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Lowell Workers' Compensation Surgery Lawyer

Does Surgery Increase a Workers’ Compensation Settlement in Massachusetts?

Navigating the complexities of workers’ compensation can be challenging, especially when dealing with the prospect of surgery. As a workers’ compensation attorney who has dedicated my career to helping injured workers secure the benefits they deserve, I often receive questions about whether undergoing surgery can affect the settlement amount in a workers’ compensation case. In this article, I will discuss the Massachusetts workers’ compensation program and explain how surgery can affect a workers’ comp settlement.

If you or a loved one was injured at work in Lowell or the surrounding communities, I invite you to call my office at 978-654-6670 to schedule a free consultation. I can listen to the facts of your case, explain your legal options, and tenaciously fight for the full and fair compensation to which you and your family are rightfully entitled.

Understanding Workers’ Compensation in Massachusetts

Before we dive into the specifics of how surgery might impact a workers’ compensation settlement, it’s essential to understand the basics of workers’ compensation benefits in Massachusetts. Workers’ compensation is a state-mandated insurance program that provides benefits to employees who suffer work-related injuries or illnesses. These benefits can include medical treatment, wage replacement, and compensation for permanent impairments.

Types of Workers’ Compensation Benefits

In Massachusetts, workers’ compensation benefits fall into several categories:

  • Medical Benefits: Covering the cost of medical treatment related to the injury.
  • Temporary Total Incapacity Benefits (TTD): Providing wage replacement if the injury prevents you from performing any gainful employment temporarily.
  • Temporary Partial Incapacity Benefits (TPD): Offering partial wage replacement if you can work but at a reduced earning capacity because of the injury.
  • Permanent and Total Incapacity Benefits (PTD): For workers who are permanently unable to performing any gainful employment due to their injuries.
  • Permanent Loss of Function and Disfigurement Benefits: Compensating for permanent loss of specific functions, scarring and/or disfigurement.
  • Survivors’ and Dependents’ Benefits: Available for a spouse or child of an employee who died due to a work-related injury or illness.
  • Burial Expenses. In cases of death due to work-related injury or illness, the insurer pays up to $8,00 for reasonable burial expenses.[1]

The Impact of Surgery on Workers’ Compensation Settlements

Workers' comp surgery attorney
One of the most common questions I hear is whether undergoing surgery will increase a workers’ compensation settlement. The answer is not straightforward, as it depends on several factors, including the nature of the injury, the necessity and outcome of the surgery, and the overall impact on the worker’s ability to return to work.

Factors to Consider

  • Severity of the Injury: More severe injuries that require surgery often result in higher settlements due to the possibility of a less-than-successful surgical outcome and longer recovery times.
  • Medical Necessity: A qualified healthcare provider must deem the surgery medically necessary. Unnecessary surgeries are unlikely to positively influence the settlement amount.
  • Recovery and Rehabilitation: The length and success of the recovery process post-surgery plays a significant role. A longer or complicated recovery can lead to higher compensation.
  • Permanent Impairment: If surgery results in a permanent impairment, this can significantly increase the settlement amount. Massachusetts law provides compensation for permanent loss of function or disfigurement.
  • Ability to Return to Work: If surgery prevents you from returning to your previous job or any job, this can lead to higher disability benefits and settlements.

Real-Life Examples: Does Surgery Increase Workers’ Comp Settlements?

Let’s look at a couple of hypothetical scenarios to illustrate how surgery might impact a workers’ compensation settlement:

Case Study 1: Simple Surgery with Full Recovery

Jane, a factory worker, injures her knee while lifting heavy equipment. Her doctor recommends arthroscopic surgery to repair a torn ligament. Jane undergoes surgery, completes her physical therapy, and is able to return to her job within three months. In this case, Jane probably will not be offered a settlement by the insurer as she has gone back to work earning her pre-injury wage. As the insurer is not obligated to pay any future weekly wage benefits, there is no reason to offer a settlement in lieu of those payments. She would be paid for the time out of work, her medical expenses and if she has any permanent loss of function of her knee, she would be paid a benefit for that.

