Will My Workers’ Compensation Settlement Be Impacted By Surgery?


Suffering an injury at work is never ideal. You’re dealing with the pain and inconvenience of the injury and worried about not being able to work and pay bills. You also have to make a claim through your employer’s workers comp insurance company to get medical bills paid and workers’ compensation benefits. If a doctor recommends surgery after your accident, you may wonder: How does surgery affect my workers’ compensation settlement?

In serious cases, you might also have to weigh the benefits and drawbacks of potential surgery. The idea of surgery can be daunting, especially if you worry your employer will not cover the costs of the surgery. Injured workers are also often worried about the time they must take away from work to recover after surgery. To make matters worse, you may still need future medical treatment following your operation.

When your doctor informs you that surgery is your best option, it is best to follow through with their orders. Although the D.C. workers comp system, and especially the risk of not getting  workers’ compensation benefits can be intimidating, having someone to help you is the right choice. Thankfully, the passionate workers’ compensation lawyers at Donahoe Kearney can help you get the medical care you need and the compensation you deserve after a workplace accident.

How Are Benefits for Workers’ Compensation Calculated After You Have Surgery?

The short answer is… it depends. Many factors that go into calculating benefits after surgery. Below are a few examples.

  •     The severity of your injury in general
  •     The type of surgery you have to have
  •     The type of injury you are experiencing
  •     The injured body part
  •     Whether you can return to work after your surgery
  •     Whether you will have life-long restrictions in mobility or lifting

Even if surgery is successful, many injured workers cannot return to the heavy-duty job they held before their work accident. Instead, they must take on lighter-duty work that might not require as much lifting, pushing, or pulling. If you must take lighter-duty work, there is also a good chance that your lighter-duty job will not pay as much as your heavy-duty work.

If you return to work in a lighter-duty job that does not pay as well as your prior work, workers’ compensation benefits will pay 66 2/3% of the difference in pay. This benefit is “temporary partial disability.” The amount of money you can receive from this benefit might vary from week to week. The benefit depends on the actual difference between your wages before your work injury and your light-duty pay.

This type of workers’ compensation benefit is based on your temporary disability after you reach “maximum medical improvement” (MMI). It can also apply when you return to work, whichever comes first. The calculation for temporary partial disability benefits can be difficult. Donahoe Kearney will do this benefit calculation for you to help you receive as much as you should under applicable laws in Washington, D.C.

What Happens If You Need Surgery After a Workplace Injury?

In general, if your employer already accepted your injury claim and provided some benefits to you, they must pay for your surgery. Your doctor simply needs to let the workers’ compensation insurance company know that they are recommending surgery and that the surgery is a result of the damage you suffered because of your workplace injury.

Under District of Columbia Code § 32-1507, an employer must pay for medical care, including surgeries, to assist with your recovery after a work accident. You have to show that any recommended surgery is reasonable, necessary, and causally related to your work injury.

Does Needing Surgery Increase My Workers’ Compensation Settlement?

Like medical benefits, the dollar value of your workers’ comp settlement amount will depend on a wide variety of factors. Workers’ compensation benefits provide you with medical care and monetary benefits after a work accident. In general, that means that if you have a severe injury, it will take more medical treatment (including surgery, physical therapy, and other future medical care) and wage replacement funds to get you back to work compared to a minor injury. And with serious injuries, especially to the neck and back, some workers are never able to return to work.

Some of the factors that may need to be considered as part of a workers’ comp settlement might include:

  •     Your pre-injury earnings
  •     Whether you can go back to the same job
  •     Whether you can go back to any job
  •     Whether you can secure a job in your chosen field
  •     Your training, education, and work skills
  •     Your age and work experience
  •     Your medical condition before your work injury
  •     The anticipated cost of future medical expenses

Ultimately, the settlement value of your claim will depend on whether you can return to work and how much you can earn after your injury.

So, does surgery increase your workers’ comp settlement amount? Perhaps.

Because having surgery affects whether you can return to work, an operation might increase your lump sum settlement. You might need to have an expert review the Washington, D.C. job market to determine if you can realistically go back to work in your field — or in any field.

Unfortunately, even a successful surgery can leave you with limitations or restrictions that can affect your ability to work. Chronic pain or the need for pain medications is sadly very common in workers’ compensation cases.

What If Surgery Still Leaves Me Permanently Impaired?

