What to do if surgery for your workers’ comp injury is denied

Unfortunately for injured workers, many times surgery for your workers’ comp injury is needed to fully heal form the work injury. The workers’ compensation insurance carrier has been paying medical bills, but has denied the surgery.

Why would surgery be denied?

Many times workers’ compensation carrier refuse to pay for surgery for your workers’ comp injury. They may challenge it on grounds of whether the surgery is ‘reasonable and necessary’ for the accepted injury. They may try and make you undergo more conservative treatment protocols that you have already been through with no to little success or relief. They may want you to undergo conservative treatment that your own doctor has advised would not be beneficial. They may also deny surgery because they believe the surgery is for a non-work-related condition, most notable ‘arthritis or degenerative disc disease, that they feel is outside the accepted injury. They may deny surgery because they have already denied the claim in its entirety. They may even file a Utilization Review to challenge the reasonableness and necessity of the recommended surgery. The key point here is that the denial of surgery in workers’ compensation cases is not all that uncommon.

If surgery is denied, what can you do?

Call Mooney Law today for a free consultation. We can help in several ways.

First, we can contact the insurance carrier, provide medical records, and negotiate coverage of the surgery.

Second, if the claim is denied, we can file and litigate a Claim Petition to get the injury accepted and therefore get the proper medical treatment you need to get better and back to work.

Third, we can file and litigate a Review Petition that seeks to expand the description of injury. Often times, insurance carrier only accept a “contusion” or “sprain/.strain” and use that injury description to deny extensive medical treatment. Injury descriptions are frequently fought over and litigated before Workers’ Compensation Judges.

Fourth, the insurance carrier may send you for an Independent Medical Examination to get the opinion they need to deny surgery. We can fight that medical opinion through litigation and testimony from your treating doctor.

Fifth, if the insurance carrier does file for a Utilization Review challenging the reasonableness and necessity of the surgery, we can litigate and fight to get the utilization review approved for treatment.

Workers’ compensation is a complex area of law that involves medical evidence and medical testimony. Mooney Law has collected tens of millions of dollars on behalf of injured workers throughout Central Pennsylvania and Maryland. No need to feel hopeless. Fight back. Call Mooney Law today for an absolutely free consultation at 717-200-HELP or 717-632-4656. You can also email us direct to schedule that free consultation at info@mooney4law.com. Finally, you can visit our website at Mooney4Law.com and complete the Schedule a Consultation form.

Mark Buterbaugh

Attorney representing injured workers and Social Security Disability clients in Pennsylvania and Maryland.