You received an injury at work. The good news is that, in South Carolina, workers’ compensation will cover your lost wages, medical costs, etc. But what if surgery is needed because of the injury? One would think that there wouldn’t be a problem because it falls under medical expenses. Unfortunately, your employer’s insurance company may try to refuse to pay for the surgery you need.
Battles with insurance companies aren’t pleasant or easy. If you’re injured on the job, your best bet is to inquire with an experienced attorney as to your rights and representation. Even if all goes smoothly, it won’t hurt to talk to an attorney when you’re injured. Many law offices offer the first consultation free of charge.
So, let’s say that your employer’s insurance company does initially deny coverage of the surgery you need in order to recover from your work-related injury. We’re going to make a closer examination of this scenario.
Before you get any treatment for your work-related injury, the workers’ comp insurer must approve any and all procedures in a workers’ compensation process. Additionally, the surgery cannot be the result of a pre-existing condition but must be related to the injury received at work.
You may well have to cover your surgery out-of-pocket if the employer, their insurance company, or the South Carolina Worker’s Compensation Commission does not agree with the medical procedures said to be required.
It is not unheard of for a physician and an employer’s insurance company to disagree on the need for a treatment such as surgery. If the procedure is particularly expensive, there are a variety of other options available, or is experimental/newer, the insurance company may deny coverage for the treatment.
If you need to fight the insurer or the commission because you were denied coverage, the following may apply:
If you can’t wait to have the surgery and it is absolutely necessary, rather than wait for workers’ compensation, you may want to have your health insurance cover the costs (you’ll likely have to cover out-of-pocket costs initially). Your number one priority is your health. So, if surgery is a must-have treatment, that outweighs everything else.
The most important thing to do if your workers’ compensation claim even seems like it’s going to get derailed is to immediately acquire the services of an experienced, reputable attorney. This cannot be stressed enough!
The representatives of Cardinal Law Partners have years of experience with workers’ compensation cases. We have successfully settled claims for our clients, acquired the financial restitution they deserved, and assured that all their rights were not only represented, but vigorously fought for. Contact us today for a free consultation.