When you get hurt on the job, dealing with the workers’ comp process can be tough, especially if you need surgery. The average workers’ comp settlement can vary widely based on the type of surgery and associated costs, covering medical expenses and lost wages. Surgery means a more serious injury which means higher compensation. But to get the full benefits you deserve you need to understand the workers’ comp system in South Carolina.
In this post, we’ll talk about how surgery can impact your workers’ comp settlement, what benefits you may be entitled to, and why you need to consult with a Columbia workers’ comp lawyer to get the benefits you deserve.
South Carolina Workers’ Comp System
The South Carolina Workers’ Compensation Commission (WCC) governs the state’s workers’ comp system. The system provides benefits to employees who get injured or ill on the job. Workers’ comp covers medical care, lost wages, and disability benefits for employees who get hurt on the job or develop a work-related injury. The goal is to make sure injured workers get the medical treatment and financial support they need to recover without having to litigate.
South Carolina employers are required to carry workers’ comp insurance if they have four or more employees so workers are protected in case of a workplace injury. The WCC oversees the process and resolves disputes between workers and insurers.
Workers’ Comp for Surgery
If a worker needs surgery, the employer’s workers’ comp insurance pays for the full cost of the surgery. This includes all medical treatments related to the surgery such as pre-op evaluations, anesthesia, the surgery itself, and any post-op rehabilitation or therapy. Workers’ comp is supposed to cover all reasonable medical expenses so the injured worker can focus on recovery without financial burden.
Injured workers need to understand that South Carolina law guarantees them medical care as long as it’s reasonable and necessary according to the treating doctor approved by the employer or insurance carrier.
Lost Wages and Disability Benefits
In South Carolina, workers who can’t return to work while recovering from a workplace injury are entitled to wage replacement benefits. These benefits are called Temporary Total Disability (TTD) and pay two-thirds of the worker’s average weekly wage before the injury. The purpose of TTD benefits is to provide financial support while the worker is healing and can’t perform their job duties.
For workers who have permanent impairments or disabilities, the system also provides Permanent Partial Disability (PPD) or Permanent Total Disability (PTD) benefits. PPD is awarded when an injury causes a partial, permanent impairment and PTD is for those who can’t return to work due to total, permanent disability.
Legal Support and Dispute Resolution
If a workers’ comp claim is denied or if there’s a dispute in a workers’ compensation case—such as whether surgery is necessary or the extent of the injury—the injured worker can request a hearing before the South Carolina Workers’ Compensation Commission. During this process, evidence such as medical records and expert testimony is presented to resolve the issue.
How Surgery Can Impact Workers’ Comp Settlement
Surgery can increase a workers’ comp settlement by showing the extent of the injury and the amount of compensation for medical expenses, lost wages, and permanent impairments. Having an experienced attorney to advocate for a fair settlement is crucial, as they can utilize damage models and demonstrate the value of the case, particularly in negotiations with insurance providers.
Surgery as an Indicator of Severity
When an injury is severe enough to require surgery it shows the worker’s condition is serious. This can directly impact the amount of a workers’ comp settlement. Injuries that require surgery are often more complex and may take longer to recover from, cost more medical expenses, and potentially permanent impairment. Surgery shows the injury is not minor and justifies a higher amount of compensation to cover medical expenses and long-term impact on the worker’s ability to return to their job.
The extent of the injury also impacts disability benefits. If surgery is required and results in ongoing limitations the worker may be entitled to Permanent Partial Disability (PPD) or Permanent Total Disability (PTD) benefits which would increase the settlement amount.
Medical Expenses and Follow-Up Care
Surgery comes with significant medical costs, and the medical benefits provided by workers’ compensation insurance are crucial in covering the procedure itself, hospital stay, medications, and follow-up treatments like physical therapy or rehabilitation. These expenses add up fast and workers’ comp is supposed to cover all reasonable and necessary medical treatment related to the work injury. In cases where multiple surgeries are required or long-term care is needed such as for amputations or major orthopedic injuries, the overall settlement can increase significantly to cover these ongoing medical expenses.
In South Carolina workers’ comp is supposed to cover all medical care related to surgery including preoperative evaluations and postoperative recovery which can result in larger settlements than cases that don’t involve surgery.
