Workers’ compensation in Georgia should cover the costs of all reasonable and necessary medical care for on-the-job injuries. If you need surgery, then workers’ comp in Georgia should pay for it. Unfortunately, many recovering workers are shocked to receive a denial from the insurance company. They feel a sense of outrage that they are not being cared for the way they were promised. Call Griffin Law Firm, P.C. to talk with an experienced Snellville workers’ compensation lawyer. Our firm is dedicated to workers’ rights, and we can step in to see if the insurer should cover surgical expenses.
When Workers Need Surgery
In many cases, workplace injuries require surgery to help a worker fully recover. Of course, surgery is often expensive. It can also be difficult for some workers to undergo, so your medical provider might attempt conservative treatments first. Nonetheless, at some point, it becomes clear that surgery is the appropriate and necessary treatment. Without it, you face a lifetime of pain.
Workers often require surgery for the following reasons:
- Spinal fusion surgery
- Installing screws, rods, or plates to hold broken bones together
- Brain surgery to stop bleeding
- Skin grafts for an abrasion or burn injury
- Knee surgery for an ACL tear or a torn meniscus
- Shoulder surgery for torn rotator cuffs or labral tears
- Carpal tunnel surgery to relieve pressure on nerves
- Any other surgery to treat an injury and help an injured worker recover.
In addition to paying for the surgery, workers’ comp in Georgia should cover any pre-operative care, such as anesthesia or imaging tests, as well as post-operative care, including assistive devices (like wheelchairs), and follow-up appointments.
Regardless of how much surgery costs, workers should not have to pay any part of the expense. Your employer’s insurer should cover the full tab. Sometimes, there is confusion over whether postoperative treatment is necessary, such as painkillers or other medication. And, unfortunately, insurers sometimes refuse to give the green light for surgery at all.
What to Do if Workers’ Compensation Denies Your Surgery
Being approved for workers’ compensation is a relief. Workers often imagine they can focus full-time on their recovery, knowing that workers’ comp is paying for necessary medical care. That is a great benefit to have when you are hurt and unable to earn a full income.
However, workers’ comp insurers are constantly analyzing medical bills submitted by doctors, as well as requests for approval of future medical care. Surgery is expensive. And many insurers do not want to pay for it.
Typically, insurance companies will argue that the surgery is not necessary to help you get better. They might claim that conservative treatment like corticosteroid injections, pain relievers, and physical therapy are all you need to get back on your feet. Or they argue that surgical treatments are “experimental” and therefore too risky to recommend. In reality, these insurance companies simply do not want to pay the expense.
A workers’ compensation surgery denial is not the end of the road. There are steps injured workers can take to improve their odds of approval:
- Document your pain and disability. Workers need surgery for all sorts of injuries. For example, carpal tunnel syndrome often requires wrist surgery to release pressure on the median nerve running down to a worker’s wrist. Other serious injuries to the back or neck require surgery to help relieve pain and improve mobility. You should fully document the limitations you are experiencing. This type of record can help strengthen your claim that surgery is warranted.
- Talk to your doctor. You need documentation that the surgery is necessary, and your doctor can provide their medical opinion. In Georgia, however, your employer can choose your doctor for treatment, which means that in many cases it is your doctor who refuses to approve surgery.
- Consult an experienced workers’ compensation lawyer. Trying to get surgery approved is complicated. You benefit from a lawyer’s view of the situation. Our firm has developed relationships with other doctors over the years, and we can check if surgery is a reasonable treatment for your injuries.
Should You Seek Help from an Unauthorized Provider?
Georgia requires that employers post a list of approved medical providers called the Posted Panel of Physicians. These are people your employer trusts, often because the doctors listed will keep medical expenses low.
Why does your employer care? After all, they purchase workers’ compensation insurance, and it is the insurer who pays for your medical care.
Although true, your employer must pay insurance premiums for coverage. And the premiums will probably rise if too many workers end up needing expensive medical care. That gives your employer an incentive to select as approved providers doctors who will limit or even deny your medical care.
If you receive treatment from an unauthorized provider, then your bills are not usually covered. But things are not always so clear-cut. There are situations where injured workers have received compensation when they sought treatment from a doctor of their choice. One such example is if their Posted Panel of Physicians is not posted or is invalid under the requirements found in the Georgia Workers’ Compensation Act.
Your best bet is to talk with a workers’ compensation lawyer at Griffin Law Firm, P.C. We can help you decide on which steps to take. The cost of medical care has spiraled out of control recently, and insurance companies are more aggressively denying claims. We don’t encourage you to pay for surgery out of pocket, because you might not be reimbursed. Instead, let our firm analyze what steps you should take next. We fight to make sure you get all of the treatment you need and that all of the authorized medical treatment is paid.
What are some of the ways we can get the State Board of Workers’ Compensation to order the authorization and payment of the recommended medical treatment?
- Conference call with the Judge and the opposing attorney
- File a Motion
- Request a Hearing
Helping with Workers’ Compensation Claims
Surgical care is not the only medical treatment insurers refuse to pay. Some will deny rehabilitation or speech therapy as unnecessary.
Thousands of workers are struggling with workplace injuries, but do not have a lawyer representing them. Some insurers take advantage of unrepresented workers and tell them they are “okay” to get back to work. Injured workers are only likely to end up hurt again.
How can the Griffin Law Firm help you with your Workers’ Compensation Claim?
- We can get medical treatment authorized and paid for by the Insurer.
- We can get your weekly lost wages paid in the form of income benefit checks called temporary total disability or temporary partial disability benefits.
- We can obtain a permanent impairment rating and help you collect your permanent partial disability benefits.
- We can negotiate a lump sum settlement based on the total projected value of your claim.
How do we evaluate the settlement value of your workers’ compensation claim?
- Medical Treatment: We project what your future workers’ compensation related treatment will cost.
- Income Benefits: We calculate what income benefits you will likely receive in the form of temporary total and temporary partial disability benefits.
- Permanent Impairment Benefits: We calculate what your future permanent impairment rating will be based on the PPD rating assigned or projected.
Great workers’ compensation settlements don’t happen if you don’t have an attorney. The Griffin Law Firm’s contingency fee is 25% of the total settlement, and we have a track record of big workers’ compensation settlements over the last 30 years.
Speak with a Snellville Workers’ Compensation Lawyer Today
Griffin Law Firm, P.C. opened its doors to help workers obtain favorable settlements and hope for the future. Call our firm if you have additional questions about what to do if workers’ comp denies your claim. We can seek a workers’ comp settlement after surgery to replace lost wages and receive additional medical care.