What to Do if Your Treatment or Surgery for a Workers’ Comp Injury Was Denied?
Your employer and their insurance company must provide you with the medical treatment you need to recover from your work-related injury and illness and return to work. However, it is not uncommon for insurers to deny a worker’s treatment or surgery. What can you do if your doctor recommended treatment or surgery, but your employer’s insurer refuses to pay for it?
When this happens, you should talk to an experienced Tampa workers’ compensation attorney to appeal the denial. If you chose to continue with the treatment or surgery despite the insurer’s denial, you might be able to seek reimbursement for the expenses.
Who Can Deny Your Workers’ Compensation Treatment or Surgery?
Only an employer’s insurance company can deny a worker’s medical treatment or surgery. Typically, workers’ compensation treatments and surgeries are denied based on a second opinion of another doctor. The majority of denials occur as follows:
- A workers’ treating doctor recommends a medical treatment or surgery;
- The employer’s insurance company does not agree with the recommendation;
- The claims adjuster seeks a second opinion from a third-party medical professional;
- The third-party doctor decides that the worker does not need the recommended treatment or surgery; and
- The insurance company denies the request and refuses to pay for the recommended procedure.
Why Can the Insurer Deny Your Workers’ Comp Treatment or Surgery?
Your workers’ compensation treatment or surgery may be denied in the following situations:
- The insurance company believes that your injury is not related to work or believes that you were not injured at all. It is not uncommon for employers and insurers to believe that a worker was not actually injured, while others may accuse the employee of exaggerating their symptoms.
- You were intoxicated at the time of the injury. If your employer finds out that you were under the influence of alcohol or drugs at the time of your workplace accident, your workers’ compensation claim could be denied. Usually, employers require that injured workers are tested for alcohol and drugs following a work-related injury.
- Your employer disputes your workers’ compensation claim. If your employer is disputing your workers’ comp claim, there is a risk of their insurer refusing to pay for your treatment or surgery, especially if the employer believes that you were not injured at all or were injured somewhere else, not at work.
- The deadline for reporting your work-related injury or illness has expired. In Florida, you must report your injury to the employer no later than 30 days of the date of the workplace accident or within 30 days of the date you find out that you have a work-related injury or illness.
- Your treating doctor or a third-party medical professional determines that the recommended surgery or treatment is not necessary anymore.
- The Independent Medical Exam (IME) shows that you have reached maximum medical improvement (MMI).
If your workers’ compensation claim was denied or the insurance company is refusing to pay for your treatment or surgery, do not hesitate to speak with a workers’ comp attorney in Tampa to discuss your options. Reach out to Kobal Law to schedule a case evaluation. Call at 813-873-2440.
