Insurance companies often dispute lumbar disc replacement claims, even when the procedure is medically necessary.
If you’ve suffered a serious back injury at work and your doctor has recommended lumbar disc replacement surgery, you may be surprised to find that the insurance company is pushing back—or outright denying coverage.
At the Law Office of James M. Hoffmann, we’ve helped countless Missouri workers fight back and secure the benefits they deserve for life-changing spinal injuries.
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What Is Lumbar Disc Replacement?
Lumbar disc replacement is a surgical procedure that replaces a damaged spinal disc in the lower back with an artificial one. It’s often used to treat chronic pain, herniated discs, or degenerative disc disease—conditions that may develop after traumatic work injuries such as:
- Lifting heavy objects
- Slip and falls on hard surfaces
- Vehicle or equipment accidents
- Repetitive strain from job-related tasks
When successful, this procedure can restore mobility and reduce pain. But it comes at a high cost—both medically and financially.
Why Do Insurance Companies Deny Lumbar Disc Replacement Claims?
1. Cost of the Surgery
Lumbar disc replacement is a high-dollar procedure. Between surgical costs, hospital stays, imaging, and rehabilitation, insurers often see this as an expensive claim—and may try to avoid paying.
- Insurer tactic: Labeling the surgery as “unnecessary” or recommending cheaper, less effective alternatives.
2. Claiming It’s Not “Reasonably Necessary”
In Missouri, workers’ comp only covers “reasonably necessary” medical treatment. Insurers often dispute the need for disc replacement, even when a treating physician recommends it.
- Insurer tactic: Requiring an Independent Medical Examination (IME) that contradicts your doctor’s findings.
3. Blaming a Pre-Existing Condition
If you’ve had any history of back pain, insurers may try to argue that your injury is not work-related or that your current symptoms are due to a pre-existing condition.
- Insurer tactic: Using old medical records to avoid liability for your current condition.
4. Delaying or Ignoring Referrals
Another common strategy is stalling the approval process—dragging out your claim with endless paperwork, delays, or requests for additional documentation.
- Insurer tactic: Hoping you’ll give up or agree to a cheaper treatment.
How to Fight Back Against an Unfair Denial
If your lumbar disc replacement surgery has been denied or delayed, you have legal rights under the Missouri workers’ compensation law.
Here’s what we recommend:
- Don’t accept the denial as final. Many denials can be overturned with strong medical documentation and legal advocacy.
- Get a second medical opinion. A qualified physician may support your need for surgery and help strengthen your case.
- Work with an experienced Missouri workers’ comp attorney. At our firm, we’ll challenge the insurance company’s denial, push for treatment approvals, and fight for your right to full compensation.
We’ve Helped Injured Missouri Workers Recover Millions
At the Law Office of James M. Hoffmann, we’ve recovered over $100,000,000 for injured Missouri workers, including those facing denied surgery claims. We understand the tactics insurance companies use—and we know how to beat them.