Ohio Workers’ Compensation Lawyers

What To Do if Surgery is Denied by Workers' Comp

Surgeon and medical team in the operating room, conducting surgery.

Severe work-related injuries require prompt medical attention to reduce the risk of future complications and facilitate recovery. Surgery is one of the most common treatments for severe and debilitating work injuries. However, even if your doctor recommends a certain type of surgery, you could find yourself at odds if it's denied by workers' comp.

Ohio's workers' compensation system is meant to provide financial benefits to injured workers. Navigating the process can be challenging, especially if it's your first time filing a claim or you're facing a denial of necessary medical treatment like surgery. When your well-being and financial stability are on the line, an experienced workers' compensation lawyer can make all the difference.

Types of work injuries that require surgery

Some of the most common work-related injuries that require surgery include:

  • Fractures: Workplace accidents, particularly involving heavy machinery or construction, can lead to bone fractures. Surgical procedures like open reduction and internal fixation (ORIF) may be necessary to realign and stabilize broken bones.
  • Tendon and ligament injuries: Jobs involving repetitive motion or physical labor can increase the risk of tendon and ligament injuries. These often include torn rotator cuffs or ACL tears. Arthroscopic procedures are often necessary to restore functionality.
  • Spinal cord injuries (SCI): Spinal cord injuries that need surgery often include herniated discs, fractures, or severe compression injuries. Surgery helps decompress nerves, stabilize the spine, or correct deformities.
  • Burns: Workers in industrial settings, kitchens, or chemical laboratories may suffer burns from hot surfaces, chemicals, or fires. Severe burns may require skin grafts or reconstructive surgery to repair and replace damaged tissue.
  • Crush injuries: Crush injuries are common in occupations involving heavy machinery or construction. These can cause severe damage to bones, muscles, and soft tissue. Surgery may be necessary to reconstruct and restore the affected areas.
  • Amputations: Accidents involving industrial equipment or machinery can result in traumatic amputations or severed limbs. Surgical amputation or reconstructive surgeries may be necessary to address these injuries.
  • Traumatic brain injuries (TBI): TBIs often occur due to falls or being struck by equipment or tools. Craniotomy or decompressive craniectomy may be required for TBIs to reduce intracranial pressure.
  • Eye injuries: Construction sites or laboratories are hotspots for eye injuries. These injuries may require corneal repair or retinal detachment surgery to restore vision and eye function.

Types of surgery covered by workers' comp

Workers' compensation typically covers surgeries that are deemed medically necessary. Below, you'll find common types of surgeries that workers' compensation covers:

  • Orthopedic surgeries: These include procedures to repair fractures, torn ligaments, and damaged joints. Common orthopedic surgeries covered by workers' compensation can include ORIF for fractures, arthroscopic procedures for joint injuries, and spinal surgeries for work-related back injuries.
  • Reconstructive surgeries: Workers' compensation may cover reconstructive surgeries to restore function or appearance. This can include surgeries to repair disfiguring injuries, such as facial trauma or burns.
  • Amputation surgeries: Workers' compensation can cover the costs associated with amputation surgeries and prosthetic devices if a work-related injury results in the loss of a limb or body part.
  • Neurological surgeries: These may be necessary to treat severe TBIs or spinal cord injuries. Craniotomies and decompressive procedures are often necessary.
  • Eye surgeries: Workers' compensation may cover eye surgeries to treat injuries caused by workplace accidents, chemical exposures, or other occupational hazards. You may need corneal repair or cataract surgery for this type of injury.
  • Reconstructive surgeries: These procedures are necessary for workers who suffer disfigurement or scarring due to work-related accidents or injuries.
  • Carpal tunnel release surgery: For carpal tunnel syndrome due to repetitive motion or other occupational factors, you may need carpal tunnel release surgery.
  • Infection-related surgeries: These include surgeries to treat infections or complications arising from work-related injuries. Infection-related surgeries often include debridement or abscess drainage.

Why workers' comp might deny your surgery

Workers' compensation typically covers medical treatments deemed medically necessary to treat work-related injuries. If the insurance provider believes that the surgery is not medically necessary or that alternative treatments are sufficient, they may deny the surgery.

Additionally, workers' comp claims often require establishing a link between your injury and a work-related accident. Workers' compensation may deny your surgery if they believe that your injury is a pre-existing condition rather than a direct result of a workplace accident.

To build a strong claim, it's important to:

  • Report the injury to your supervisor right away.
  • Document the time, date, location, and nature of your workplace accident.
  • Keep records of medical visits and diagnoses.
  • Follow all doctor's recommendations and attend all appointments.
  • Ensure that your application is accurate and complete.
  • File your claim within one year (the sooner, the better).
  • Consult an experienced workers' compensation attorney to help you navigate the process and protect your rights.

How a workers' comp lawyer can help

It only takes one small error for your workers' compensation benefits to be denied. If you're suffering from a serious work-related injury, there's simply too much at stake to navigate the process on your own.

At Hochman & Plunkett Co., L.P.A., we understand the nuances of Ohio's workers' compensation system, and we're here to help injured workers like you. Our dedicated workers' compensation attorneys have a deep understanding of the laws and regulations governing these cases.

We can work tirelessly to ensure you receive the medical treatment you need, which may include surgery, and fight for the benefits you deserve.

Don't let a denial of surgery or other essential medical treatments stand in the way of your recovery. Contact us online and schedule a free consultation. With law offices in Dayton, Cincinnati, Springfield, Troy, and Columbus, we proudly serve injured workers across Ohio.

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