[{"@context":"http:\/\/schema.org","@type":"BlogPosting","about":"Workers' Compensation","wordCount":583,"dateModified":"2023-12-19","datePublished":"2023-05-01","url":"https:\/\/www.puttingpeoplefirst.law\/blog\/workers-comp-denied-my-surgery-now-what\/","mainEntityOfPage":"https:\/\/www.puttingpeoplefirst.law\/blog\/workers-comp-denied-my-surgery-now-what\/","name":"Workers\u2019 Comp Denied My Surgery. Now What?","headline":"Workers\u2019 Comp Denied My Surgery. Now What?","articleBody":"If your doctor recommends surgery after a workplace injury, your employer\u2019s workers\u2019 compensation insurer should pay for it. However, the insurance company may deny payment for various reasons, and they are not always fair. Fortunately, a denied claim or rejected treatment isn\u2019t necessarily the end. You have options and should consult an experienced workers\u2019 compensation lawyer for help.Who Has the Authority to Deny My Surgery for a Work-Related Injury?The insurance adjuster can decide whether to approve or deny your surgery. They represent the insurance carrier and oversee workers\u2019 compensation claims.Why Do Worker\u2019s Compensation Insurance Companies Deny Treatment?Like any business, insurance companies want to maximize income and minimize expenditures. Surgery is expensive. So, the insurer will likely seek reasons to reject the doctor\u2019s recommendation.Although an injured worker can appeal a claim denial, the red tape is enough to make many employees with valid claims give up in frustration. When that happens, the insurance company wins, keeping the money the injured worker is entitled to under Georgia law. Don\u2019t give up \u2014 talk to a lawyer instead.\u00a0\u00a0Possible Reasons for Denials\u00a0The insurer might deny a surgery request for various reasons. The company may argue:\u00a0Surgery doesn\u2019t offer any medical benefits, such as curing the disease, alleviating pain, or restoring loss of mobility.The patient has reached maximum medical improvement (MMI), meaning surgery will not improve the condition.The injury isn\u2019t work-related, so workers\u2019 compensation shouldn\u2019t pay for the procedure.\u00a0The doctor isn\u2019t on the employer\u2019s panel of approved physicians.The injured worker didn\u2019t follow their doctor\u2019s treatment plan, causing the injury to worsen.The insurer disagrees with the physician\u2019s diagnosis or believes the injury doesn\u2019t require surgery.The employee didn\u2019t report the job-related accident or file their claim by the deadline.The insurer may claim the need for surgery is due to a pre-existing condition such as degenerative disc disease.How Can I Get My Surgery ApprovedYou might be able to resolve the problem and get the workers\u2019 comp adjuster to approve your surgery by:Talking to the adjuster\u00a0\u2013 Contact the insurer to explain why surgery is necessary. The denial might be a miscommunication. Maybe your claim form includes incomplete or inaccurate information. Submitting relevant evidence to prove you need surgery might convince the insurer to approve it.Ask for a hearing\u00a0\u2013 You can request a hearing with the Georgia State Board of Workers\u2019 Compensation (SBWC). At the hearing, you must demonstrate why the insurer should approve your surgery and pay the expense.File an appeal\u00a0\u2013 During an appeal, the workers\u2019 compensation board reviews the initial decision and decides whether to approve or deny it.Your claim\u2019s success depends on providing strong supporting evidence during the hearing and appellate phases of your case. A knowledgeable workers\u2019 compensation attorney can determine what you need to give you the best possible chance of success.\u00a0Talk to a Workers\u2019 Comp Lawyer if Your Surgery Has Been DeniedThe Law Offices of William F. Underwood, III, P.C. puts people first. If you need surgery and receive a denial from the insurance company, our workers\u2019 compensation attorneys will fight fiercely for you to get the medical care you deserve. Call or contact us today for a free consultation with a workers\u2019 comp lawyer in Georgia.\u00a0\u00a0                    .swal2-popup {                width: 40em;                height: 25em;            }            .swal2-title {                font-size: 3em;            }            .swal2-styled.swal2-confirm {                font-size: 1.2em;            }            .cw-infographic {                margin: 0 auto;                margin-top: 30px;                margin-bottom: 30px;            }            .cw-infographic .infographic-wrap {\t\t\t\tmax-width: 1280px;\t\t\t\twidth: 100%;\t\t\t\tmargin: 0 auto;            }            .cw-infographic .infographic-wrap .image-wrap{\t\t\t\tbox-shadow: -1px -1px 20px 0 rgb(0 0 0 \/ 12%);            }            .cw-infographic .infographic-wrap img {\t\t\t\twidth: 100%;\t\t\t\tborder: none;            }            .cw-infographic .embed-section {                margin-top: 30px;                text-align: center;            }             .cw-infographic .embed-section .embed-textarea {                opacity: .01;                height:0;                position:absolute;                z-index: -1;            }            .cw-infographic .embed-section .embed-label {                font-weight: bold;            }            .cw-infographic .embed-section textarea {                width: 100%;                min-height: 130px;                border: 1px solid #34103873;                text-align: justify;                padding: 10px;                color: #00000080;            }            .embed-container, .embed-textarea, .embed-section button {                margin-top: 20px;            }                        .cw-infographic button, #infographic-button {                cursor: pointer;            }\t\t\t.cw-infographic button {\t\t\t\tmargin-inline: auto;\t\t\t}                                                                                                                                                                                        Share this image on your site                                                    Infographic provided by Law Offices of William F. Underwood, III, P.C.                                                Copy to clipboard                                                                            jQuery( document ).ready(function($) {                console.log( \"ready!\" );                $('.copy-btn').each(function(i) {                    $(this).click(function() {                        Swal.fire( {                        title: 'The code has been copied',                        icon: 'success',                        confirmButtonText: 'Continue'                        } );                        $('#' + $(this).data('ta-id')).select();                        document.execCommand('copy');                    });                           });            });        \t","description":"If your doctor recommends surgery after a workplace injury, your employer\u2019s workers\u2019 compensation insurer should pay for it. However, the insurance company may deny payment for various reasons, and they are not always fair. Fortunately, a denied claim or rejected treatment isn\u2019t necessarily the end. You have options and should consult an experienced workers\u2019 compensation lawyer for help. Who Has the Authority to Deny My Surgery for a Work-Related Injury? The insurance adjuster can decide whether to approve or deny your surgery. They represent the insurance carrier and oversee workers\u2019 compensation claims. Why Do Worker\u2019s Compensation Insurance Companies Deny Treatment?...","author":{"@type":"Person","image":{"@type":"ImageObject","url":"https:\/\/secure.gravatar.com\/avatar\/dd9950fc740b2abd2fc268264d7c845d?s=96&d=mm&r=g","height":96,"width":96,"@id":"https:\/\/secure.gravatar.com\/avatar\/dd9950fc740b2abd2fc268264d7c845d?s=96&d=mm&r=g"},"url":"https:\/\/www.puttingpeoplefirst.law\/blog\/author\/puttingpeoplefirst\/","name":"Law Offices of William F. 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