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September 1st, 2022

Will Surgery Increase My Workers’ Comp Settlement?

Whether you have surgery or not after a work-related injury shouldn’t impact your benefits if your employer’s subscribed to the state’s traditional workers comp system. If they’re not, you can sue your employer through a lawsuit filed in a state court. In that case, the settlement value is calculated in part on your medical bills. Surgical costs will increase your case’s settlement value depending on the circumstances.

Workers’ Compensation Benefits

If you’re involved in a workplace accident, are injured, and your employer subscribes to Texas’ workers’ compensation coverage, you’ll receive benefits allowed under state law, including partial wage replacement, payment for medical treatment, and a lump sum if you suffer a permanent impairment or disability. 

If you need wrist surgery to recover, comp benefits should pay for it. If you’ve lost wages due to the injury, benefits will make up for some of that loss. If you’ve reached maximum medical improvement after surgery and you’re expected to be permanently physically impaired, you would get a lump sum benefit. The greater the disability, the larger the amount should be.

With this approach, there is no settlement to be affected by surgery, though if you have a permanent limitation the parties can negotiate the lump sum you’ll receive.

This traditional approach has costs and benefits for an injured worker. One cost is you’re not compensated for pain, suffering, or mental anguish, which may be substantial in a severe accident. The benefits are the workers’ comp system include:

  • The process moves faster than the courts
  • It’s generally easier and simpler to prove you should get compensation
  • Depending on the facts, if you are injured on the job, you should get benefits

Your employer, not you, decides which system will resolve your claim, so make the most of whatever opportunities you have.

Non-Subscriber Lawsuit

Non-subscriber cases are treated as personal injury lawsuits. Though proving liability may be much more complex, and the litigation process may take longer, you may obtain a much greater recovery. 

Some defenses a defendant may use in a standard personal injury lawsuit aren’t available to an employer in a non-subscriber case. They can’t claim your case should be dismissed, or your judgment should be reduced because:

  • You’re at fault (unless you were intoxicated or intentionally harmed yourself)
  • You assumed the risk of dying or suffering an injury
  • Another employee’s negligence caused the accident

You may obtain a higher settlement through a lawsuit, but it takes longer, and there’s usually more uncertainty.

How are Settlements Calculated?

Settlements are generally based on adding up your damages (the harm you suffered measured in dollars) and some multiplication. Damages are labeled “special” and “general.”

  • Special damages are what the accident and injury cost you out of pocket. That could be property damage, past income losses, medical treatment co-pays, and future expected lost income 
  • General damages start with adding up your expenses for injury-related medical, rehabilitation, and psychological treatment (whether you paid for them or not) plus the estimated costs of expected future treatments to get you as healthy as possible. These figures are added together and multiplied by a “multiplier” to come up with your general damages

The multiplier generally starts at 1.5 and goes up to five. What it should be is subjective and up to the plaintiff’s lawyer and the insurance company. Generally, the higher the number, the more pain you suffered, the more outrageous the employer’s acts (or failures to act) causing the accident, and the overall strength of your case.

You add up your general and special damages, and you have an idea of your case’s settlement value.

How Would Surgery Affect My Case’s Settlement Value?

The costs of surgery vary greatly. Depending on what’s done, its complexity, and what’s needed to recover afterward (medications, physical therapy, follow-up visits with your surgeon), this could add tens or hundreds of thousands of dollars to the amount multiplied by the multiplier to come up with your general damages. 

If your surgery’s expense is $100,000 and the multiplier is three, your settlement value increases by $300,000. Part of the multiplier is impacted by how much pain you’re in. Your multiplier may go up if you’re in greater pain after the operation and during rehabilitation.

A long recovery will add to your income losses, and co-pays for follow-up visits and medications will boost your special damages.

If your healthcare professional suggests surgery as part of your treatment plan, you should consider the procedure’s physical and mental costs and benefits. You should have surgery if you’re confident in your surgeon and believe it will help you recover. Don’t have surgery because you think it will result in a better lawsuit settlement.

Your settlement will probably be less than your case’s total value (if you demand the defendant pay all it may be liable to pay to settle, it will go to trial and hope it pays less because you may lose or a jury may think your damages aren’t that high).

The final settlement amount is impacted by many things, including:

  • How risk averse you are: You’d rather have a smaller settlement amount for sure than risk a lower recovery, or no recovery at all, at a trial
  • The time value of money: Getting a settlement sooner than possibly collecting on a judgment much later

We can tell you if the insurer’s offer is fair or whether we think they may go higher, but the choice to accept it or not is your decision.

Should I Hire a Schechter, Shaffer & Harris Lawyer for My Non-Subscriber Case?

Call Schechter, Shaffer & Harris, L.L.P at 713-893-0971 if you need a Houston personal injury lawyer with years of court system experience. We help people like you win settlements and judgments for their injuries. Contact our team today and schedule your free consultation to start the process of getting the compensation you deserve.

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