After an amputation: what an injury claim can cover for the years ahead

What should I focus on first after losing a limb?

Your health and your family come first. You do not need to understand any of this today. MedlinePlus says sadness, anger and frustration are common after limb loss, and that medicine or counseling can help. Those feelings are not a weakness, and they are part of what happened to you. If you are having a very hard time, tell your care team.

This guide is not medical advice. When you or someone close to you feels ready, the steps below can protect your options. A trusted relative can do most of them.

1. Keep every hospital record, discharge paper and bill together in one place.
2. Ask a family member to photograph the scene, machine or vehicle, if it is safe.
3. If it happened at work, ask for the incident report. The employer must report an amputation to OSHA within 24 hours.
4. Write down names of witnesses and anyone who came to help.
5. Before signing anything from an insurer, employer or equipment company, have someone you trust read it.
6. Note the date of the injury and check the deadlines below, especially if a government agency may be involved.

How much is an amputation settlement worth?

There is no honest average. Settlements are often private, and the loss of a fingertip and the loss of both legs are very different lives. Numbers you find online usually come from law firm marketing. What does exist is research on cost, and it is sobering.

In a study of 545 people with severe leg injuries at trauma centers, two-year costs including prosthetics were $91,106 for people who had an amputation. Projected lifetime health care cost was $509,275, about three times the cost for people whose limbs were reconstructed. Those are 2002 dollars and research figures, not settlement amounts. They show why a claim needs to look decades ahead.

Things that shape the value of a claim include which limb and at what level, whether it is your dominant hand, your age, your job, whether you need help at home, and how much insurance or how many responsible companies exist.

What will my doctors document, and why does it matter?

Severe trauma from an accident is one recognized reason for amputation. Sometimes doctors try to reattach a severed part, which can work when the part and limb are cared for properly. Your records should show why each decision was made. Insurers sometimes argue that a different choice would have saved the limb, and a clear surgical record answers that.

Other notes matter over time. Fitting for a prosthesis may begin when the wound is mostly healed and no longer tender. Learning to use one takes time, and physical therapy can help. You may feel the missing limb is still there. These sensations often fade slowly. Skin problems can come with wearing an artificial limb, and those visits belong in your file too.

It is also true that most people can still be active after amputation. A fair claim does not have to pretend otherwise. It accounts for the cost of getting there and for what was changed for good.

What can an amputation claim cover, including future prosthetics?

Many families work with a life care planner, a professional who lists likely needs and costs year by year. Health coverage helps but has gaps. Medicare Part B covers prosthetic devices a provider orders, and you generally pay 20 percent of the approved amount after the deductible. Some states may require prior authorization for certain lower-limb prosthetics. If Medicare paid for injury care, it must be repaid from a liability settlement.

How do insurers dispute amputation claims?

It rarely makes sense for an insurer to deny the loss. The arguments are usually about who is responsible and how much the future will cost.

What if the amputation happened at work?

Workers' comp is usually the first source of benefits, but it may not be the only one. A company that made or installed a machine, or a contractor on the site, can sometimes be sued separately.

In Arizona, comp uses a schedule. It lists 50 months for the loss of a leg, and 60 months for a major arm or 50 for a minor arm. In Texas, lifetime income benefits can apply to the loss of both feet at or above the ankle, or one foot and one hand. Not all Texas employers carry comp. Those rules can be complicated, and benefits for one limb may be less than people expect, so a claim against a third party can matter a great deal.

What differs in Arizona and Texas for amputation claims?

How long will an amputation claim take?

There is no set timeline, and it is reasonable for this to take time. The full picture of a prosthetic and of your work life may not be clear for a year or more. In 2005 government data, jury cases averaged 27 months from filing. Serious cases with several defendants can take longer. Still, the 2-year deadlines keep running, and government notices are far shorter. A lawyer can often file to protect your rights while your care continues.

Things that can quietly reduce a claim:

• Accepting an early offer before your prosthetic and work needs are known.
• Letting an employer or equipment company keep or change the machine without a request to preserve it.
• Leaving future replacements out of the estimate.
• Forgetting Medicare or health plan repayment when comparing offers.

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