Major surgery normally increases workers’ comp settlements. Minor surgery might not affect them much, if at all.

Major medical procedures aren’t just costly. Major surgery also involves a longer recovery time, which means additional lost wages. Physical therapy is also longer, more difficult, and more expensive in these situations. Other ancillary medical costs, like prescription drugs, also often go up as well.

Workers’ compensation pays both wage replacement benefits and medical payment benefits, as outlined below.

These benefits are available, but insurance companies don’t hand them out like toys at Christmas. In these situations, insurance company lawyers typically argue that the surgery was unnecessary, or at least over the top. To counter these arguments, workers’ comp lawyers usually partner with independent doctors who give Administrative Law Judges the straight dope.

Benefits Available

A couple of workers’ compensation defenses are available. Usually, however, insurance company lawyers cannot contest fault in these cases. But they can, and do, contest the amount of damages the victim should receive.

Temporary and permanent disability lost wage benefits are based on the victim’s average weekly wage (AWW). Most insurance companies calculate lost wages the way schools calculate grade point averages. They take the worker’s last five or six paychecks and divide by five or six.

But the AWW must also account for future wages the victim loses because of a job-related disability. If Max breaks his arm and he will miss three weekends of possible overtime, he deserves compensation for those losses.

As for medical bill payment, many insurance companies use boilerplate tables to determine what’s “reasonable.” THese tables are usually based on large amounts of data. Usually, such data collection makes these calculations more accurate. But in this case, it makes these calculations more inaccurate.

Not all broken arms are the same. Some victims require extensive surgery, and some just need casts. Additionally, not all victims respond to physical therapy at the same rate.

The Workers’ Comp Claims Process

Once upon a time, the claims process was so easy workers almost immediately received benefits. Now, the process is long and complex.

Most Claims Examiners either partially or entirely deny workers’ comp claims during initial reviews. Frequently, these examiners use technical flaws as an excuse to avoid addressing the merits of the claim. So, a denial doesn’t mean your claim isn’t worth pursuing.

To obtain full benefits, lawyers usually appeal these matters in a hearing before an Administrative Law Judge. An ALJ hearing isn’t just a paper review. Lawyers may make legal arguments, challenge evidence, introduce evidence, and otherwise do their jobs. As a result, the ALJ approval rate is even higher than the Claims Examiner denial rate.

Even a “minor” work injury could cost thousands of dollars in medical bills and lost earnings. Your employer, not your insurance company and certainly not your family, is financially responsible for these expenses.

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