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Shapiro, Lewis, Appleton & Favaloro
Shapiro, Lewis, Appleton & Favaloro
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Surgery increases insurance claim value.

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A Virginia (VA) or North Carolina (NC) injury case involving a surgery is worth more money than a case without a surgery. In some ways this makes sense in that an injury which is serious enough to require a surgery likely involves pain and suffering greater than one where the doctor did not see the need to send the patient to a surgeon.

In an automobile accident lawsuit, the insurance company will pay you and your attorney more on the case in part based upon the amount of the medical bills. The more complicated a procedure, like a surgery, the more bills there are that the insurance company must take into account in their evaluation of the claim. Typically a surgery will involve multiple medical bills including that for the surgeon like an orthopedic doctor or a neurosurgeon, as well as bills from the hospital, the radiologist, and the anesthesiologist.

In a typical car crash case, the insurance company like State Farm will treat a case that required surgery for the injured person more seriously than they will a case where the client only had conservative treatment like physical therapy. The insurance companies often refer to cases without broken bones as “soft tissue” cases. The top personal injury lawyers in Virginia (VA), North Carolina (NC), and the United States, have tried to change the language to move away from that phrase and instead talk about “connective tissue” injuries. In either case the part of the muscular-skeletal system is the same, namely, the parts that attach to the bone like the muscle, ligaments and tendons. Sometimes an injury to these other structures that connect the skeleton and the muscle together can be just as debilitating and painful as ones where a bone is broken and requires surgery. In fact a broken bone that gets surgically reduced or put back in its proper shape is likely to heal in most circumstances. A tendon or ligament which has been stretched out of shape may be harder cure. However, insurance companies still treat cases where the injury is to the soft tissues of the body as less deserving of full and fair compensation.

This kind of evaluation of serious lawsuits is also made in the context of FELA cases against the rail on behalf of injured railroad workers. The railroad will nearly always pay more to a person who got hurt during their railroad work where surgery was required, than where they have, for instance, a back injury that does not require surgery. This is true in FELA cases even though medical bills are typically not admitted into evidence in a FELA trial the way they are in an automobile accident trail. The assumption by the railroad claim agent and law department is that the lawyer with a FELA case involving a surgery is in a stronger position to get the jury to be fair with the client than where there’s not been a surgery.

This increased evaluation and compensation for surgery over other methods of treatment in some ways is unfair and not necessarily a fair reflection of the amount of pain, suffering, and disability suffered by a person in an injury case. First, I would never recommend to a client to have a surgery. This is always a decision that needs to be made by the client in conjunction with his doctor. However, the decision of whether to have a back surgery to alleviate chronic back pain is typically based upon the patient’s own perception of the pain and their ability to deal with it. If the patient wants to avoid surgery then the doctor will simply continue with conservative measures like pain medication, physical therapy, exercises, and perhaps injections. If the pain is so excruciating that the person can not function on a daily basis with their chronic back pain, then they and their doctor will normally elect for surgical remedies. Sometimes, the patient who has surgery may end up being significantly better off having had it. Other times the surgery will in the long run not greatly change the extent of their permanent pain from an injury. However, there are certain pressures toward having a back surgery including that the insurance companies will pay better for a surgery than for long term conservative chiropractic treatment for example. I try to stay out of the decision as a personal injury lawyer about whether or not to have surgery because it really is up to the individual client and their physicians. I have also known clients who because of unusual circumstances ended up dying during or after a back surgery. The risks of surgery are real including permanent paralysis and death. I certainly would think long and hard before undergoing surgery. I think most patients and doctors generally don’t go for surgery unless it’s a last resort after going through the normal conservative measures first, even in the context of a lawsuit.

Related Information:Determining the Worth of a Personal Injury Claim