What if Your Workers’ Comp Surgery is Denied?

Many people find that they need to fight for their workers’ compensation benefits when they are injured at their job. In some instances, a denial of benefits may be for a legitimate reason (such as filing a claim too late). However, when it comes to needing surgery for your injuries, you may be expecting your workers’ compensation benefits to cover this. After all, it is serious enough to warrant surgery. What should you do if your employer says that workers’ compensation benefits do not extend to your surgery? You should not give up hope that workers’ compensation can cover this. 

What does a denied claim mean? 

Denied workers’ compensation benefits do not mean it is the end of the road. Instead, you should speak with a lawyer, like a workers’ compensation lawyer from a law firm like Rispoli & Borneo, P.C. to ensure your rights are upheld. When your employer’s insurance company denies your benefits for surgery, you will want to understand why they denied your claim. They may have done so because: 

  • Your employer’s insurance company does not agree with the claim that you need surgery for your injuries
  • Your employer’s insurance company provides you with a doctor who will give a second opinion that may disagree with your treating doctor
  • Your employer’s insurance company agrees that you need surgery but claims that you became injured outside of work
  • The recommended treatment or surgery may not be what you need at this point in the healing process 

There are various reasons that an insurance company may deny your claim and it is important to get to the bottom of it so that you and your attorney can file an appeal, if necessary. 

What if I need the surgery? 

If you are at the point where you simply need the surgery to start recovering, your lawyer may recommend that you move forward with paying for the surgery through your own insurance. It is still possible to get a settlement in the future that will cover the expenses of your surgery and working with an attorney will help to ensure you have everything necessary in your claim when asking for compensation for your surgery. 

It is important to have representation when you are filing a workers’ compensation claim, particularly when you need to get surgery as part of your treatment. Speak with a local attorney you can trust after you were injured at work.

Posted in Workers Compensation

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