How Does Surgery Affect The Value Of A Claim?
The smartest medical course of action following an injury is often to treat conservatively (physical therapy, anti-inflammatory medication, injections), if possible. Nobody should rush into surgery, given that every surgical procedure carries the risk of medical complications. Our bodies have amazing healing powers if we give ourselves the time to heal.
However, claimants should recognize that there are both medical and legal ramifications to turning down or delaying recommended medical treatment. From a medical standpoint, a traumatic injury may become unfixable if too much time passes. From a legal standpoint, the larger the gap in time between an accident and the surgery, the more opportunities an insurance carrier will have to question causal relationship (ie: if there is an intervening fender-bender). In addition, the settlement value of a claim is limited if the injured person only pursued conservative treatment.
Case in point: my client, Steve. A workers’ compensation physician proposed surgery to Steve’s lumbar spine. Since he is only 33 years old, Steve wisely decided to decline surgery and live with the pain. In some ways, his decision highlights the lunacy of the New Jersey workers’ compensation system. If Steve went through with the surgery, the value of his partial permanent disability claim would be substantially higher, even if the surgery eliminated his pain. This outcome is a homerun for the insurance carrier, which avoided paying those medical bills and also got away with paying Steve a much lower settlement award, even though his pain might be worse than if he had the surgery.
Does this make sense? Why does our system pay a premium to injured workers who undergo invasive, risky medical procedures? In a perfect world, we should be judging each case on its own merits, based upon the actual disability, regardless of the amount of medical treatment obtained by the injured worker. However, from a practical perspective, our Courts look to surgical procedures as objective evidence of an injury, which is required to qualify for an award of permanent disability.
Your health is more important than the results of litigation. For that reason, you should base the decision on whether to proceed with any medical procedure upon your level of pain, and how the injury impacts your quality of life, compared to the risks of that procedure. However, be aware that the decision to forego surgery will negatively affect the value of your claim. Fortunately for Steve, he received a settlement award which enables him to reopen his claim if his condition deteriorates, and he ultimately chooses to move forward with surgery.