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Will Workers Compensation Pay for My Surgery?

doctors performing surgery after work injury

Accidents at work happen all the time, whether you are a construction worker or a computer operator in an office. From the mildest to the most severe ones, work-related injuries often affect one’s life in unpredictable ways, from being unable to go to work and get the necessary income to experiencing pain, emotional distress, and isolation.

Fortunately, work injuries are covered by workers’ compensation, a system through your employer’s insurance company will pay for your medical expenses, lost wages, and other damages. Even if the employer is uninsured or underinsured, you still have the possibility to ask for compensation through state-funded programs.

However, most of us who have dealt with insurance companies at least once in our lives know how carefully they verify every single claim to make sure they will not cover any expense that is not included in the policy.

Some companies go as far as denying your claim, even if it’s perfectly justifiable. Other times, the victim does not get the surgery they need because the medical provider is awaiting approval that is not actually required under the Workers’ Compensation act. Quite often, these situations get tricky and tend to linger over a long period of time, which is why having an experienced St. Louis workers compensation attorney on your side from the very beginning can help tremendously.

Will Workers’ Comp Pay for Your Surgery?

Getting back to the main question, it’s important to know that workers’ compensation should cover any medical treatment that you need for an injury caused by your work conditions or your employer’s negligence. This generally includes surgery, no matter what the insurance company wants you to think.

As long as your surgery is reasonable, necessary and related to your work injury, the insurance company has no grounds for refusing the coverage. They can hire an independent doctor who can give a second opinion and decide if the surgery is needed or not, but if the final answer is not satisfactory, you can make an appeal and defend your case further.

If you find yourself in such a situation, it’s highly recommendable that you speak with an experienced St. Louis workers’ comp attorney who has experience with these cases and knows what kind of proof is needed to get your claim through.

How a Lawyer Can Help

As mentioned above, insurance companies will go to extreme lengths to lower the amount or even deny it. That’s why it’s important to see a doctor as soon as you can after the injury and follow their recommendations carefully. You don’t want to give the insurance company any grounds for denying your claim.

Surgery is a big medical decision, and if you want to have it, it’s clear that your injuries are not getting better through alternative treatments. If you believe you need the surgery, contact a good attorney, follow your doctor’s advice thoroughly and don’t give up.

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Updated: February 25, 2020