Does it Help My Workers Compensation Case if I Elect to Have Surgery

Dealing with a workplace injury is tough enough. When your doctor recommends surgery or a medical procedure, a wave of questions and concerns can wash over you. On top of your health, you're likely wondering how this decision will affect your workers' compensation claim. The short answer? It can have a significant impact, but it's crucial to understand the nuances. Let's break down how electing to have surgery can influence your workers' comp case.

How Surgery and Procedures Can Influence Your Compensation

The decision to undergo surgery or other medical procedures isn't just about your physical recovery; it directly ties into several aspects of your workers' compensation benefits:

• Medical Benefits: Workers' compensation is primarily designed to cover reasonable and necessary medical treatment related to your work injury. This includes the cost of the surgery itself, anesthesia, hospital stays, pre-operative evaluations, post-operative care, physical therapy, and necessary medications. Electing for a recommended surgery is generally seen as a necessary step in your recovery, strengthening your claim for these benefits.

• Temporary Disability Benefits: If your surgery and subsequent recovery period leave you unable to work, you'll likely be eligible for temporary disability benefits. These benefits replace a portion of your lost wages while you're out of work recovering. The duration you receive these benefits will depend on your recovery timeline as determined by your treating physician.

• Permanent Impairment Benefits: In some cases, even after surgery and rehabilitation, you may be left with a permanent impairment due to your work injury. This could be a loss of range of motion, chronic pain, or other lasting effects. If surgery helps to mitigate the extent of this permanent impairment, it can indirectly influence the rating assigned to your impairment and, consequently, the amount of permanent impairment benefits you receive. Conversely, if surgery fails to fully resolve the issue or leads to further complications, it could potentially increase your permanent impairment rating.

Understanding Additional Coverage and Financial Implications

While workers' compensation should cover the direct costs of your surgery and related care, it's wise to consider potential additional financial implications:

• Travel Expenses: You may be entitled to reimbursement for reasonable travel expenses to and from your medical appointments, including those related to your surgery and follow-up care. Keep meticulous records of mileage and any other transportation costs.

• Lost Wages Beyond Temporary Disability: While temporary disability benefits provide wage replacement during your immediate recovery, there might be a gap if your recovery extends beyond the maximum allowable period for temporary benefits, or if your permanent impairment prevents you from returning to your previous job at the same wage. Consulting with a legal professional can help you understand your options in such situations.

• Future Medical Care: Depending on the nature of your injury and the outcome of your surgery, you may require ongoing medical treatment in the future. Workers' compensation may cover these future medical expenses if they are deemed reasonable and necessary for your work-related condition.

What Will Workers' Compensation Cover?

Generally, workers' compensation should cover the following related to your surgery, provided it's deemed medically necessary and directly related to your work injury:

• Surgeon's fees

• Anesthesiologist's fees

• Hospital or surgical center charges

• Pre-operative and post-operative care

• Physical therapy and rehabilitation

• Necessary medical equipment and medications

It's crucial to communicate openly with your treating physician and the workers' compensation insurance adjuster to ensure that the proposed surgery and related treatments are pre-authorized, if required, to avoid potential disputes over coverage.

The Impact of Multiple Surgeries

If your work injury necessitates multiple surgeries or procedures, the complexity of your workers' compensation case can increase. Each surgery and its subsequent recovery period will likely extend the duration of your temporary disability benefits. Furthermore, multiple surgeries can potentially lead to a higher overall permanent impairment rating if the cumulative effect of these procedures leaves you with more significant and lasting limitations. It becomes even more critical in such situations to maintain thorough medical documentation and potentially seek legal counsel to navigate the intricacies of your claim.

Proving Damages: The Role of Surgery

Electing to have surgery can be a crucial piece of evidence in proving the extent of your damages in a workers' compensation case. The medical records documenting the need for surgery, the surgical procedure itself, and your recovery process provide concrete evidence of the severity of your injury and its impact on your ability to function. This documentation supports your claim for medical benefits, temporary disability, and potentially permanent impairment benefits.

However, it's essential to remember that simply having surgery doesn't automatically guarantee a specific outcome in your workers' comp case. The insurance company will still review the medical evidence to determine if the surgery was reasonable and necessary due to your work injury. They may also seek independent medical evaluations.

The reality is that accidents can occur unexpectedly, despite taking all necessary safety measures. If you have queries or issues about a work-related injury, hazardous work environment, or unjust treatment, don't hesitate to contact us for a complimentary consultation and case evaluation.

To learn more or share your experiences call Barsoum Law (877) 299-1555 or schedule a consultation online.

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