How Long Does It Take Workers’ Comp to Approve Surgery?

One of the more frustrating aspects of the workers’ comp process is the time it takes to get medical procedures approved. For claimants hoping to get their surgery covered by workers’ comp, the approval time can range from several weeks to several months, depending on processing times, the type of surgery, the presence of evidence that supports their claim, and most importantly, the willingness of the assigned insurance company to play fair.

With that being said, regardless of the situation, workers’ comp claimants are protected by laws that mandate that insurance companies must respond to a claim and make a decision within a certain number of days. If you have not received a decision within a month or two of filing or you feel that the insurance company assigned to your case is avoiding you or treating you unfairly, a workers’ compensation lawyer can help speed up the process and fight for your right to fair payment.

How the Workers’ Comp Surgery Approval Process Works

The process for getting a surgery approved through workers’ comp starts by notifying your employer of your injury as soon as possible. If your surgery is an emergency procedure, go to the emergency room and tell your doctor that you are there for a work-related injury. In non-emergency situations, you may be required to see a doctor under your employer’s insurance, depending on your state.

Once your doctor recommends surgery, they will submit an authorization request to the insurance company, which will review their recommendation and make a decision on whether or not they will approve the surgery. If there is a dispute between you, the doctor, or the insurance company, they may require further evaluation by an independent medical examiner. While the examiner may seem like a neutral party, they unfortunately tend to side with the insurer, so it’s important to make sure to speak up and advocate for yourself during the examination if you feel that your medical needs are not being heard.

Once the insurance company has enough information to make a decision, it will either approve or deny the claim. If your claim is denied, you will have the option to appeal, but if you do so, it’s important to work with a lawyer.

What Can Cause Delays in Workers’ Comp Approving Surgery?

There are many reasons why your workers’ comp surgery approval is being delayed. Here are a few of the more common reasons our clients frequently experience

• Inaccurate filing: There’s a considerable amount of paperwork involved with getting a surgery approved by workers’ comp. In the initial filing, you may have made a mistake in the paperwork itself or filed too late; however, mistakes in filing can also happen due to negligence by your employer, the insurance company, or your doctor.
• Administrative setbacks: In some cases, the paperwork is accurate and filed on time, but there is a delay in processing on the part of the workers’ compensation board, the insurance company assigned to your case, or your doctors.
• Disputes: Because so many parties are involved in the claims process, the insurance company may dispute information that is given to them, especially if this information differs from the statements made by you, your employer, or your doctors.
• Lengthy investigations: Insurance companies conduct their investigation into the statement and paperwork given to them, and in many cases, this involves deep dives into documentation, phone calls, security footage, and even in-person visits or surveillance. These investigations can take up a significant amount of time, to the dismay of workers who are reeling from severe conditions.
• Negotiation methods: Another frustrating tactic that many insurance companies may employ is putting off approval until the last minute in order to pressure claimants into accepting a low settlement. When the claimant finally receives an offer, they often feel compelled to accept the offer due to a limited deadline. If you feel that this may be happening to you, contact a lawyer for help.

How to Speed Up Surgery Approval with Workers’ Comp

There are a few different ways you may be able to speed up your surgery being approved by workers’ comp. The first is having your doctor advocate for a more timely response. 

Most states have a process that allows workers’ comp doctors to file a specific form that notifies the insurance company that the surgery is a time-sensitive procedure. Doing this can mandate that the insurance company make its decision within a week or even less. Additionally, working with a lawyer often results in faster processing times when it comes to medically necessary procedures.

What Do I Do if My Surgery Is Denied by Workers’ Comp?

Receiving a denial by workers’ comp for surgery is incredibly disheartening, but the good news is that with a prompt and effective response, your denial may not be permanent. When insurance denies a workers’ comp claim, the claimant typically has the right to an appeal. However, it’s important to understand that if your appeal is denied, you may not receive another chance to get your surgery approved. Because there is very little room for mistakes, it’s always best to hire a lawyer to handle your appeal.

Your lawyer will start the process by gathering evidence, which usually includes medical documentation, witness statements, security footage from the jobsite, and communications between you, your employer, your doctor, and the insurance company. Then, once they’ve built a solid case, they will submit your case to a judge for review. During this time, it’s important to let your lawyer handle all paperwork and communication with the necessary parties.

How Can a Workers’ Comp Lawyer Help Me?

While our firm excels at handling the appeals process, we also have over a decade of experience offering legal services that prevent workers’ comp cases from ever reaching that point. 

Regardless of what point in the filing process you’re at, Pond Lehocky’s disability lawyers can help you manage paperwork and filing deadlines, help you access crucial evidence and documentation, and negotiate a fair settlement on your behalf. This includes advocating for you when insurance fails to recognize your right to surgery or other medically necessary procedures and treatment.

Talk to the Lawyers at Pond Lehocky Disability Today

Pond Lehocky’s disability lawyers have over 250 years of combined legal experience, and in that time, we’ve seen firsthand how frustrating it can be for our clients to get access to the medical treatment they deserve. Whether you need help filing an initial claim or you need immediate representation during a workers’ compensation surgery appeal, our firm is here to help and answer any questions you may have about your legal options. Contact us today for a free consultation.