Workers Comp Surgery

Workers Comp Surgery

A doctor may recommend workers comp surgery if injuries are severe. A surgery may improve the worker’s medical condition. However, It will also lead to lost time from work. When thinking about workers comp surgery, the worker should first look at cost of living. Cost of living includes the needs of dependents. Dependents include a spouse, parents, or children.  Cost of living also includes expenses like rent or mortgage. The injured worker should consider if other income is available such as Social Security Disability or other benefits. 

Surgery is a medical question that is best left for discussion with a doctor. This is especially true for shoulder injuries. But the injured worker should also consult with an attorney to discuss how surgery will affect the case. An attorney can advise the worker on what income after surgery will look like.

Authorization of Workers Comp Surgery

The carrier will only pay for an authorized surgery  This includes payment of post-surgery treatment. It also includes payment of lost wage benefits. Most surgeries require written approval by the carrier. The Workers’ Compensation Medical Treatment Guidelines list which surgeries need approval. Usually, the surgeon must file a request for surgery with the carrier. From there, the carrier will either approve or deny the surgery.

The injured worker is entitled to weekly payments when out of work due to surgery. The worker should receive the maximum rate of pay. The worker is considered temporarily totally disabled after surgery. At some point, the insurance carrier will have the worker examined. The carrier will argue against the worker’s disability status in order to cut benefits. Disability status affects the rate of weekly pay.

Already Out of Work?

Oftentimes, an injured worker is already out of work prior to having workers comp surgery. If so, the carrier must increase weekly pay to the maximum rate.  This rate will begin on the date of surgery forward. The carrier will schedule the worker for an exam with its own doctor. This exam typically happens about three months from surgery. The carrier’s doctor will evaluate the worker’s disability and treatment needs.  If the carrier’s doctor feels the injured worker is able to work, the carrier will file to cut benefits. It will seek to reduce the rate of weekly pay.

How to Maximize Benefits After Surgery

There are steps an injured worker can take to maximize benefits after workers comp surgery. For one, the injured worker should notify the insurance carrier of the surgery date. The worker should also forward the carrier a copy of the operative report after surgery.  But more importantly, the injured worker should file for a hearing with the Workers’ Compensation Board. This hearing will address the rate of pay. The judge should make the carrier continue payments at the total disability rate. This hearing is needed to protect the injured worker from the carrier cutting payments without another hearing. Many injured workers are not aware of this protection. Without it, the insurance carrier can reduce rate of pay without a hearing as soon as its doctor feels the worker can return to light duty.

If you are an injured worker considering workers comp surgery, contact the Platta Law Firm to discuss the process for maximizing your benefits.

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