Surgery Approval After Work Injuries - How To Avoid Delays

If you suffer a major injury at work and are rushed to the hospital for an emergency procedure, you won’t have time to worry about getting insurance approval for the procedure. Emergency operations are clearly medically necessary, and if the necessity for this procedure was due to a work-related accident, then you can take solace in knowing that your surgery will be covered as long as you submit your claim correctly.

But what if the surgery isn’t emergent in nature? If you’re hoping to receive approval from your employer’s workers’ compensation provider to move forward with an elective procedure, you can expect to receive some pushback from the insurance company. They’ll make you follow every necessary step in order to gain approval, and even then it can take weeks or even months before you get the go ahead from insurance. However, there are some things you can do to speed up this process and avoid unnecessary delays if you’re hoping to receive clearance from insurance to move forward with an elective operation after a work injury. In today’s blog, we spotlight some ways you can work to limit delays when waiting for surgical approval after a work injury.

Avoiding Delays To Work-Related Elective Surgery

Minnesota law requires a workers’ compensation provider to cover surgeries that are considered “reasonably necessary to manage or cure a job-related injury or condition.” So the most important thing you’ll need to do is ensure that you get a medical report that confirms your surgery is medically necessary. You’ll want to seek out an independent medical exam and get it in writing that your treating provider is recommending surgery as medically necessary.

However, this alone doesn’t guarantee that your surgery will absolutely be covered by insurance. They may request a second opinion or need more information from you before surgery is approved, so don’t schedule your surgery just yet. Once you’ve visited a doctor and been told that surgery is medically necessary, here’s what you’ll want to do to ensure the approval process remains on track:

Before you leave your appointment, ask for a copy of the surgical referral. Whether it comes in e-mail form or you receive a paper copy, make sure you have a copy in your possession before you leave the care center.

Follow up with your doctor’s office after a day or two to ensure all medical records and forms have been submitted to the insurer.

Hire a lawyer to ensure all forms are filled out correctly and any additional paperwork is submitted in a timely manner. This will also ensure that nothing is missed.

Have your attorney reach out to your claims adjuster to ensure they have all the information they need to make a decision on the matter. You can reach out on your own, but oftentimes it’s easier if your experienced attorney reaches out and applies any necessary pressure.

Approval delays can lead to a worsening of your condition and delay your return to work, so don’t stand for it. It’s impossible to get the insurance company to move at the speed you’d like, but if you follow the above tips and sync up with an experienced injury lawyer, you can greatly reduce the likelihood of unwanted delays.

For more information, or for help with a different injury claim issue, reach out to Dean and the team at Margolis Law Firm today at (952) 230-2700.