Call Us!Does Surgery Increase Your Workers’ Comp Settlement?
When you are injured on the job, you may be eligible for workers’ compensation benefits.
You may be wondering, “What is workers’ compensation and how does it work?”
Colorado requires all businesses with employees, regardless of the number of employees, to have workers’ compensation insurance. This requirement applies whether the employees are part-time, full-time, or family members.
Workers’ compensation insurance is a no-fault system. Thus, an employee does not need to prove negligence to be covered.
So, who is involved in a workers’ comp claim?
This claim involves an injured worker, their employer, and the employer’s insurance company. It also often involves other parties, such as medical teams and state departments.
Workers’ compensation benefits include medical care, lost wages, and temporary and permanent disability. But does workers’ comp pay for surgery? In some cases, it does.
This insurance covers the costs of approved, reasonable, and necessary surgeries and related medical expenses resulting from a work-related injury or illness. A surgery must have been deemed reasonable, medically necessary, and directly related to a work injury.
Typically, undergoing surgery after a work injury increases workers’ compensation as well. A workers’ compensation attorney can help you determine the true value of your claim. At Bachus & Schanker, we help injured workers receive compensation that covers all the damages suffered.
How Does Surgery Make a Workers’ Compensation Claim More Serious?
Does workers’ comp cover lost wages? Yes, it does. Wage replacement will typically pay two-thirds of your average weekly pay. However, there are statewide maximum limits that you will not be able to surpass. These are adjusted annually.
Who Qualifies for Lost Wage Benefits After a Workplace Injury?
In Colorado, workers who miss more than three shifts because of an accepted work-related illness or injury may be eligible to receive lost wage benefits. An Authorized Treating Physician (ATP) must officially state that you cannot work, or that you can only do so in a restricted capacity.
What Is Temporary Total Disability (TTD) Benefits?
Temporary total disability benefits cover two-thirds of your average weekly wages if you are unable to work. Benefits start on the fourth day of missed work, but if you miss more than 14 days of work or are hospitalized, those first three missed days can be reimbursed.
What Is Temporary Partial Disability (TPD) Benefits?
Temporary partial disability benefits are partial wage replacement payments that you receive if you return to work in a limited capacity. You would be paid two-thirds of the difference between your pre-injury and post-injury wages. To be eligible for TPD benefits, your doctor must have released you to modified or light duty.
What Permanent Disability Benefits May Include Wage Replacement?
Both permanent total disability (PTD) and permanent partial disability (PPD) benefits provide wage replacement. If you can’t work at all and are eligible for PTD, you can receive two-thirds of your wages for the rest of your working life.
If you have reached maximum medical improvement and still cannot return to your full working capacity, you can receive PPD benefits. Your ATP will designate a rating to your injury, and this will dictate the wage replacement amount you may be eligible for.
What Surgery-Related Costs May Workers’ Compensation Cover?
The pre-operative costs that may be covered include surgeon and surgical team fees, anesthesia and anesthesiologist services, facility fees, pre-operative tests and imaging, medications ordered prior to surgery, and travel to and from appointments.
Post-surgery related costs that can be claimed include prescription drugs, a hospital stay, medical equipment, like braces and crutches, rehabilitation, follow-up visits, revision surgery, travel to and from appointments, nursing care, and home and vehicle modifications.
What Benefits May Injured Workers Receive When a Workplace Injury Requires Surgery?
An injured worker may receive medical care (pre- and post-op medical expenses), wage replacement benefits (temporary total/partial disability), long-term disability benefits (permanent total/partial disability), and mileage reimbursement.
Should You Settle a Workers’ Compensation Claim Before or After Surgery?
Some injured workers settle a workers’ compensation claim before surgery. After determining they need surgery, they factor in anticipated costs and sign a negotiated settlement agreement.
However, it’s generally recommended to settle after reaching maximum medical improvement (MMI), which means after the implemented treatment options, including surgery, have stabilized your condition, and further medical treatment is unlikely to significantly improve your condition. Waiting to reach MMI allows you to establish an accurate value for your claim.
Settling before your recovery and future medical needs are known increases the risk of paying expenses out of pocket. For instance, if surgery costs more than anticipated or results in complications that increase the overall cost.
You may also be wondering, “How long does workers’ comp take to settle?”