Case Study 2: Complex Surgery with Permanent Impairment

John, a construction worker, suffers a severe back injury after a fall from scaffolding. His doctor recommends spinal fusion surgery. Despite the surgery, John experiences chronic pain and limited mobility, preventing him from returning to his previous job. In this scenario, John’s settlement would likely be much higher due to the fact that he could not return to his prior work and the insurer will have to pay him for years into the future. He may also be eligible for permanent total disability benefits.

The Role of a Workers’ Compensation Surgery Attorney

Navigating the workers’ compensation process can be daunting, especially when surgery is involved. As an experienced workers’ compensation attorney, I can guide you through every step of the process. My goal is to ensure you receive the maximum benefits you’re entitled to, including compensation for medical expenses, lost wages, and any permanent impairments.

Why Choose Me as Your Workers’ Compensation Surgery Lawyer?

  • Personalized Attention: I take the time to understand your unique situation and tailor my approach to meet your specific needs.
  • Tenacious Negotiation: I have recovered millions of dollars in compensation for my clients and have a proven track record of negotiating favorable workers’ compensation settlements.
  • Comprehensive Support: From filing your claim to appealing a denial, I provide comprehensive legal support throughout the entire process.

Steps to Take If You’re Considering Surgery for a Work-Related Injury

If you believe surgery is necessary for your work-related injury, follow these steps to protect your rights:

  • Consult with Your Doctor: Ensure that surgery is medically necessary and discuss potential outcomes and recovery times.
  • Seek a Second Opinion: It can be beneficial to get a second opinion to confirm the necessity of the surgery.
  • Notify Your Employer: Inform your employer about your injury.
  • Document Everything: Keep detailed records of all medical treatments, communications with your employer, and any time missed from work.
  • Contact a Workers’ Compensation Attorney: Reach out to an experienced workers’ compensation surgery attorney early on to discuss your case and ensure you receive the benefits you’re entitled to.

Want to Understand How Surgery May Affect Your Workers’ Comp Claim? Schedule A Free Consultation Today!

If you’re facing surgery for a work-related injury, don’t navigate the workers’ compensation process alone. Contact me, Jeffrey A. Young, today for a free consultation. Together, we can ensure you receive the full benefits you deserve and help you get back on the road to recovery.

This comprehensive article aims to provide you with the information you need to understand how surgery can impact your workers’ compensation settlement in Massachusetts. By following the steps outlined above and seeking the right legal support, you can maximize your compensation and focus on your recovery. If you have any questions or need assistance with your workers’ compensation claim, don’t hesitate to reach out to my office. I’m here to help.

For a free consultation, call 978-654-6670. Let’s work together to secure the benefits you deserve.

[1] Types of worker’s compensation benefits | Mass.gov

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Massachusetts Workers' Compensation Surgery FAQs

Yes, workers’ compensation in Massachusetts covers all necessary and reasonable medical expenses related to your work injury, including surgery. Your surgery must be deemed medically necessary by a qualified healthcare provider and related to your work injury to be covered.

Generally, yes. Your healthcare provider will need to obtain prior approval through the Utilization Review process. And if there is an issue regarding the fee your doctor wants to charge, that will require working it out with the workers’ compensation insurance carrier. This typically involves submitting a request to the Utilization Review agent for authorization along with medical documentation supporting the necessity of the surgery. The Utilization Review agent decides if the proposed surgery is appropriate for your injury based on  state guidelines.

Yes, you have the right to choose your own healthcare provider, including your surgeon, for your workers’ compensation-related treatment in Massachusetts. However, it’s important to ensure that your chosen surgeon accepts workers’ compensation insurance rates.  If your surgeon does not accept the set rates, it is possible the insurer will pay a higher negotiated fee. But an insurer cannot be forced or ordered to pay a higher rate.