Lost Wages During Recovery
In addition to medical expenses surgery often requires a significant amount of time off work for recovery. During this time the worker is entitled to receive wage replacement benefits in the form of Temporary Total Disability (TTD) payments. These benefits are two-thirds of the worker’s average weekly wage and continue until the worker reaches Maximum Medical Improvement (MMI) or can return to work in some capacity. If your operation results in an extended recovery period or the worker can’t return to their previous job the lost wage benefits will increase the overall settlement.
If surgery results in long-term limitations the worker may transition from TTD to Permanent Partial Disability (PPD) or Permanent Total Disability (PTD) benefits both of which are calculated to compensate for future lost earning potential and increase the settlement value.
Permanent Disability and Scarring
Surgery can result in permanent impairment, scarring, or disfigurement all of which can have a lasting impact on a worker’s quality of life and earning capacity. Workers who suffer permanent disabilities as a result of surgery may be entitled to PPD or PTD benefits depending on the extent of the injury. In South Carolina, the duration and amount of these benefits are determined by the type and severity of the disability.
Can You Settle a Workers’ Comp Claim Before Surgery?
Settling a workers’ comp claim before surgery is an option that comes with pros and cons and workers need to weigh their choices carefully before moving forward.
Pros of Settling Before Surgery
Settling a workers’ comp claim before surgery can provide immediate financial relief and allow the worker to move forward with the surgery without having to wait for the insurance company to approve it. Insurers may delay authorizing expensive surgeries leaving the worker in a tough spot. By settling beforehand the worker has control over the timing of the surgery and has the funds to move forward. This can give peace of mind and ensure necessary medical treatment isn’t delayed.
Settling before surgery may also avoid prolonged disputes with the insurer who may challenge the necessity or cost of the surgery. With a settlement in place, the worker can move forward without the uncertainty of ongoing negotiations or litigation.
Cons of Settling Before Surgery
However, there are big risks in settling a claim before surgery. Once a settlement is finalized the worker generally gives up the right to seek additional compensation if complications arise during or after the surgery. If the surgery is unsuccessful or results in further impairment the worker may not be able to claim additional benefits for increased disability or future medical expenses. This can result in financial hardship if the worker’s condition worsens and more treatment or extended recovery time is needed.
Settling beforehand may leave the worker exposed if the full extent of the injury or long-term effects of the surgery aren’t known. You need to have a clear understanding of the injury and the outcome before settling.
Steps to Maximize Your Workers’ Comp Settlement Post-Surgery
Maximizing your workers’ compensation settlement requires careful planning and strategic actions to ensure you receive full compensation for your medical expenses, lost wages, and long-term needs.
Seek Legal Representation Early
Hiring an experienced workers’ compensation attorney is crucial after your operation. They can guide you through the process, negotiate with insurance companies, and ensure your rights are protected, helping you maximize your compensation.
Gather Comprehensive Medical Evidence
Ensure you collect all medical records related to your surgery, including doctor’s notes and rehabilitation plans. This documentation proves the severity of your injury and helps justify a higher settlement by showing your ongoing medical needs.
Request an Independent Medical Examination (IME)
If there is a dispute about your injury, requesting an IME provides an objective medical opinion. This can validate your claim and strengthen your case for a larger settlement, especially if your operation was necessary for recovery.
Document the Impact on Your Ability to Work
Track how your surgery has affected your ability to work. This includes documenting time off, work restrictions, and any loss in earning capacity. Providing this evidence helps increase compensation for lost wages and future earning potential.
Be Cautious About Settlement Offers
Be careful when considering early settlement offers from the insurance company. These may not cover long-term medical needs or potential complications. Always consult your attorney before accepting any offer to ensure it’s in your best interest.
Prepare for Potential Appeals
If your claim is denied or the offer is too low, you may need to appeal through the South Carolina Workers’ Compensation Commission. Proper preparation and legal representation are key to improving your chances of success.
Work With an Experienced Columbia Workers’ Comp Attorney ASAP!
If you’ve been injured at work and are facing surgery, it’s essential to have experienced legal support to navigate the complexities of your workers’ compensation claim. Our team at Connell Law Firm is dedicated to helping injured workers in Columbia and across South Carolina secure the maximum compensation they deserve.
Contact us at [phone] for a free case consultation today!