What Can I Do If My Workers’ Comp Surgery Has Been Denied?

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.

*** REMEMBER ***

It’s your treating doctor’s job to fight for your medical care in the event that the insurance company refuses to pay for treatment or procedures that your doctor feels are necessary to help you improve. If your doctor is not willing to fight for your medical care, call our office right away. It’s possible that your doctor has a conflict that is limiting his or her ability to truly see to your best interests instead of just doing the bidding of the workers’ comp insurance company. Call 888-434-COMP to talk to a lawyer and find out.

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Abbott & Associates attorneys are licensed only in the state of Texas unless otherwise indicated in the biographical section. Past performance is no guarantee of future results. We consider employment in another State only in association with co-counsel licensed in that State. References to laws are limited to federal and State of Texas law.