If your request for surgery is denied by Utilization Review, you have the right to request an expedited appeal of the decision. The request is then reviewed by a medical provider in the same field as your surgeon. If the denial is upheld on appeal, you can file a claim with the Massachusetts Department of Industrial Accidents (DIA) to dispute the denial. Consulting with a workers’ compensation attorney can help you navigate this process and increase your chances of a successful appeal.

Undergoing surgery can affect your workers’ compensation benefits in several ways. If the surgery requires you to take time off work, you may be eligible for Temporary Total Incapacity Benefits, which provide 60% of your average weekly wage. If the surgery results in a permanent impairment, you may be entitled to Partial Disability (TPD) benefits or even Permanent Total Disability (PTD) benefits, depending on the extent of the impairment. Partial Disability benefits compensate for a reduction in your earning capacity due to your injury, while Permanent Total Disability benefits are available if you are unable to return to any form of gainful employment.

Surgery can potentially increase your workers’ compensation settlement, especially if it results in a prolonged recovery period, or a permanent impairment. However, each case is unique, and the impact on your settlement will depend on various factors, including the severity of your injury, the necessity and outcome of the surgery, and your ability to return to work.

Yes, if you are unable to work while recovering from surgery, you may be eligible for Temporary Total Incapacity Benefits, which provide 60% of your average weekly wage during your recovery period. If you can work but at a reduced capacity, you may be eligible for Temporary Partial Incapacity Benefits, which compensate for the difference between your pre-injury wages and your current earning capacity.

The timeline for receiving workers’ compensation benefits after surgery can vary depending on whether the insurer has accepted your case or not. If they have then  temporary disability benefits begin on the day of your surgery if you are not already being paid weekly benefits  and of course the surgery has rendered you  unable to work. Permanent Total Disability benefits, if applicable, may take longer to determine and receive, as they often require a formal assessment of your impairment.

Yes, you can return to work before fully recovering from surgery if your doctor approves and provides work restrictions that your employer can accommodate. This might involve modified duties or reduced hours. It’s important to follow your doctor’s recommendations to avoid jeopardizing your recovery and benefits.

If you can’t return to your previous job after surgery due to permanent restrictions, your continued receipt of weekly benefits will depend on whether or not you can perform any gainful employment. In making that determination, the factors looked at are your injury and any permanent impairment you have, the amount of pain you have, your age, your work history, and your educational level. If you can do some kind of gainful employment but not earn the wages you were earning in your prior job, then you would probably be entitled to Partial Incapacity Benefits.  If you are unable to perform any gainful employment and your condition will continue into the foreseeable future then you may be entitled to Permanent and Total Incapacity Benefits, which provide ongoing wage replacement, possibly for the rest of your life. Additionally, you may be eligible for vocational rehabilitation services to help you find alternative employment. Your workers’ compensation attorney can help you navigate these options.

WHAT MY CLIENTS SAY

I’ve worked with Attorney Young on several cases and found him to be extremely knowledgeable, effective, and compassionate toward clients.
Brenner Webb 5.0

Attorney Jeffrey Young and his team have been incredible throughout my workmans comp claim. Jeff achieved the best possible outcome for me and I cannot express how appreciative I am. My emails and calls were answered, all my concerns were taken care of. I felt like someone was on my side, standing up for me and against a really tough insurance company. I highly recommend this firm for any workers comp and personal injury. Very professional, caring and Jeff is dedicated to helping people. I would give this law firm 10 stars but only allowed 5.

J.G. 5.0

I was in need of professional legal assistance with a workmen’s compensation situation. Attorney Jeffrey Young was highly recommended to me. Jeff and his staff were extremely patient, respectful and knowledgeable. They handled my case expediently and thoroughly. Jeff’s rapport with me, my family and the courts were way beyond my expectations! If I’m ever in need of council again, I’ll call Attorney Young!

John. Di 5.0