Getting hurt on the job can turn your life upside down. If your injury is serious, you might need surgery. That’s not only stressful—it can get expensive fast. Workers’ compensation is supposed to cover your medical costs, but what happens when you need surgery? How much money can you expect from your settlement?
The average workers’ comp settlement for surgery depends on many things, like the part of your body that was hurt and how serious the injury is. In this post, we’ll go over common surgery types, average settlement amounts, and how you can protect your rights if you’re going through a workers’ comp claim in Los Angeles.
When Does Workers’ Comp Cover Surgery?
Workers’ comp helps cover costs after a work injury. It usually pays for doctor visits, medication, therapy, and lost wages if you can’t work. But when the injury is serious enough, you may need surgery. If your doctor says the surgery is necessary and it’s tied to your workplace accident, it should be covered by workers’ comp.
But the insurance company may not make it easy. They might push for other treatments first to avoid paying for surgery. That’s why it’s important to have the right medical proof and support early on.
Average Workers’ Comp Settlements Involving Surgery
It’s hard to give one number that fits all surgeries, but we can look at averages across different body parts. National data shows the average workers’ comp settlement for all injury types is around $41,757. But when surgery is involved, the amount usually goes up—sometimes well into six figures, especially if the injury is severe or permanent.
Here are some rough averages for injuries that often require surgery:
- Head/Brain injuries: $94,285
- Neck injuries: $65,659
- Leg injuries: $60,901
- Shoulder injuries: $49,838
- Lower back injuries: $39,328
- Knee injuries: $35,332
These numbers include medical costs and money for lost wages. If you need more than one surgery or ongoing rehab, your settlement may be even higher.
What Affects the Value of a Surgery Settlement?
Many things can change how much your workers’ comp settlement ends up being. Here are the biggest factors:
1. Type of Surgery
Some surgeries are more complex and expensive than others. For example, a knee scope may cost $30,000, while a spinal fusion can go beyond $100,000. More serious or high-risk surgeries usually lead to larger settlements.
2. How Long You’re Off Work
If your injury keeps you from working for a long time, your lost wage benefits will go up. That means a larger payout overall.
3. Whether You Can Go Back to Work
If surgery leaves you with a permanent injury or disability, you may get money for permanent loss of function. This can greatly increase your settlement.
4. Medical Proof
You need strong medical records that show your surgery is necessary because of your work injury. Insurance companies often look for reasons to deny or delay claims, so solid documentation is key.
5. Future Treatment
Sometimes, surgery is just the first step. You might need rehab, more procedures, or help returning to your job. Your settlement should cover these future costs, too.
Lump Sum vs. Structured Settlements
In workers’ comp cases, you may have a choice between a lump sum (one large payment) or a structured settlement (smaller payments over time).
A lump sum can be helpful if you need the money right away—for bills, treatment, or living expenses. But if you might need more surgeries later, a structured payment plan could be safer so you don’t run out of money.
Before you decide, talk to a lawyer who knows how workers’ comp works in California. Once you accept a settlement, it can be hard—or impossible—to ask for more money later.
Should You Settle Before Surgery?
In some cases, the insurance company will try to settle your claim before you get the surgery. That can be risky. If the settlement doesn’t fully cover the cost of the procedure and recovery, you’ll have to pay out-of-pocket.
It’s usually best to wait until you reach maximum medical improvement (MMI). That means your doctor believes your condition has gotten as good as it’s going to get. At that point, it’s easier to figure out what your long-term needs will be.
Tips for Getting a Fair Settlement
Insurance companies may try to settle your claim for as little as possible. Here’s how you can protect yourself:
- Get the right doctors. Make sure your medical team understands your injury and documents everything.
- Don’t rush. Settling too early can leave you without enough money for future care.
- Work with a lawyer. A good workers’ comp attorney can make a big difference in your settlement. They’ll deal with the insurance company and fight for what you deserve.
Talk to a Los Angeles Workers’ Comp Lawyer Today
If you need surgery after a work injury, your settlement should reflect the true cost of your recovery—not just now, but in the future too. The insurance company may not offer you a fair deal on its own.
The Law Offices of Hinden & Breslavsky has been helping injured workers in Los Angeles for years. Our attorneys understand what you’re going through, and we know how to build strong cases that lead to better settlements. You don’t have to do this alone.
Call (323) 954-1800 today to schedule a free consultation. We’ll explain your options, help you plan your next steps, and fight to get you every dollar you’re owed. Don’t wait until it’s too late—let’s make sure your surgery and recovery are fully covered.