Archive for June, 2023

Jun 2023

What To Do When Workers’ Comp Denies Surgery

Paperwork of a denied compensation claim.

A lawyer can help you secure the treatment you need.

While some work injuries can be resolved with rest, ice, and over-the-counter pain medication, others may require more extensive medical intervention, including surgery.

Fortunately, workers’ compensation is designed to cover the costs of reasonable and necessary surgeries to treat work-related injuries. However, the not-so-great news is that obtaining approval from the workers’ compensation insurance company can be a challenging process to navigate on your own.

If your request for surgery to address a work injury has been denied, a workers’ compensation attorney can provide the support you need to fight back and protect your rights.

What types of surgery are covered under workers’ comp?

In Massachusetts and Rhode Island, workers’ compensation generally covers all reasonable and necessary surgeries for work-related injuries.

The following types of surgery are commonly covered:

  • Surgery to repair fractures or broken bones.
  • Skin grafts for burns sustained at work.
  • Spinal fusion procedures.
  • Carpal tunnel release surgery.
  • Knee or shoulder surgeries.
  • Eye surgeries.
  • Neck or back surgeries.
  • Brain surgeries.
  • Reconstructive surgeries.
  • Any other surgeries deemed reasonable and necessary for treating work-related injuries.

If surgery is covered by workers’ compensation, the insurance company is typically responsible for paying the entire cost, including pre-and post-operative care, anesthesia, medications, and medical devices. There should be no co-pays, deductibles, or out-of-pocket expenses for the injured worker.

Additionally, workers’ compensation should provide a percentage of lost income while the worker is recovering from the surgery or if they are assigned to a reduced-paying “light duty” role due to the procedure.

Common reasons why workers’ comp denies surgery

Unfortunately, even when your doctor deems surgery necessary for your work injury, the insurance company may deny approval, leading to a frustrating and challenging situation. They might dispute the surgery’s “reasonableness and necessity” and suggest alternative treatments. In some cases, they may insist on a second opinion from a doctor more aligned with their perspective. Alternatively, they may argue that the injury requiring surgery is unrelated to work, thus not covered by workers’ compensation.

It’s important to recognize that insurance companies have a financial motive to act in this manner. Surgery can be costly, and their primary objective is to protect their own financial interests. In such circumstances, it becomes crucial to seek the assistance of a workers’ compensation attorney who can navigate the complexities of the system and advocate on your behalf.

Remember, your well-being and recovery should be the top priority, and legal representation can help you pursue the treatment you need.

How a workers’ compensation attorney can help

At The Law Offices of Deborah G. Kohl, we understand that getting the medical treatment you deserve shouldn’t be a frustrating experience. That’s why we advocate for the rights of injured workers in Rhode Island and Massachusetts. We help our clients fully understand their rights and options so they can make informed decisions that protect their best interests.

If your surgery has been denied by workers’ comp, we can thoroughly review your case, gather evidence, and build a strong argument to challenge the denial. Through negotiations with the insurance company, we can advocate for the approval of the surgery, guide you in filing an appeal, represent you in hearings, and present compelling evidence to obtain the outcome your case deserves.

Don’t let a denied surgery claim from workers’ comp prevent you from receiving the medical treatment your doctor recommends. Take action today. Contact us now to schedule your free consultation.

Jun 2023

Watch Out for These Workers’ Comp Insurance Company Tactics

Massachusetts workers' compensation attorney

The right work injury attorney can protect your rights.

Both Massachusetts and Rhode Island have workers’ compensation systems designed to protect injured workers. In theory, this is simple: you’re hurt on the job, you file a claim, and your medical expenses are covered, as are a portion of your lost wages and other benefits if you have a permanent, disabling injury.

In practice, things are rarely that simple. The workers’ comp insurance company, like any other business, is concerned with their bottom line, and they know how to use the system to their advantage. That’s why you need the right workers’ compensation attorney on your side to protect your interests throughout the process.

Some of the insurance companies’ tactics include:

Delay tactics and slow communication

Workers’ comp insurance companies are notorious for taking their time to make a decision on claims. Sometimes, there are legitimate reasons for delays and processing, such as a need for further investigation. But often, they slow the process down as a deliberate tactic to put pressure on the injured worker and discourage them from pursuing their claim.

Fortunately, a workers’ compensation attorney who knows the system and the rules and regulations insurance companies must follow can fight back. We know how to keep your claim moving forward and protect your rights throughout the process.

Questioning the extent of your injuries and disputing medical treatment

Workers’ compensation is supposed to pay for the full cost of reasonable and necessary medical treatment for your work injury. This means the insurance company has a strong incentive to question whether treatment is “reasonable and necessary,” especially if you need surgery and other costly procedures.

They may dispute or deny treatment, require you to get a second opinion, or try to argue that your injuries were not work-related and thus not compensable.

The result of these tactics is lengthy delays and a highly frustrating situation when you’re just trying to heal and get back to work. As experienced workers’ compensation attorneys, we understand the rules and regulations surrounding medical treatment for work injuries, and we can push back on the insurance company’s attempts to downplay your injuries.

Asking for a recorded statement

An insurance adjuster or case manager may ask you to provide a recorded statement about your work injury, implying that it’s a necessary step to move your claim forward. Here’s what you need to know: any recording can be taken out of context and used against you. Plus, you only have one chance to get it right, and it’s easy to get tripped up.

If the insurance company asks you to give a recorded statement, it’s best to politely decline until you have a chance to discuss with your attorney. We can advise you on the best way to proceed and help you craft a statement that accurately tells your side of the story.

Talk to an experienced workers’ compensation attorney today

Remember, the workers’ compensation insurance companies have attorneys on their side. Their goal is to protect the insurance company’s bottom line. The only way to level the playing field is to hire a workers’ compensation lawyer who knows the system and will advocate for your interests from start to finish.

If you’ve been hurt on the job in Rhode Island or southeastern Massachusetts, you don’t have to deal with the insurance company on your own. Contact the Law Offices of Deborah G. Kohl for a free consultation.