Thankfully, Washington, D.C. has specific workers’ compensation laws that apply to permanent injuries. Suppose your work injury permanently affects your arms, legs, hands, or feet, but you can still work in your regular job. In that case, you may be able to get additional benefits even after you return to work, depending on the severity of the injury. These are “permanent partial disability” benefits.

In addition, if your injury is to your neck or shoulder and causes permanent symptoms in one or both arms (or, for example, if a back injury causes symptoms in your legs), these permanent benefits might also be available for your workers’ compensation claim.

Many factors go into whether you can get these additional benefits for a work-related injury.

Pain

Pain is perhaps the most common reason workers end up with permanent injuries. Even if medication controls the pain, discomfort is certainly a factor in determining permanent impairment.

Loss of Endurance

After surgery, you may not be able to work as long or as hard as you once could. This lack of endurance can lead to decreased earnings in the future, so it is also a factor to consider in determining permanent impairment.

Weakness

Sometimes surgeries can lead to weakness or instability in or around the affected areas of the body. When your body is weak, you may not be able to withstand the same type of work that you were used to doing before your work accident.

Atrophy

Atrophy is the progressive physical deterioration of a body part or tissue. In most cases, it arises from non-use or limited use of muscles. For example, if you have shoulder surgery, you might be unable to move your arm for some time after the surgery. That non-use can lead to atrophy over time, which causes weakness, discomfort, and sometimes a loss of mobility.

Loss of Function

Decreased function and mobility are huge factors in determining permanent disability. Ultimately, workers’ compensation law is designed to help you get back to work, which may not happen if you lose function in certain body parts.

Only qualified medical professionals can determine the extent of your permanent impairment, and our D.C. workers comp team can identify several great local physicians who can determine this for you. However, this evaluation should not happen until after you are released back to work or have received all of your other benefits. If you cannot return to work after surgery, you should still receive temporary total or permanent total disability benefits.

What Happens If Your Employer Decides Not to Pay for Your Surgery?

Surgery is often only recommended after all other more conservative treatments have failed or have not provided enough relief for you. Remember that a physician must have recommended surgery for workers’ compensation benefits to apply to surgery. That means that if the insurance adjuster declines to pay for the surgery, the insurance carrier is ignoring your doctor’s recommendations.

If the workers’ compensation insurance company refuses to approve a surgery, you can request a hearing and ask the judge to award the surgery. This is a complicated and time-consuming process, so if your doctor has recommended surgery, but the insurance adjuster denied it, you should not delay in getting a workers’ comp lawyer involved.

When is a D.C. Workers’ Compensation Settlement Finalized?

Unlike personal injury cases, every workers’ comp settlement in Washington, D.C., has to be approved by the D.C. Office of Workers’ Compensation (OWC). They require this approval process to ensure that employees are protected and get a reasonable settlement offer for their work injuries. However, your workers’ compensation attorney works to help you get all of the compensation you deserve — not just evaluate whether your settlement is reasonable.

Once you reach an agreement with the workers’ comp insurance carrier, the settlement agreement has to be reduced to writing as part of a Settlement Petition. Your attorney will then file that petition with the OWC, and the OWC will review and approve it. All settlements are final once they are approved. After approval, the insurance company will pay out a lump sum settlement within 14 days.

Why Do I Need a Workers’ Comp Attorney?

A workers’ compensation attorney strives to prevent insurance companies from taking advantage of people hurt at work and violating your rights under workers’ comp law in D.C. — rights most people don’t even know they have (and no, the insurance company won’t tell you your rights — they’re working against you). The experienced workers’ comp attorneys at Donahoe Kearney know how to handle insurance companies in addition to all of the laws surrounding workers’ comp. Just as we have done for hundreds of other clients, we will work diligently to secure your rightful compensation.

Are You Concerned That Needing Surgery Will Affect Your Workers’ Comp Claim?

The team at Donahoe Kearney can help you navigate having surgery as part of your workers’ comp case. Don’t worry about dealing with insurance companies. Our law firm will handle this for you and help you assert your rights if the insurance adjuster refuses to pay for your surgery. Learn more about our free consultation strategy session and get tailored legal advice for your situation by calling (202) 393-3320.

by Frank R. Kearney, Attorney-at-Law

Experienced DC Workers’ Comp, Long Term Disability & Accident Lawyer,

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