Surgery can be the right medical decision and still complicate your legal case. Workers’ comp doesn’t pay for pain and suffering, disability ratings can change after surgery, and timing matters more than most people expect. Understanding how surgery really affects your case can help you avoid costly mistakes.
A lot of injured workers believe surgery automatically makes their case more valuable. It feels intuitive—if the injury is serious enough for surgery, the case must be worth more. But workers’ comp doesn’t look at cases that way.
Pain, suffering, and how difficult recovery is don’t factor into compensation. You don’t get paid more just because the treatment was intense or invasive. What matters is permanent disability, not how hard the process was.
Workers’ comp only looks at what limitations you’re left with after treatment. Surgery is meant to improve your condition, and when it works, your disability rating can go down. When that happens, the value of the case can go down with it. This is one of the most surprising parts of the system. If surgery improves your function, your permanent disability rating may drop. And lower ratings often mean lower settlements.
Surgery can increase case value when it creates clear future medical needs. Some procedures almost always lead to more treatment later. After surgery, many workers are temporarily placed back on total disability, which usually increases weekly checks to two-thirds of their average wage (up to the legal max). That increase doesn’t last forever.
There’s also a big issue people miss: labor market attachment. If you were required to do a work search before surgery and didn’t, benefits can still be limited—even while you’re recovering from surgery.
Surgery usually resets the timeline for disability evaluations and maximum medical improvement (MMI). Since settlements typically happen near MMI, surgery often delays settlement instead of speeding it up. Complications or longer recovery can push things out even further.
Every surgery carries risk. Some people need more therapy, medication, or follow-up care than expected.
As long as your case stays open, workers’ comp should cover that care. But if you settle too early, those costs can become your responsibility. That’s why settling before or during surgery is often risky—you don’t yet know how recovery will go.
It’s understandable to want the case over once surgery is involved. Some people try to settle before surgery. Others want to settle right after.
The problem is uncertainty. If recovery doesn’t go as planned and your case is already closed, the insurance company is done paying. Settling too fast can create long-term financial problems.
You need a doctor who understands workers’ comp rules, authorization requirements, and treatment guidelines. Insurance companies often deny surgery due to missing documentation or claims that conservative care wasn’t done. A doctor who knows the system can address those issues and keep treatment moving.
No one can force you to have surgery. People delay or decline for many reasons—fear, religion, family obligations, or timing.
Choosing not to have surgery can affect settlement value in different ways. Sometimes insurers argue the injury isn’t serious. Other times, documented future surgery can increase value. There’s no one-size-fits-all answer—it depends on your situation.
In the instance of a denial, it's important to know that isn't a finality. Denials can often be challenged with better documentation and resubmission.
Even if surgery isn’t approved now—or you choose not to have it—you may still be able to settle and reopen the case later if surgery becomes necessary. Knowing your options helps protect both your health and your benefits.
If you want to talk things through, feel free to call me, Rex Zachofsky, anytime. No pressure—just a straightforward conversation about your options and how to protect yourself while you focus on getting better.
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