If you’re receiving a workers’ comp settlement, you may be wondering if the total settlement amount will change if you need to undergo surgery. The answer is yes, generally surgery does increase workers’ comp settlement in cases where the surgery happens after the settlement has been negotiated, and the payout is relative to the severity of the surgery needed. For example, a minimally-invasive surgery with a short recovery time will result in a smaller payout than a major surgery like an organ replacement. However, there are other factors that can impact this, namely how your workers’ comp settlement is being calculated, what kind of payment type you’ve opted for, and whether the surgery is being completed prior or after your case is settled.

How Will My Workers’ Comp Settlement Be Calculated?

Your workers’ comp settlement is calculated based on two types of benefits; disability benefits, and medical expenses. 

With disability benefits, these compensate you for the wages you’ve lost due to time missed from work, or the wages you stand to lose due to your injury. They are calculated based on your average weekly wage and how long you’ll need to be away from work for. There are two types of disability benefits:

  • Temporary Disability: these cover wage loss until you’ve reached maximum medical improvement - MMI. This is denoted as the point at which no further medical care will improve your condition.
  • Permanent Disability: this coverage is for when a worker’s injury will only improve up to a certain point, such as in the case of an amputation. This can be classified as a partial disability, which does not render a worker completely disabled, or a total disability, which results in a complete inability to return to work.

Medical benefits, on the other hand, will cover all medical expenses needed for your recovery, including emergency treatment, medical supplies, medications, surgeries, and rehabilitative therapy.

Note: you’re unlikely to directly see the medical benefits, as these are paid directly to your treatment provider and are accredited to the treating doctor through the insurance carrier.

How Does My Choice of Payment Plan Affect My Compensation?

During settlement negotiations, you’ll be given the choice between either a lump sum payment or a structured payment plan. These choices will determine how and when you receive your compensation, as well as the stipulations attached to it.

If you opt for a lump sum payment, your settlement will be calculated based on the current value of all future benefits, including medical benefits. So, if your surgery is expected to be expensive, opting for a lump sum payment can help you receive more money upfront.

If you opt for a structured payment plan where the settlement is divided into regular payments over time, then your medical benefits will be split with each payment. This means that any future medical care, including surgery, will be covered as needed.

What If My Condition Worsens?

If your condition worsens, and you require additional medical assistance, this may be covered as part of your workers’ comp settlement. Depending on the type of payment you’ve opted for and whether the surgery is being completed prior or after your case is settled, the amount of compensation may vary.

If you have chosen a lump sum payment and your condition worsens after the case has been settled, unfortunately, you may not receive any additional compensation beyond the original settlement amount. However, if a structured payment plan has been chosen, and you require further medical care after the case has been settled, the need for surgery and other procedures may increase your workers’ comp settlement.

What Does The Average Workers Comp Settlement for Spinal Fusion And Other Types of Surgery Look Like?

The average workers comp settlement for spinal fusion and other types of surgery can vary greatly depending on the severity of your injury and the corresponding medical expenses. It is not uncommon for workers to receive settlements that range anywhere from $10,000 to $100,000+ for surgeries, though this is not a guarantee. Additionally, if your workers’ comp settlement has been delayed due to negotiations or other disputes, this can also significantly impact the amount that you receive.

What Impact Does Surgery Have on Injury Settlement Amount?

The type of surgery you need impacts the total payout of the settlement amount, with the number being defined by the cost of surgery (both surgical and non-surgical costs), the indirect expenses it will cause, as well as, the extent of the injury. Due to these things, the amount awarded to you will be highly variable and is determined on a case-by-case basis. This is why it’s best to discuss these terms with a lawyer experienced in worker’s compensation laws to ensure that you’re receiving all the funds you’re entitled to.

What If I Need Surgery Before My Case is Settled?

When dealing with settlements, timing is always highly important, and when medical care gets involved, that timing tends to get tricky, as your physical health can change drastically, and quickly. In case you find yourself needing surgery somewhere in the middle of filing your claim, you’re in luck. Simply including your surgery in your claim is one of the easiest, and fastest, ways of having your procedure covered as long as your claim is approved. Your medical provider will forward any and all billing documents to the insurance company, who will then proceed to pay the costs included within.

What About After My Case is Settled?

On the other hand, once a case has been settled, and you’ve received a settlement, claiming additional costs can be problematic and will depend on a number of factors. As stated above, lump sum payments typically aren’t very flexible, as they often contain a waiver for future medical benefits. Thus, if your doctor has deemed surgery a necessity after the fact, requesting additional funds will likely be denied. The advantage with structured payment plans is that they often don’t include such a waiver, and so offer more security in the form of adaptable coverage.

Wrapping It Up

The impact of surgery on your workers’ comp settlement can increase the total amount, but this will depend on a number of factors, such as the type of payment you’ve chosen, the timing of your surgery, and the type of injury you are dealing with. It is highly recommended that you speak with a lawyer like Frank Eidson P.A. who is an experienced attorney in workers’ comp settlements, as he and his team will determine what the best course of action would be for your unique case. Additionally, if you are still going through the claims process, you should make sure to include any surgery as part of your initial claim as it will help ensure that you receive the benefits you deserve. Regardless, if your case involves surgery, it is important to remember that an experienced lawyer can help you ensure that you get the best possible outcome for your unique situation.


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