Reviewed by Laurence P. Banville, Esq.Frequently asked questions
What factors determine a workers’ comp settlement for spinal fusion in NY?
The NY Workers’ Compensation Board evaluates your permanent impairment rating, pre-injury average weekly wage (AWW), and total medical costs including surgery and rehabilitation. Wage replacement is calculated at two-thirds of your AWW up to the state maximum. A higher impairment rating and longer expected recovery period generally produce a larger settlement.
Does workers’ comp cover the full cost of spinal fusion surgery in New York?
Yes — NY workers’ comp covers all medically necessary treatment, including spinal fusion surgery, hospital stays, anesthesia, and post-operative physical therapy, with no out-of-pocket cost to the injured worker. The WCB must authorize the procedure, and treatment must be provided by a Board-authorized provider.
What does NY WCB cover versus what a personal injury lawsuit could recover?
Workers’ comp through the NY WCB covers medical bills and a portion of lost wages but does not compensate for pain and suffering or full lost earnings. A personal injury lawsuit against a negligent third party — such as a defective equipment manufacturer or a contractor on a job site — can recover those additional damages, and injured workers may pursue both simultaneously.
Can I receive a lump-sum settlement for a spinal fusion workers’ comp claim in NY?
Yes. In New York, injured workers can negotiate a Section 32 settlement — a lump-sum agreement that closes out future indemnity and/or medical benefits. For spinal fusion cases, Section 32 settlements require WCB approval and are typically negotiated with the employer’s insurance carrier, often with the help of an attorney.