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June 12, 2023

Does Surgery Increase Workers’ Comp Settlement in California?

Legally reviewed by: Jessica Anvar Stotz, JD, MBA

Short answer: Typically in California, undergoing surgery for a work-related injury results in an increased workers’ compensation settlement.

In California, workers’ compensation generally covers the costs of necessary surgeries related to work injuries.

The California workers’ compensation system aims to provide medical treatment, including surgical procedures, to injured workers to help them recover and return to work.

However, the specific coverage and approval process may vary depending on the circumstances of the injury and the medical evidence supporting the need for surgery.

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Does Multiple Surgeries Increase a Workers’ Comp Settlement?

Multiple surgeries can potentially increase a workers’ compensation settlement as they often signify the severity and complexity of the work-related injury, resulting in:

  • higher medical expenses,
  • prolonged disability, and
  • potential long-term effects on the worker’s earning capacity

All of these are considered in settlement negotiations with the right legal counsel by your side. Most surgery happens after you reach a settlement, but there are instances where it can happen before.

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Should Someone Get Surgery Before or After Their Workers’ Compensation Settlement?

The decision of whether to undergo surgery before or after a workers’ compensation settlement is highly dependent on the specific circumstances of the case, including the severity of the injury, the recommended treatment plan, and the advice of medical professionals and legal counsel.

It is crucial for individuals to consult with their healthcare providers and workers’ compensation attorneys to assess the best course of action based on their unique situation.

Factors such as the urgency of the surgery, the potential impact on the claim, and the availability of medical coverage should be carefully considered before making a decision.

Example of Surgery Increasing a Workers’ Comp Settlement

Let’s say an employee sustains a severe back injury while lifting heavy equipment at work, resulting in chronic pain and limited mobility.

After a comprehensive medical evaluation, it is determined that surgery is necessary to alleviate the condition and improve the employee’s long-term prognosis. The surgery is successfully performed, followed by a period of rehabilitation and physical therapy.

During the workers’ compensation claim process, the medical documentation and evidence of the surgery, along with associated expenses, strengthen the employee’s case. Without surgery, the initial settlement offer may have been $50,000.

However, with the inclusion of surgery and its associated costs, future medical needs, potential loss of earning capacity, and the pain and suffering endured by the employee, the settlement negotiations result in an increased settlement offer of $150,000.

The surgery significantly enhances the settlement amount by recognizing the additional medical expenses incurred due to the procedure, the impact on the employee’s ability to work, and the long-term implications of the injury.

How Are Workers’ Comp Settlements Calculated When Surgery is Involved?

Workers’ comp settlements are calculated to typically include two types of benefits:

  • Medical benefits, and
  • Lost wages compensation

Medical benefits under workers’ compensation are typically calculated based on the reasonable and necessary medical expenses incurred for the treatment of a work-related injury or illness.

Calculating lost wages happens by assessing your average weekly wage prior to the injury and the duration of time you are required to be away from work due to the injury or illness.

It is important to note that medical benefits in workers’ compensation are typically paid directly to the healthcare provider, as mandated by workers’ comp laws.

These providers often have approval or affiliation with the insurance carrier handling the claim. This means you may not receive cash for medical benefits upfront unless it’s a reimbursement, but the value of these benefits will be considered in the overall settlement calculation.

Should You Take a Lump Sum Payment or Structured Settlement?

The decision between a lump sum payment or a structured settlement in a workers’ compensation case depends on various factors and individual circumstances. Both options have their pros and cons.

A lump sum payment provides immediate access to the full settlement amount, allowing the injured worker to have control over the funds.

This can be beneficial for individuals who require immediate financial assistance, have pressing medical needs, or prefer to invest the funds independently.

However, it is crucial to carefully consider future financial planning, as the lump sum may need to cover long-term medical expenses, ongoing care, and potential loss of income.

On the other hand, a structured settlement provides regular payments over an agreed-upon period, ensuring a steady income stream. This can help ensure ongoing financial stability and assist in managing long-term medical costs and daily living expenses.

Structured settlements may also have tax advantages, as the payments can be tax-free in certain circumstances. However, it limits flexibility and may not accommodate unexpected expenses or changes in financial needs.

Ultimately, the choice between a lump sum payment or structured settlement should be made after consulting with a workers’ compensation attorney, financial advisor, and considering individual financial goals, medical needs, and future expenses.

Get in Touch with a Lawyer

If you are suffering from a recent work injury and need surgery, get in touch with one of our work comp lawyers today. We have connections with some of the best lawyers in the state and can connect you with top rated legal counsel for free.

Save yourself a potential headache researching an attorney for your case. Contact LawLinq to get connected today.

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About the Author

Jessica Anvar

California Consumer Litigation Attorney Jessica Anvar, Esq. is the Founder and Managing Partner of Lemon Law Experts California’s leading lemon law firm. She has multiple years’ worth of experience working with both state and federal lemon laws. Her practice focuses exclusively on consumer protection cases. Ms. Anvar received her J.D. from Loyola Law School. She also earned a Master of Business Administration degree from Loyola Marymount University. Jessica is very active in her local legal community and has helped thousands of clients across the state of California. She has an outstanding record as a true advocate for consumers.

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