When accidents occur at work in Ohio, injured employees may be entitled to various benefits under the state’s workers’ compensation laws. These benefits are designed to cover medical expenses, compensate for lost wages, and even provide survivor benefits in the event of a fatal incident.
Some work-related injuries require surgery to treat, which raises some questions. Does the Bureau of Workers’ Compensation cover it? Should you settle before or after the operation? If you settled before, does that mean you can’t claim further medical benefits if your situation worsens later on?
At Plevin & Gallucci, we understand the critical nature of these decisions and the impact they can have on your life and recovery. Whether you are at the beginning of your claim or are considering settlement options post-surgery, consulting with our workers’ compensation lawyers in Cleveland and Columbus can help you make the right decision. We invite you to schedule a free consultation to discuss the specifics of your case and explore the best steps forward.
Does Workers’ Compensation Pay For Surgery in Ohio?
In Ohio, workers’ compensation does cover surgical procedures if they are deemed related to and medically necessary due to a workplace injury. This coverage is part of the broader spectrum of workers’ comp benefits, which support workers who suffer job-related injuries or illnesses by covering their medical expenses and providing financial compensation for lost wages.
When an injury at work requires surgery, the first step is to have the treatment request approved by the Bureau of Workers’ Compensation (BWC) or the self-insuring employer. This approval process ensures that the surgery is essential for the treatment of the severe injury and not for pre-existing conditions. The approval is based on medical evidence and consultations with healthcare professionals.
If approved, the costs for the surgery, including pre-operative and post-operative care, are generally covered by workers’ comp with 100% of the costs being covered. That means that the injured worker does not pay any portion of claim-related medical care. This includes hospital stays, surgical fees, and necessary medications. However, the process can be challenging to navigate, as it involves submitting appropriate medical documentation and sometimes undergoing evaluations by medical providers appointed by the insurance carrier.
For many workers, this coverage is vital as it provides access to necessary surgical interventions without the burden of out-of-pocket expenses. Understanding your rights and the procedures to follow can ensure that you receive the full benefits you are entitled to under the law. If you are facing this situation, it may be helpful to consult with a workers’ compensation attorney who can guide you through the process and help address any disputes or challenges that arise.
Does Surgery Increase Your Workers’ Compensation Settlement?
In the Ohio workers’ compensation system, settlement amounts are not directly determined by whether surgery is performed. However, the need for surgery can play an indirect role in the settlement process, as it reflects the severity and potential long-term impact of the injury.
Settlements in workers’ compensation cases are determined by a range of factors. They include the nature and extent of the injury, your future ability to work, and the overall cost of medical treatments anticipated. When a workplace injury requires surgery, it is usually indicative of a more serious condition that could affect your future employment prospects. This, in turn, could increase the value of your workers’ comp claim, especially if the surgery leads to complications that require additional care and affect your employment prospects.
What is the Average Settlement for a Claim Involving Surgery?
As stated previously, workers’ compensation settlement amounts can vary based on the severity of the injury, the type of surgery required, the anticipated recovery time, and the long-term impact on your ability to return to work. In general, if surgery is needed, it is advised to keep your claim open to cover your surgery and other related benefits.
In workers’ compensation cases, settlements are calculated to cover various costs, including medical expenses, lost wages, and compensation for any permanent disabilities resulting from the injury. When surgery is involved, these factors tend to increase the overall costs, often leading to higher settlement amounts compared to cases where surgery is not necessary.
For example, surgeries that require a longer recovery period or result in significant ongoing health issues may lead to larger settlements because they affect your ability to earn an income for a longer duration. Additionally, should future surgery be necessary, the cost of the future surgery itself, along with post-operative care, rehabilitation, and any future treatments related to the injury, are included in the calculation.
It’s important to remember that each workers’ compensation claim is unique. The amount of a settlement can be influenced by your job role, salary, age, and the specifics of your medical condition. To get a clearer idea of what a fair settlement might look like for a case involving surgery, you should consult with a workers’ compensation attorney who can provide appropriate guidance.
