If you’re injured at work and workers compensation won’t pay for surgery, you’re probably wondering what options you have available to get the recovery you need for your medical expenses and lost wages. Chances are likely that you were able to get your workers compensation claim approved but you’re battling with the insurance company to get the medical treatment you need accepted.
Why won’t workers compensation pay for surgery?
As part of the workers compensation injury settlement, you need to have all procedures approved by the workers comp insurer before you can get the treatment you need. Your workers compensation benefits are obligated only to cover medical expenses that pertain to an injury you sustain in your workplace, not just any medical condition you wish to treat.
When you request approval for your treatment plan, your workers compensation claim will be evaluated to determine if the medical procedure is truly necessary. If the South Carolina Workers Compensation Commission or your employer’s private insurance company don’t believe it is, they’ll likely deny coverage for that procedure and you’ll have to cover the costs out-of-pocket on your own.
There are situations where you and your doctor may believe that a procedure is necessary but the insurer decides it’s not. This is especially an issue that arises if the procedure is newer or experimental or in circumstances where there are a variety of options available to treat your injury but you and your doctor are set on something in particular that best fits your individual needs and interests. Coverage for surgery also comes into questions when the procedure you’re seeking is particularly expensive.
Your rights in getting getting workers compensation to pay for surgery
If you need to go against the Commission or the insurer when coverage is denied, there are a few things to consider.
If the surgery is absolutely necessary and can’t wait and you have health insurance available to use, use your health insurance to cover the surgery rather than wait for workers compensation future medical settlement. You’ll likely have to pay out-of-pocket fees but if the surgery is a must-have procedure, you need to take your health into consideration as your top priority.
In this type of circumstance, you can still pursue a personal injury claim to reclaim the costs that you paid for the surgery. Keeping documentation of your injury report, the prescribed treatment, your doctor’s recommendations and notes about your injury and need for surgery is incredibly important in helping to support your case.
Get help from an attorney to help make a claim for coverage for your surgery. Having an experienced workers comp attorney available in the first place will help you fight to get coverage for your workers comp denied surgery. If things become more complicated, your attorney will be there to help you and get you the compensation you need for the costs of your surgery. Contact The Clardy Law Firm for more information about how we can help you get the treatment and compensation or coverage you need to recovery from your work injury.