How Much Does Surgery Increase Your Workers’ Comp Payment in Pennsylvania?

Medical care after an injury can be expensive, especially if you need to have surgery.  When it comes to work injuries, your employer’s Workers’ Compensation insurance should be the one to cover your surgical costs, which can result in a higher payout.

The actual amount of your Workers’ Compensation payment for surgery will depend heavily on what surgery you are having.  However, the important thing to consider is that all surgery should be covered if it is related to treating your work injury, meaning that the actual cost is set and does not require negotiation.  However, if you are seeking a settlement or your surgery increases your time away from work, knowing how it will affect your total benefits is important.

For a free case evaluation, contact Cardamone Law’s Pennsylvania Workers’ Compensation Attorneys today at (267) 651-7945.

How Surgical Costs Are Paid for Under Workers’ Compensation in Pennsylvania

When you get medical care after a work injury, it is typically supposed to be covered by your employer’s Workers’ Compensation.  There are certain requirements to qualify in the first place – such as the requirement that you are an employee rather than a contractor and that your injury was work-related.  Once you meet these standards, surgical care should be covered under your Workers’ Comp claim, along with other care you might need.

Typically, all medical care costs should be covered as part of your Workers’ Comp claim, including the cost of emergency surgery at the hospital, later surgery needed to treat a tear or other injury, and other surgeries to treat long-term occupational illnesses like cancer.  Along with other medical care like doctor’s appointments, scans, tests, and medication, your Philadelphia Workers’ Compensation lawyers can see that your claim gets these costs covered.

As for the actual mechanisms of payment involved in your case, you usually will not see the money for your medical care in your bank account.  Instead of making you pay for expensive medical care like surgery and then reimbursing you for it, Workers’ Comp often gets billed directly by the doctor or hospital.  This means that if you need to get an operation, you can have the hospital interface with Workers’ Comp and get the costs paid that way instead of having to worry about how much it costs.

How Much Does Workers’ Comp Cover for Surgery in Pennsylvania?

Usually, Workers’ Compensation should cover all medical care costs related to your treatment for your work injury.  This means that surgery costs should be covered in full.

While Workers’ Comp also pays wage-loss benefits that scale based on your income, and you can get “specific loss” benefits based on what injury you faced, medical benefits should be covered regardless of the cost.  Some injuries are incredibly serious, but the fact that they were work-related should get the surgeries for those injuries covered in full, even if they end up being quite expensive.

Common surgeries for a work injury can include rotator cuff or ACL tear repair as well as orthopedic surgery to stabilize a broken bone with rods, pins, and screws.  These surgical costs, along with other common surgeries, can start at thousands of dollars for each procedure.  Having these costs covered by Workers’ Comp might make the difference when it comes to being able to afford surgery at all.

Does Workers’ Comp Pay for a Surgeon of Your Choice in Pennsylvania?

Often, medical care in the first 90 days must be performed by a doctor that your employer or their insurance carrier has chosen, or else it is not covered.  However, your employer’s list of doctors will usually have some physicians and will likely be filled out with other care providers, such as chiropractors or physical therapists.  If this list does not have a surgeon in the first place, then you will not be required to use your employer’s chosen surgeon, and you can use a doctor of your choice.

If you need a specialist who is not on the list, then you should be entitled to choose your own specialist, too.  For example, if your employer’s list has no orthopedic surgeons or no spinal surgeons, then you can choose your own surgeon in most cases where you need those specialized surgeries.

When it comes to surgeries, you can also get a second opinion from a doctor of your choice.  Sometimes the insurance carrier’s doctor will get things wrong, and surgery might not actually be required.  This ability to get a second opinion from a doctor you might trust more is incredibly helpful.

How Much Does a Settlement Go Up for Workers’ Compensation Claims Involving Surgery in Pennsylvania?

When you get benefits from Workers’ Comp, they are usually paid on an ongoing basis.  Your wage-loss benefits will usually be paid weekly or bi-weekly, and medical care costs will be paid as the doctor bills insurance for them.  However, when you seek a settlement, all payments might be paid in a lump sum instead of being paid as ongoing benefits.  Seeking a settlement means incorporating the total cost of the procedures you still need into the settlement, often increasing the settlement amount by thousands, tens of thousands, or even hundreds of thousands of dollars to cover the surgical costs, recovery costs, and other care you need to receive.

If you wait until all of your medical care is done, then you usually do not need to incorporate the cost of surgery into your settlement because it will have already been paid for.  However, if you need more surgeries down the line, you should work with your lawyers and seek information about costs from doctors to include enough money for those future surgeries into your settlement amount.

If you still need surgery or other ongoing medical care, it might be better to wait to settle the rest of your claim.  If something goes wrong during surgery or the operations are unsuccessful, you might need more surgery or other medical care than you initially anticipated, and the cost might peak above what you settled for, leaving you to pay out of pocket for further care.  Our lawyers can help you weigh your options and decide whether a settlement would be right for your case based on how much more surgery you have to go.

Call Our Pennsylvania Workers’ Compensation Attorneys Today

If you need help with a Workers’ Comp claim, call our Montgomery County Workers’ Compensation attorneys at Cardamone Law at (267) 651-7945 today.