How Surgery Impacts Your Arizona Workers’ Compensation Settlement
When you are injured on the job, hearing a doctor say that you need surgery is incredibly daunting. Beyond the physical pain and the fear of the procedure itself, there is the overwhelming stress of how it will affect your livelihood and your workers’ compensation claim. At Arizona’s Work Injury Firm, we frequently speak with injured workers who ask a very practical question: “Will having surgery increase the value of my workers’ compensation settlement?”
The straightforward answer is yes, undergoing surgery typically increases the overall value of a workers’ compensation claim. However, the reasons behind this increase are complex and rooted in how the Arizona workers’ compensation system values injuries and recovery.
Why Surgery Generally Increases Claim Value
In the Arizona workers’ compensation system, settlements are not based on “pain and suffering” like they are in personal injury lawsuits. Instead, settlements are calculated based on your medical expenses, your lost wages, and any permanent impairment you suffer as a result of the injury.
Surgery impacts all three of these categories:
- Increased Medical Costs: Surgery is inherently expensive. It involves surgeon fees, anesthesiology, hospital or surgical center facility fees, and extensive post-operative care such as physical therapy and prescription medications. A settlement that resolves future medical care must account for these high costs if the surgery is anticipated but hasn’t happened yet, or it reflects the severity of the care already provided.
- Extended Time Away from Work: Recovery from a surgical procedure almost always requires a significant period of time away from work. During this recovery, you are entitled to temporary total or temporary partial disability benefits to replace a portion of your lost wages. The longer you are out of work recovering from surgery, the more wage replacement benefits the insurance company must pay, which increases the overall cost of the claim.
- Higher Permanent Impairment Ratings: Once you have reached Maximum Medical Improvement (MMI)—the point where your condition is stable and unlikely to improve further—your doctor will assign an impairment rating. Injuries that require surgery, such as spinal fusions or joint replacements, often result in a higher permanent impairment rating than injuries treated conservatively. A higher impairment rating directly translates to higher permanent disability benefits, which significantly increases settlement value.
The Insurance Company’s Perspective
Because surgery increases the cost of a claim, workers’ compensation insurance carriers frequently fight surgical recommendations. They may demand an Independent Medical Examination (IME) with a doctor of their choosing, hoping that their doctor will say the surgery is unnecessary or unrelated to the workplace accident.
If your treating physician recommends surgery and the insurance company denies it, you have the right to request a hearing before the Industrial Commission of Arizona (ICA). This is a critical juncture where having an experienced attorney is vital. We know how to counter the insurance company’s tactics and present compelling medical evidence to prove that your surgery is necessary and related to your work injury.
Focus on Your Health, We Will Handle the Rest
Your primary focus should always be on your health and recovery. If your doctor believes surgery is the best path to healing, you should not let the insurance company bully you into settling for less or foregoing necessary treatment. As dedicated Arizona workers’ compensation lawyers, we understand the physical and financial stakes involved in surgical claims. We are committed to ensuring that your settlement accurately reflects the severity of your injury and the extensive care you require.
Frequently Asked Questions (FAQs)
Can I be forced to have surgery to get a settlement?
No. You have the right to direct your own medical care. While refusing a recommended surgery might impact your impairment rating or the timeline of your claim, the insurance company cannot force you to undergo an invasive procedure against your will.
What if the insurance company’s doctor says I don’t need surgery?
This is a common dispute. If the insurance company denies your surgery based on an IME, you can request a hearing before an Administrative Law Judge at the ICA. The judge will review the medical evidence from both doctors to make a determination.
Should I settle my case before or after I have surgery?
It is generally highly inadvisable to settle your claim before undergoing a recommended surgery. Until the surgery is complete and you have reached Maximum Medical Improvement, the true extent of your permanent impairment and future medical needs is unknown.
Protect Your Right to Comprehensive Medical Care
If you are facing surgery due to a workplace injury, the insurance company will likely try to minimize your claim. Do not face them alone. Contact Arizona’s Work Injury Firm today for a free consultation. We will fight to ensure you receive the treatment you need and the maximum compensation you deserve.