A workers’ comp case can settle in months or a couple of years, depending on its unique circumstances. A disputed case takes longer than one in which an injured worker agrees with the decisions of the insurance company.
Can Workers’ Compensation Insurers Deny or Dispute the Need for Surgery?
Yes, they can.
After filing workers’ compensation, your employer’s insurer will investigate the case. That’s why it’s crucial to build a strong case. For example, it’s vital to document a workplace injury and be informed about workers’ compensation tips.
If your case is solid, it can be approved. But even after approval, the need for surgery can be denied or disputed through an independent medical examination (IME).
The insurer may claim the operation is not medically necessary, as other treatment options, such as physical therapy, can be used. In most cases, insurance companies do this to reduce payouts. If your need for surgery is denied or disputed, gather documents from your physician and work with an attorney to prove the operation’s necessity.
What Should You Do if You Need Surgery After a Workplace Accident?
If you need surgery after a workplace accident, you should do the following:
- Ensure the surgery is recommended by an authorized treating physician (ATP).
- Get pre-authorization for the specific surgical procedure from your employer’s insurer. If your case is an emergency, which means you need immediate surgical intervention, you will be exempted from the prior authorization requirement. Go to the nearest capable medical facility for treatment. You will notify your employer as soon as possible.
- Give a written notice of injury to your employer within 10 days of sustaining the injury.
- File a WC15 Worker’s Claim for Compensation form with the state division.
- Comply with any requests for an IME.
- Wait for approval or denial of your claim.
- Follow your doctor’s recommendations.
When Should You Contact a Colorado Workers’ Compensation Lawyer?
It’s important to work with a workers’ compensation lawyer if your claim is denied, your injury is disputed, or your need for surgery or other treatment options is disputed or delayed.
Your employer’s insurer may argue that your injury is not work-related, argue that a pre-existing condition is what’s resulting in the need for surgery, delay approving tests or referrals, or offer a lower settlement. An attorney will help you build a strong case that gets you fair compensation.
How Can Bachus & Schanker Help Injured Workers With Workers’ Compensation Claims Involving Surgery?
At Bachus & Schanker, we help injured workers gather evidence, prove the need for surgery, and understand Colorado laws. We also help them overcome insurance pushbacks, challenge unfavorable IMEs, and dispute a low permanent impairment rating after surgery. Accordingly, an injured victim can sign a well-negotiated settlement agreement.
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Kyle Bachus & Darin Schanker
Top-rated Colorado-based personal injury lawyers and co-founders of Bachus & Schanker, Kyle Bachus and Darin Schanker, have represented car accident victims and families across Colorado for more than 30 years, earning a reputation as some of the best car accident attorneys for serious injury cases. The firm is structured to handle car accident cases of all types and severities, with a team organized to provide focused support and guidance throughout the process. Kyle and Darin guide victims through the legal process with the support of a dedicated team of car accident specialists and Victim Advocates, ensuring care and advocacy from start to finish so clients can stay focused on healing.
Both Kyle and Darin are nationally recognized for their trial skills and leadership in the legal community. They are members of the Million Dollar Advocates Forum, an exclusive group of attorneys who have achieved million and multi-million-dollar verdicts and settlements, a distinction earned by fewer than 1% of U.S. lawyers. In addition, they have been named Colorado Super Lawyers every year for nearly two decades, included in the Lawdragon 500 Leading Plaintiff Lawyers in America, named Top One Percent by the National Association of Distinguished Counsel, Top 10 Personal Injury Attorneys in Colorado by America’s Best Advocates, and recognized as top civil plaintiff attorneys by The National Trial Lawyers. Beyond the courtroom, they support the Colorado community through the Bachus & Schanker Cares Foundation, which sponsors local nonprofits and initiatives. See Kyle Bachus and Darin Schanker on Super Lawyers.
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#1 Amazon Best Seller in the Legal Industry
Attorney Kyle Bachus knows first-hand how difficult it can be to suddenly lose a loved one in an accident. It’s also devastating when you or a family member suffers severe injuries that forever change your lives. Kyle wrote this book as a resource from his personal experience for families who have suffered a traumatic loss.
A Spanish edition of the book is also available, offering the same support and guidance to Spanish-speaking families.
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