Work Injuries and Failed Back Surgery Syndrome

“Failed back surgery syndrome,” now often called persistent spinal pain, isn’t really a medical syndrome. It’s a broad term doctors use when someone has back or spine surgery, but still has pain afterward, or the surgery doesn’t work as expected. It doesn’t mean the surgery was done wrong, just that the pain didn’t go away. There isn’t a similar term used for other surgeries, like heart or knee surgery; this label is mainly used for ongoing pain after back surgery.

Back surgery can have different results for different people. Even when a skilled surgeon does everything right, surgery does not always relieve pain or improve symptoms. There is no guarantee that back surgery will work.

When someone has severe, long-lasting pain after back surgery, it can be hard to measure their disability in the workers’ compensation system. The system relies on a book called the AMA Guides, which focuses on medical impairment. Medical impairment looks at physical findings, not how the injury affects daily life or the ability to work. It also often does not fully account for how much pain limits a person.

Medical Treatment

Treatment for ongoing pain after back surgery can involve many approaches. This may include pain medications, physical therapy, and learning ways to manage pain. It can also involve procedures like injections, nerve treatments, implanted devices to help control pain, or, in some cases, another back surgery.

These cases can be very expensive for workers’ compensation insurance companies because of ongoing medical care. For that reason, insurance carriers often want to settle future medical costs. But without a clear picture of how much long-term care will cost, it can be hard to know what a fair settlement is. If a Medicare Set-Aside is not done, it’s usually a good idea for a lawyer to get a life care plan from a qualified expert to estimate future medical needs and costs.

Medicare / Social Security

In many serious injury cases, the injured worker may qualify for Social Security Disability benefits. Even if the workers’ compensation lawyer does not handle Social Security cases, it’s still important for them to understand how those benefits affect the workers’ compensation claim. Special forms and paperwork may be required to avoid problems later.

Medicare is very important, especially if the injured worker has other health problems. A workers’ compensation settlement can affect Medicare coverage. Because of this, the Texas workplace injury lawyer handling the case needs to know how to prepare the right paperwork so Medicare will approve it and the worker’s benefits are protected.

Medicare Set Aside Trusts / Structured Settlements

If you receive Social Security Disability or Medicare, a Medicare Set-Aside is usually required before you can fully settle your workers’ compensation case. The workers’ compensation insurance company typically hires a company to prepare the MSA. That MSA is then sent to CMS, the agency that handles Medicare’s approval of these arrangements.

To prepare the MSA, the company will need copies of your workers’ compensation medical records from the past two years, a list of all prescriptions you’ve filled at any pharmacy during the past two years, and a signed release allowing access to your Social Security information.

Special Needs Trusts

If someone receives public assistance, welfare, or other benefits based on income or assets, a Special Needs Trust may be needed to settle a workers’ compensation case without putting those benefits at risk.

Failed Back Surgery and Pre-Existing Medical Conditions

Having ongoing pain after back surgery does not always mean someone cannot work or have a productive future. But in some cases, the worker already had other injuries, health problems, anxiety, or depression that they were managing before the back surgery. The continued back pain can make those issues much worse and push the worker past the point where they can reasonably keep working.

In practical terms, when a worker’s prior health problems are combined with ongoing pain from failed back surgery, they may no longer be able to work in regular, competitive jobs. This does not mean they cannot live their life or do anything at all; it means they cannot realistically compete in the job market. 

In these situations, there is a special type of workers’ compensation claim called a Subsequent Injuries Benefit Trust Fund claim, and it’s important for the attorney handling the case to know about it and consider whether it applies.

Discuss Your Case With a Texas Workplace Injury Lawyer

If you’re dealing with a serious work injury and you feel confused or like the system is stacked against you, getting reliable legal help is important. A knowledgeable attorney will be able to look at the full picture and make sure that no benefits or claims are overlooked.

For dependable advice and help protecting your future, contact The Law Office of Sandy McCorquodale, P.C. at (833) 712-4472 or reach out online to speak with a Texas workplace injury lawyer about your case.