Employees who suffer catastrophic injuries may need surgery to repair the damage. Severe injuries can also leave workers with permanent impairments, making it necessary for an injured worker to pursue a workers’ comp settlement and medical benefits.
Having surgery for a work injury can increase the size of your workers’ comp settlement. However, the need for surgery represents just one factor in determining your settlement. Other factors include the type and severity of your disabilities and your pre-injury wages.
What Types of Work-Related Injuries Might Require Surgery?
Treatment for some work injuries may only involve rest and physical therapy. However, more severe trauma may require an injured worker to undergo surgery. Examples of injuries that may require surgical treatment to repair and heal include:
- Third-degree burns
- Degloving injuries, where the skin gets torn away from muscle and bone
- Broken bones
- Ligament, tendon, and muscle tears
- Internal organ injuries and internal bleeding
- Crush injuries
- Perforation and penetrating injuries
- Nerve disorders, such as carpal tunnel syndrome or thoracic outlet syndrome
- Herniated spinal discs
- Dislocated vertebrae
- Spinal cord injuries
- Eye injuries
- Severe brain injuries, including penetrating brain injuries, brain hemorrhage, or excessive swelling of the brain
- Traumatic amputations or gangrenous limbs
Will Workers’ Compensation Pay for Surgery?
Workers’ compensation benefits will pay for surgical treatment for an injury that an employer or workers’ compensation insurer deems work-related. A work-related injury occurs when the trauma or harmful exposure causing the injury happens while the employee is performing job duties.
In addition to the work-related requirement, workers’ comp will pay for surgery for an injury or health condition when an employee’s treating physician deems the surgery reasonable and necessary to treat the injury or condition.
Workers’ comp will not pay for surgeries to treat pre-existing injuries or degenerative conditions. For example, suppose a worker suffers from a herniated disc due to natural degenerative changes. Workers’ comp will not pay for surgery to treat the herniated disc unless the herniation occurs due to some traumatic event at work, such as a fall or overexertion.
However, if a work accident aggravates or exacerbates a pre-existing condition, it could be a different story. The condition may have been asymptomatic before the work accident, but symptoms appear after the accident. If those symptoms reveal that surgical treatment is required, workers’ comp could pay for the surgery.
Workers’ comp will only pay for surgeries reasonably expected to improve the patient’s condition. It likely will not cover surgery when non-surgical treatments will treat the patient’s injury just as effectively.
Will My Employer’s Insurance Company Have to Approve My Surgery?
Even if your treating physician recommends surgery for a work-related injury or condition, you may need to wait to undergo surgery. Your employer or insurer must approve the surgery before they will cover the cost.
In cases where your injury or condition has become life-threatening or you need immediate surgery to prevent further deterioration, the workers’ compensation insurer may issue an approval or denial within a few days. However, for non-emergency situations, insurers may take several weeks to evaluate a request for surgery. In those circumstances, the insurer can ask you to submit to an independent medical examination (IME). Another physician performs an IME to confirm your treating physician’s recommendation for the surgery.
What Do I Have to Prove to Receive the Increased Benefits for Surgery?
When you undergo surgery to treat a work-related injury, you could be left with a greater degree of permanent impairment than if you hadn’t required surgery. Or you may have more costly medical care bills and be out of work longer to recover. These factors could be used to argue for an increased workers’ compensation settlement. However, successfully negotiating a larger settlement with your employer’s workers’ compensation insurer may require you to prove that:
- You suffered a severe injury that didn’t respond to less invasive treatment.
- You needed the surgery to reach maximum medical improvement.
- You need other treatment, physical therapy, and rehabilitation for your injury.
- You missed a prolonged period of work.
- You have suffered a disability that entitles you to permanent disability benefits.
- You have lost future earning capacity or potential due to your permanent disability.
- You cannot work in other jobs, even with vocational rehabilitation or support services.
- You’ll need future treatments or ongoing care even after your injury reaches maximum medical improvement.
- You need assistance or home health care to cope with permanent disabilities or impairments.
How Long Can a Workers’ Compensation Case Take to Settle?
Unfortunately, your attorney cannot predict precisely how long it may take to settle your workers’ compensation claim. Some cases settle in a few weeks, while others take years. The timeline and duration of a workers’ comp case depends on various factors, such as:
- The types of injuries you’ve suffered and their severity
- The duration of your medical care treatment and how long it takes you to reach maximum medical improvement (MMI)
- The nature of any permanent disabilities left by your injuries
- Whether you may need ongoing or future care after reaching MMI, such as pain management care or revision surgeries
- Whether you can return to work after reaching MMI
- Your lost future income or earning capacity
- Whether you may need personal care or support to cope with disabilities or bodily impairments
- How long it takes the workers’ compensation insurer to investigate your claim
- Whether the insurer asks you to undergo an independent medical examination
- Whether you need to file a formal workers’ comp claim with the Georgia State Board of Workers’ Compensation
Contact a Georgia Workers’ Compensation Lawyer
After suffering a catastrophic work injury that prevents you from returning to your job or other employment, you may need to negotiate a workers’ compensation settlement to get the financial resources you need. Contact Sherrod & Bernard, P.C., today for a free, no-obligation consultation to learn how a Georgia workers’ compensation lawyer can help.
