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Will Surgery Increase a Workers Compensation Settlement?

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.

Doctor examining man with shoulder pain 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.

Doctor and patient arm injury 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.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.

To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

Brittney-lee orourkeBrittney-lee orourke
05:23 18 Feb 22
Amazing! Jason and his team were very helpful and had the best communication by far. Walked me though every step with great detail and had answers for any question I had. They handled my case better then I could imagine, it was a weird case and they stayed on top of it and kept me updated every step of the way! Highly recommend this Team! Thanks so much to Jason and his Awesome team!-Brittney
China JonesChina Jones
18:58 08 Feb 22
I absolutely love this group of attorneys, when I was at my lowest they did everything they could to help me get justice for my injury. I believe if I were to have never picked my phone up and called the amazing group that helped me I definitely would not have received my idea of rights. If you have an issue and are just not sure please understand that they will help you, stay in contact, answer any question you have, and for sure get you the justice you deserve I thank them from the bottom of my heart and I will definitely refer them to anyone who has been hurt because they most definitely care about their work and clients.
Luv LocsLuv Locs
16:08 15 Jan 22
The entire law office was attentive and responsive to all of my concerns dealing with my workers compensation case.
21:14 02 Jan 22
If you must get a lawyer involved, you’d do well to work with Jason Perkins and his team at Perkins Studdard Law.They were thorough in gathering information and in sharing all the steps in the workers comp process specific to my case. Jason and the team were responsive to my bevy of questions and concerns.I appreciated the informative videos and consultations provided by Jason over video meetings and multiple phone calls.I hope I’m never injured on the job again. However, if I am and if my employer responds as my previous employer did, I’ll contact Perkins Studdard Law immediately to handle the case.
Dana BessDana Bess
23:57 10 Dec 21
Everyone at Perkins Studdard was kind and professional. They were always extremely responsive and answered all questions that I had and followed up to make sure I had an understanding of what was going on along with emailing videos to explain every step of my case so I would know what to expect and be prepared. Jason is a very genuine person and I trusted him with my case. He answered so many questions for me even before I retained him as my WC lawyer. I highly recommend him and his associates at Perkins Studdard.

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Jason Perkins

Workers' Compensation Attorney

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