers compensation surgery has been recommended or has actually taken place?
When workers compensation insurance companies evaluate a case for settlement, they look at what the case will cost them in the future. Because they are looking at future costs, they do not really consider the medical costs and other benefits they have already paid.
If the insurance company has already paid for a workers compensation surgery, then the cost of the surgery itself will not be factored into a settlement. The reason why is that cost has already been paid by the insurance company. So, it is not a future cost for them – it is a past cost.
However, sometimes surgeries do result in workers compensation benefits being owed in the future. Surgeries often take people out of work for a period of time resulting in temporary total disability benefit payments. Also, surgeries can result in permanent impairments which lead to entitlement to permanent partial disability benefits. These factors come into play at settlement even when the surgery has already occurred.
Why does the type of surgery matter?
The type of surgery matters when an insurance company looks at future costs on a workers compensation case. Some surgeries do not cost very much. Other surgeries are expensive.
Some surgeries result in one hundred percent recovery. Other surgeries may result in permanent work restrictions even when they are successful.
Since the workers compensation insurance company is looking at future costs, they will consider the type of surgery and how it is likely to affect you. If the surgery does not result in one hundred percent recovery, your case will likely cost the insurance company more money in the future. That will likely affect what the insurance company will offer to settle.
How does the surgery being successful affect a settlement?
Surgeries have risks. You should discuss those risks with the doctor recommending surgery. They should inform you of the risks associated with the surgery that has been recommended.
Often, surgeries go well, but sometimes they do not. When a surgery is not successful, the limitations from your injury and the surgery will often keep you from returning to work. You may also need additional medical treatment that will cost the insurance company more money.
Because the insurance company looks at future costs when deciding what to offer in settlement, the successfulness of the surgery usually affects what the insurance company will offer to settle.
How does the cost of the surgery factor in?
The cost of the surgery matters when the surgery has not occurred yet. It matters because the insurance company has the potential cost of paying for surgery in the future. But, they have not been charged that cost yet.
If the insurance company expects to have to pay for that surgery in the future, they will usually offer more in settlement. The reason why is that settling prior to having to pay for the surgery saves them money. The more expensive the surgery is, the more they save. In this situation, many insurance companies will pay more in settlement to close out your file and avoid having to pay for the surgery.
Will the insurance company denying responsibility for the surgery affect a settlement?
Yes. One factor that affects how much the insurance company will offer in settlement is what the chances are that they will have to pay for the surgery.
If the insurance company thinks they will have to pay the cost of the surgery, they will likely offer a greater percentage of the cost of the surgery in settlement. If the insurance company does not think they will have to pay for the surgery, they will likely offer less.
The opinions of your treating and evaluating doctors about surgery are important as well. Those opinions usually matter a lot if your case goes to court. So, the insurance company will likely look at those opinions in evaluating whether they will likely have to pay for the surgery or not.
What if I want more information about workers compensation settlements?
Surgery is just one of the factors in workers compensation settlements. There are a number of other factors that should be considered when deciding if and when you are going to settle your case. Please check out this article that provides a more complete explanation of what workers compensation settlements are and discusses a number of the other factors that affect settlements.