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Does Surgery Increase Workers’ Compensation Settlements?

Last year, more than 55,000 claims were filed with the Florida Division of Workers’ Compensation. With three decades of experience in workers’ compensation law, Berlin Law Firm has seen firsthand the impact a work injury can have on a person’s life. From medical costs and lost wages to physical and emotional pain, a job-related injury or occupational illness presents considerable challenges.

Our proactive and dedicated team of workers’ comp lawyers advocates for employees across Florida who have been hurt on the job.

While it can be stressful navigating the claim process after a work injury—help is available.

Keep reading to learn how surgery can affect your settlement and what to do if your procedure is denied.

Surgery and Workers’ Compensation Settlements in Florida

Surgery may be medically necessary after a work injury. But is your procedure covered under the Florida workers’ compensation system, and will it increase your settlement? The answer depends on a few factors:

The complexity of the procedure

Not all injuries, illnesses, and surgical procedures are alike. The National Council on Compensation Insurance’s  (NCCI) Workers Compensation Statistical Plan assigns dollar amounts to specific injuries. Minimally invasive procedures cost less and have a shorter recovery than more complicated operations. These variables all help adjusters and employers calculate your total settlement amount.

Settlement Plan

In Florida, Workers’ Compensation offers two types of settlement plans. A Compromise & Release plan pays a set amount based on anticipated costs for your procedure and post-op care. You can request compensation in a single, one-time payment or opt for a structured settlement paid out in installments over the long term. (A structured settlement typically offers more compensation.)

The other option is a Stipulation & Award settlement plan. In this case, the insurance company consents to paying all medical costs associated with your injury or making periodic payments over time.

Additional Medical Expenses

Surgery is just one piece of a larger healthcare picture. Your medical needs do not end once you’re discharged from the hospital or surgical center. You must consider the costs of hospitalization, copays, physical therapy, medication, tests, and other expenses associated with your condition. Your workers’ compensation settlement should cover these expenses.

If your healthcare provider determines you will not recover to the point where you can go back to work, your settlement should also include future permanent disability benefits as well.

Timing

When you have surgery also factors into your workers’ compensation settlement.

Should I Settle Workers’ Compensation Before Surgery?

You are permitted to have surgery after receiving your workers’ compensation settlement. Requesting a larger settlement to cover the projected costs for future care is possible. Also, because you don’t need insurance authorization if you go this route, you have the freedom to choose your provider and schedule surgery at your convenience.

However, you won’t be able to recover additional compensation for unexpected expenses like medical care for any complications. Instead, you’ll have to pay those out of pocket.

Should I Settle Workers’ Compensation After Surgery?

If you have surgery before receiving your settlement, you leave the door open to pursue compensation for subsequent procedures and medical care you may not have anticipated. Also, if you have sustained a permanent impairment that impacts your ability to work, you can seek a higher settlement to reflect your condition. However, waiting to settle also opens the door for your insurer to deny your claim or push it to litigation.

Ultimately, your health and wellness should always be your top priority. Always follow your healthcare provider’s guidance regarding the best course of care.

What to Do if Surgery is Denied

Employee accidents and injuries affect productivity and profits. The bottom line is typically the reason companies and employers deny surgery—even if your physician recommends it.

Your claim may be denied if:  

  • Insurers disagree with the diagnosis.
  • They don’t feel surgery is necessary.
  • They don’t believe you got hurt at work.
  • The claim deadline has expired.
  • A third-party provider determines surgery is no longer needed,

It’s understandable if you feel overwhelmed when you need a procedure, but your claim is denied. How are you going to pay for your care? A case review from an experienced lawyer is the best way to determine your options.

Contact Berlin Law Firm for a Free Consultation

Guidance from a dedicated and knowledgeable attorney at Berlin Law Firm is invaluable. We won’t back down when fighting for the treatment you need and deserve. We work to maximize your benefits—so you can focus on healing. If you were injured on the job and have questions about your workers’ compensation claim, schedule a free consultation with a Florida workers’ compensation lawyer; there is no obligation to hire us afterward. And since we work on a contingency fee basis, you will not pay attorney’s fees unless we win compensation for your injuries.

We look forward to hearing from you. With offices in Tampa and Sarasota, we serve clients across Florida.

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