Although surgery is not always needed after an on-the-job accident, sometimes the nature of your injury leaves no alternative.

During your recovery, your employer’s insurance company pays for your medical treatment before you reach maximum medical improvement. Eventually, many workers’ comp claims will settle, and when they do, any remaining surgical procedures you need must be included in your settlement negotiations.

Because of the high costs of surgery, getting your settlement done right is critical. This is where the Matt Fendon Law Group can help you. Our Arizona workers’ compensation attorneys have the experience you need to ensure that your surgery needs will be appropriately accounted for in your workers’ comp settlement.

When is Surgery Needed in Workers’ Compensation?

Workers’ compensation is a form of insurance that your employer carries. Its purpose is to provide benefits to you after a work-related injury or medical condition. Arizona workers’ compensation covers medical expenses including surgery, lost wages, and rehabilitation costs. 

If your workplace injury requires surgery, the cost of this remedy makes workers’ compensation coverage even more important. The average workers’ comp settlement for surgery varies but can run into six figures. This can lead workers’ comp insurance companies to try to settle your claim as cheaply as possible. 

For example, a workers’ compensation insurance company will often seek to have your injury treated by non-invasive methods before resorting to surgery. Approving a surgical procedure will depend on the seriousness of the injury and whether it is responsive to non-invasive solutions.

Surgery is likely to be approved in cases where you have suffered a severe injury, like a penetrating brain injury or traumatic brain injury that includes brain bleeding, or to prevent an existing injury from becoming worse.

Insurance companies rely on several factors when deciding when surgery is necessary in a workers’ comp claim and in claim settlement.

• Is the surgery medically necessary? A key consideration here is the assessment of your treating physician and the available medical evidence connected to your claim, like diagnostic tests, treatment records, and expert opinions.
• What are the results of any functional capacity evaluation (FCE)? An FCE assesses your physical abilities and limitations to return to work, which may impact the necessity and reasonableness of surgery.
• Future medical care expenses related to your surgery, including anticipated follow-on surgeries or ongoing rehabilitative treatment.
• Permanent disabilities that can result from surgery. These can include the loss of use of a body part and lead to the need for permanent disability benefits.
• Your long-term impairment rating on your ability to work, which can be affected by the results of a post-surgery functional capacity evaluation. The higher your long-term impairment once you have reached maximum medical improvement, the larger your settlement needs will be.

Surgery Considerations in Workers’ Comp Settlements

The average workers’ compensation settlement for surgery depends on several interacting factors, starting with the kind of surgery you need.

Common Work Injury-Related Surgeries

Here are some examples of injuries that our workers’ compensation lawyers at the Matt Fendon Law Group have helped clients to include in settlement packages with insurance companies.

Injury Type	Surgery Examples	Average Cost
Knee Injury	Arthroscopic surgeryTotal knee replacement	$30,000 to $200,000
Spinal Cord Injury	Spine surgeryStabilization surgery	$1,000 to more than $100,000
Shoulder Injury	Rotator cuff surgeryCarpal tunnel surgery	$10,000 to more than $50,000
Back Injury	Lumbar laminectomyDiscectomy	$10,000 to more than $50,000

Tips for Negotiating a Fair Settlement Amount

Medical costs generally are a significant part of the settlement you negotiate with your employer in workers’ compensation cases. When surgery is needed, it becomes even more important to properly factor medical expenses into what you receive.

Based on our experience helping clients to get the maximum settlement compensation in workers’ comp settlement for surgery, here are some key considerations.

Get Experienced Lawyers on Your Side Early in Settlement Negotiations

Workers’ comp insurers can play hardball when it comes to compensating you for your surgery and post-surgical needs. Having a workers’ comp lawyer on your side reduces the chance that these tactics will succeed.

Obtain all the Medical Evidence you can to Support Your Surgery Needs

Your workers’ compensation attorney can make sure that you support your settlement negotiations with the medical records, medical billing statements, treating physician recommendations, FCE results, and other evidence you need to show that your surgery is reasonably medically necessary.

Including your surgery needs in your claim is critical not only to having your procedure covered but also to maximizing your overall settlement value.

Include the Need for Long-Term Rehabilitation

Surgery does not always lead to a complete recovery and sometimes leads to consequences of its own that can affect your ability to return to work. Physical and vocational rehabilitation are often needed in the aftermath of surgery.

Will You Need Additional Surgery in the Future?

More severe injuries can require multiple surgical procedures to treat, and sometimes your condition can worsen after you reach maximum medical improvement.

Anticipating these possibilities in your settlement amount can avoid trouble later, especially if you are negotiating a full and final settlement under Arizona’s workers’ compensation laws.

What Kind of Settlement is Best for Your Surgery Needs?

Arizona law allows for structured or full and final settlements of workers’ compensation claims. Which one is best for you depends on your needs.

Structured Settlements

If you, your treating doctor, and your lawyer believe that your long-term medical and surgical needs may be difficult to predict with certainty, a structured settlement may be a good choice for you.

These settlements pay compensation benefits over multiple installments, helping to ensure that ongoing medical expenses are covered. Structured settlements are also easier to reopen than lump sum settlements are.

Full and Final Settlements

In a full and final settlement, you receive a lump sum payment for all your anticipated medical treatment needs.

A full and final settlement offer can lead to a larger payment upfront, but if you do not fully account for all your possible treatment needs in a lump sum settlement, including for surgery and post-surgery considerations, it can be difficult or even impossible to reopen your workers’ compensation case to account for them.

The Industrial Commission of Arizona is not obligated under Arizona law to ensure that a full and final settlement agreement is in your best interest as an injured worker. This makes it vital to get your settlement agreement right the first time. The potential consequences of accepting a low-ball agreement with the insurer, especially if it is a full and final settlement, are too potentially grave to leave to chance.

You should carefully consider the advisability of a full and final settlement with the help of an experienced workers’ compensation attorney.

Talk to an Arizona Workers’ Compensation Lawyer Today

To get the best workers’ compensation settlement you can, hire a workers’ compensation attorney who truly knows how Arizona’s workers’ compensation laws work and understands how to negotiate with insurance companies who want to keep their settlement payouts down to a minimum.

You can expect a workers’ compensation insurance adjuster and a workers’ compensation lawyer hired by the insurer to know Arizona workers’ comp benefits laws. You can expect these adjusters and lawyers to be tough negotiators to the point where they seem to lack compassion. 

Most people do not have the training or experience to deal with these people from a position of strength. This is where you can benefit from having an experienced workers’ comp lawyer on your side to even the odds.

At the Matt Fendon Law Group, our highly skilled and compassionate workers’ compensation lawyers are ready to help you with all aspects of your workers’ compensation claim, including your surgical treatment and settlement. 

• We will help you understand the nature of your work-related injury, illness, or medical condition and what you will need to treat and recover from it––including medical care, surgical procedures, lost wages, and future medical expenses.
• We will represent you in negotiations with your employer and its workers’ comp insurer. We handle all communications with these parties for you, so you need not worry about being outmaneuvered in negotiations.
• If your workplace injury results in you being subject to a temporary or permanent disability after surgery, you might be able to claim workers’ comp disability benefits as part of your settlement.

If you need surgery after a work-related accident, we want you to clearly understand that the costs connected with surgery can easily make paying them all crucial to reaching a fair settlement amount with your employer’s insurance company.Call the Matt Fendon Legal Group today at (800) 229-3880 to discuss your surgery needs after an accident on the job and to schedule a free initial consultation with one of our experienced Arizona workers’ comp attorneys. You can also contact us online to communicate with a quality workers’ compensation attorney and set up a free consultation.