What to Do If Your Doctor Recommends Surgery After a Workers Compensation Claim

Your doctor will generally recommend a less invasive course of action at first, however surgery may be recommended if it is the best course of action.

surgery after a work injury

Workers compensation cases can be very difficult. Most workers believe that once a claim gets approved by the employer and the insurance company that the battle is won, but reality shows this is not always the case.

In Missouri, your employer has the right to choose the doctor that will be administering your treatment in a workers comp case, which is often left at the hands of the insurance company. This can lead to many issues and concerns about whether you are getting the right form of treatment.

Case in point, your workers’ comp doctor recommends surgery. What should you do?

Understanding Your Health Issues

Surgery is rarely the first choice for treatment. Most often, it is a last case resort to get immediate intervention and fix a medical problem. For instance, if in the work accident you got punctured by an object, then surgery may be required immediately. It’s also possible for additional surgeries to be needed later on, if there are complications, for instance.

Your doctor will generally recommend less invasive courses of action at first, but if at one point they consider it the best option, surgery might be brought to the table. The insurance company may not have a say in your treatment, but it does need to know about your medical procedures and approve them for compensation. In their eyes, it prevents workers from taking advantage of these benefits to cover additional health issues that have nothing to do with the workplace injury.

Workers’ compensation benefits stop when you reach the maximum recovery, meaning you reasonably cannot get better, even if your health condition after workers comp isn’t the same as before the accident. Sometimes, workers will require additional medical interventions, like surgeries, after these benefits stop. In this case, can the intervention still be covered by your employer?

Do You Have a Settlement?

If you have accepted a settlement from the insurance company, this generally means that you agree not to get reimbursed for future medical costs later on, even if it’s clear they are still part of your work injury. If you’ve already accepted a settlement, and this measure is clearly defined, then, unfortunately, there is not much you can do. In some cases, your health insurance may cover the costs of your surgery, though some health plans explicitly exclude work-related injuries.

If you know you’ll be having additional medical costs, they can be added to the settlement, and then you can rest assured that all future costs of treatment will be covered, even if you technically settled your case. If the insurance company offers a settlement you should discuss it with an experienced work injury lawyer before accpeting it.

Workers’ compensation laws are complex, so you should generally work closely with a St. Louis work injury lawyer to make sure your legal right to workers compensation is protected right from the start of your claim. Give us a call 24/7 at (314) 361-4300 for a FREE case evaluation.

Updated: September 24, 2019