Does Surgery Increase Workers’ Comp Settlement In Maryland?

In Maryland, surgery can significantly impact a workers' compensation settlement by increasing the settlement amount. Here are some key facts and figures:

1. Increase in Settlement Amount: Surgery often leads to a significant increase in workers' compensation settlements due to higher medical expenses, extended recovery periods, and the severity of the injury.
2. Factors Affecting Settlement: The extent to which surgery affects the settlement depends on the level of surgery required, the type of settlement received, and whether the surgery is performed before or after the settlement.
3. Medical Costs: The cost of surgical procedures is reflected in the settlement to cover medical expenses. For example, spinal fusion procedures can cost around $110,000, joint replacement surgeries range from $16,500 to $33,000, and surgeries to fix a broken wrist can cost approximately $8,000.
4. Settlement Types: Maryland workers' comp settlements can be structured as "stipulation and reward," where the insurer agrees to cover all future medical treatments, or "compromise and release," which involves a lump sum payment including anticipated future costs.
5. Compensation Rates: For temporary total disability, individuals receive two-thirds of their average weekly wage, with a maximum cap not exceeding 100% of the state average weekly wage or $1,456.00 per week, whichever is lower

Understanding How Surgery Increases Workers' Comp Settlements

Case 1: Workers' Compensation Claim Involving Surgery

Scenario: An employee suffers a severe back injury at work, requiring spinal fusion surgery.

Medical Costs: The surgery costs approximately $110,000. Additional costs include hospital stay, anesthesia, diagnostic tests, physical therapy, and follow-up visits.

Recovery and Rehabilitation: The employee requires several months of rehabilitation and is unable to work during this period. This results in lost wages, which are covered by workers' compensation benefits.

Settlement Impact: The need for surgery significantly increases the workers' compensation settlement. The settlement includes compensation for medical expenses, lost wages, and potential future medical costs related to the surgery. If the surgery leads to a permanent impairment, the employee may also receive disability benefits.

Case 2: Workers' Compensation Claim Without Surgery

Scenario: An employee suffers a moderate wrist injury at work, treated with rest and physical therapy.

Medical Costs: The treatment costs are relatively low, covering physical therapy sessions and any necessary medications.

Recovery and Rehabilitation: The employee is able to return to work within a few weeks, with minimal lost wages.

Settlement Impact: The workers' compensation settlement is lower compared to a case involving surgery. It primarily covers the medical expenses and any short-term lost wages. Since there is no surgery, there are no additional costs for hospital stays or potential complications, and the likelihood of permanent impairment is lower.

Workers' compensation claims involving surgery tend to result in higher settlements due to increased medical costs, longer recovery times, and the potential for permanent impairments, compared to claims without surgery.

What If The Surgery Happens After Settlement?

If surgery occurs after a workers' compensation settlement, it generally does not increase the settlement amount. Here are some key points to consider:
Settlement Types: Workers' compensation claims can be settled in two primary ways: "compromise and release" or "stipulation and award." In a compromise and release settlement, the injured worker receives a lump sum that covers all future medical expenses, including potential surgeries. If the surgery occurs after such a settlement, the worker cannot claim additional compensation for it.

Stipulation and Award: In a stipulation and award settlement, the insurance company continues to cover medical expenses as they arise. If surgery is needed after this type of settlement, the insurer is responsible for paying the medical bills related to the surgery.

Risks of Post-Settlement Surgery: If surgery occurs after a compromise and release settlement, the worker may face financial risks. Any complications or additional medical needs arising from the surgery would not be covered, as the settlement is considered final.

The timing of the surgery relative to the settlement is critical, and it is important to carefully consider the type of settlement and potential future medical needs before finalizing any agreement.

Does The Type Of Surgery Matter?

the size and seriousness of the surgery significantly influence the settlement amount. This is because the medical costs, recovery time, and long-term impact on the worker's health and ability to work vary depending on the complexity of the surgery.

Smaller, Less Serious Surgeries

• Lower Medical Costs: Minor surgeries, such as arthroscopic procedures to address issues like torn ligaments, typically have lower costs, ranging from $5,000 to $15,000. Because these procedures are less invasive and generally have quicker recovery times, they contribute less to the overall settlement amount.
• Shorter Recovery Period: Workers who undergo smaller surgeries often return to work sooner, reducing the amount of Temporary Total Disability (TTD) benefits paid. For example, a worker might receive TTD benefits for only a few weeks, resulting in a smaller overall payout.
• Lower Disability Ratings: Minor surgeries are less likely to result in significant permanent impairment. This leads to lower Permanent Partial Disability (PPD) ratings, which translate into smaller long-term compensation payments.

Larger, More Serious Surgeries

Higher Disability Ratings: Complex surgeries often result in higher levels of permanent impairment, leading to higher PPD ratings. These higher ratings mean more weeks of compensation, significantly boosting the overall settlement amount.

Higher Medical Costs: Major surgeries, such as spinal fusions or joint replacements, can be very costly, often exceeding $50,000 to $150,000. These high medical expenses contribute significantly to the overall settlement.

Extended Recovery Time: Serious surgeries usually require a longer recovery period, during which the worker may be unable to work, leading to a longer duration of TTD benefits. This extended time away from work increases the settlement value.

Takeaway

Undergoing surgery prior to settling a workers' compensation claim can significantly increase the settlement payout. This is because surgery often indicates a more severe injury, leading to higher medical expenses, longer recovery times, and potentially greater long-term impacts on your ability to work. These factors are all taken into account when calculating the final settlement amount.

To fully understand how your specific surgery might affect your workers' comp settlement, it's crucial to get professional legal advice. Reach out to Shultz Legal today to explore your options and ensure you receive the compensation you deserve.