How Long Does it Take to Settle a Workers’ Compensation Claim?
The amount of time required to settle a workers’ compensation claim in Ohio can vary. While the process is not bound by a strict timeline, understanding the general flow can help in setting realistic expectations about how your claim may unfold.
If you have sustained a serious injury at work, it may not be a good idea to rush into settlement negotiations. This is because your long-term medical needs and the potential impact of your injury on your future earning ability need to be addressed first. Prematurely entering into a settlement without a clear understanding of these factors can lead to an agreement that might not adequately address all your needs.
Once your ongoing medical requirements and possible changes to your earning capacity have been evaluated, you can proceed with settlement negotiations. The time it takes from the start of negotiations to the finalization of a settlement can range from several months to about a year. This period covers discussions over the settlement amount, finalizing the terms, and the formal drafting and signing of the settlement agreement.
Following the signing and filing of the settlement agreement, Ohio law mandates a 30-day waiting period before it becomes irrevocable. During this interval, any party involved—the injured worker or the employer’s insurance company—has the option to rescind the agreement. This waiting period acts as a safeguard by allowing both parties a final opportunity to reflect on the terms and ensure that the settlement is satisfactory.
Benefits of Hiring an Ohio Workers’ Comp Attorney
Hiring an Ohio workers’ compensation attorney offers several key benefits. The workers’ compensation system can be challenging, especially when facing large insurance companies equipped with resources aimed at minimizing their payouts. An experienced attorney levels the playing field and provides critical support in several ways, including:
- Background in Workers’ Compensation Law: Workers’ compensation laws are complex and constantly evolving. An experienced lawyer will be up to date on the most recent changes and how they could impact your case. They can effectively handle the legal requirements, deadlines, and paperwork that must be filed correctly to avoid delays or denials of your claim.
- Legal Advocacy: Insurance companies are in the business of making money and have dedicated teams to help them reduce how much they pay on claims. They often employ tactics that can include disputing the severity of injuries or the necessity of medical treatments like surgery. A workers’ compensation attorney is skilled in negotiating with these companies and can advocate on your behalf, ensuring that your claim is fairly evaluated and that the insurance tactics do not unduly influence the outcome.
- Maximizing Your Compensation: A knowledgeable attorney can accurately assess the value of your claim, taking into account not just immediate medical costs and lost wages, but also long-term effects of your injury, potential future medical treatment, and any permanent disability benefits you may be entitled to. They work to ensure that the settlement you receive is truly reflective of the total impact the injury will have on your life.
- Protecting Your Rights: One of the critical roles of a workers’ compensation attorney is to protect your rights throughout the claims process. This includes ensuring that you do not sign any agreements that could inadvertently waive your rights to future benefits, such as ongoing medical care or adjustments in benefits if your condition worsens.
- Representation in Appeals: If your claim is denied, or you are not satisfied with the decision, an attorney can represent you in the appeals process. They can prepare and submit the necessary documentation, represent you in hearings, and argue on your behalf, providing you with the best chance to overturn an unfavorable decision.
In essence, an Ohio workers’ compensation attorney acts as your advocate and guide through a complex system. This support is critical for anyone facing the challenging circumstances that follow a workplace injury.
Speak to an Ohio Workers’ Compensation Lawyer Today
At Plevin & Gallucci, our experienced attorneys are dedicated to supporting injured workers throughout Ohio. We understand the impact that a workplace injury can have on your life and are here to ensure that you get through the claim process with the best possible guidance and advocacy. From beginning to end, our goal is to secure maximum compensation for your work-related injuries.
If you or someone you know has suffered a workplace injury that requires surgical intervention, contact Plevin & Gallucci today to schedule a free consultation. Contact our offices in Cleveland, Columbus, or Waverly to learn more about what we can do for you.
