Many workers who suffer a workplace accident in the United States face not only the physical and emotional pain of an injury, but also uncertainty about whether their case will be taken seriously by the insurance company. One of the most frequent questions is: can surgery really increase my workers' compensation?
The answer is yes. And not only can it increase it, but many times it represents a key turning point in how insurance companies, judges, or defense attorneys evaluate the case.
How does surgery affect the value of a workers' compensation case?
When an injured worker requires surgical intervention, the likelihood that their case will be considered more serious increases considerably. This type of treatment not only involves higher medical costs, but also suggests a longer recovery, more severe consequences, and possible permanent disabilities.
Additionally, surgical procedures are usually supported by detailed clinical studies, which strengthens the medical file of the case. Surgery can also indicate that the injury did not resolve with conservative treatments, which demonstrates the seriousness of the damage.
You can read more about this topic in the article What type of surgery increases your Workers' Comp case?.
Examples of surgeries that increase the value of a case
There are surgical procedures that, because of their complexity, cost, and recovery time, have a greater impact on the final amount you could receive. Some examples are:
- Spine surgeries (such as discectomy, laminectomy, or spinal fusions): are usually associated with permanent injuries and chronic pain.
- Ligament reconstruction (such as ACL in the knee): require months of rehabilitation and can limit future activities.
- Rotator cuff repair: common in construction workers or factory workers who do repetitive arm work.
- Hand or wrist surgeries: especially if there is nerve damage, as occurs with severe carpal tunnel syndrome.
- Joint prosthetics (hip or knee): reflect significant structural damage and affect long-term mobility.
This type of intervention can result in compensation schedules by affected body part, which gives an economic value to each affected part of the body.
How is surgery related to the disability percentage?
After surgery, the treating physician issues a report on the patient's condition, in which they can determine if there is a permanent partial or total disability. This diagnosis translates into a percentage of loss of function, which is fundamental for calculating how much compensation you will receive.
The higher the disability percentage, the greater the amount that can be claimed. This percentage also influences whether you can return to your previous job, whether you must change activities, or whether you qualify for total permanent disability benefits.
Can the insurance company refuse to cover a necessary surgery?
Yes, and it's more common than it seems. Insurance companies, seeking to minimize costs, may argue that the surgery is not medically necessary or that the injury is not work-related. They can also delay authorization or require evaluations by doctors hired by them.
In these cases:
- Ask for an independent second medical opinion.
- Keep all reports, studies, and diagnoses.
- Consult with workplace accident attorneys in the United States to help you file the correct claim.
How much can compensation increase after surgery?
Although there is no fixed amount, various studies and cases have shown that surgery can double or even triple the value of a Workers' Comp claim. This is due to:
- Increase in medical costs.
- Longer period of work disability.
- Possibility of permanent partial or total disability.
- Associated psychological damages (such as depression or anxiety).
This makes surgery a determining factor that can substantially change the course of your case.
What impact does surgery have on the duration of the case?
A workers' compensation case can be extended if the result of surgery is pending. Although this can delay the closing of the file, it also gives time to gather stronger evidence and claim a higher amount. It is important to consider time as an investment: waiting can lead you to receive a much fairer amount.
What to do if the insurance company denies surgery authorization?
In that scenario, it is crucial to have legal support. A specialized attorney can help you file an appeal, request a hearing with the workers' compensation judge, and even take your case to other state agencies. They can also help you find doctors willing to operate under a letter of protection, that is, a promise of future payment upon settlement.
Frequently Asked Questions
What happens if I don't have surgery?
Refusing a recommended surgery can cause the insurance company to question the severity of your injury and reduce your compensation.
Can I choose the doctor who will operate on me?
It depends on the state. In some, the employer or insurance company chooses the doctor, but you can request a change or a second opinion.
Does surgery guarantee higher compensation?
It is not a guarantee, but it does considerably increase the valuation of your case and can facilitate a better settlement.
Is rehabilitation also taken into account?
Yes. The duration and success of post-operative physical therapy influence costs and the calculation of the percentage of recovery or disability.
What if I have complications after surgery?
Complications such as infections or additional surgeries can justify even greater compensation.
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