What can I do if my workers’ comp surgery has been denied?

Answer: Talk to your doctor about it.

Your treating doctor carries the most weight when determining whether or not you actually receive the medical care that you need in order to return to full health (including surgery). If your treating doctor (or a specialist referred by your treating doctor) determines that you need surgery, and then the insurance company refuses to voluntarily pay for the recommended surgery, it’s up to your treating doctor to dispute the findings of the insurance company.

The doctors that handle workers’ compensation cases (and their staff) understand that it’s their job to “go to bat” for their patients. They also understand that the insurance companies don’t want to pay more than they absolutely have to, so medical disputes are common. Your treating doctor should “have your back” and be willing to put in the extra effort that it takes to convince the insurance carrier that you actually need the surgery that has been recommended, and if the insurance company still refuses to pay, your treating doctor should request an appeal in order to get your surgery approved.