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As I wrote about in series 1 and 2 (two) there are a number of issues that may come up in the Maryland workers comp process that may leave the injured worker confused. It may be that it has taken quite some time to get an initial medical evaluation, or even obtaining authorization for a particular treatment such as physical therapy or cortisone injections. There may also come a time, after the initial medical evaluation and follow up treatment is performed, that medical treatment comes to an abrupt halt.
Worker’ Comp approved my therapy and diagnostic test but then denied my surgery?
Perhaps this is the most shocking denial and often leaves the injured worker perplexed that everything was going smooth and then their treatment came to an abrupt halt. Injured workers in Maryland often hear horror stories about dealing with workers comp. They then dismiss these stories as the exception because their case is moving smooth. Initial medical eval, physical therapy, medications were all approved and obtained with no problem. Then the case progresses to a surgery recommendation and the denial comes! While there is no clear explanation as to why surgery gets denied so often it can be assumed that the workers comp insurer wants to save money. Those injured in Maryland should not lose hope because they have other options in getting the surgery authorized.
Why the denial?
Once a surgery is performed to any given body part the Maryland workman’s comp insurers’ exposure increases dramatically. An accident that lead to only some physical therapy and a brief course of NSAIDs is not likely to cost the insurer much in the long run, however an operable condition is a serious condition and can not be easily dismissed as a minor injury in the future. This means that Workers comp in Maryland is exposed to treatment expenses in the future. Perhaps annual physical therapy, further surgery, more medication, and possibly years of treatment.
The minor injury that consisted of only a course of physical therapy and some medication will likely result in a low permanency award and perhaps close out the chances of the injured Maryland worker from reopening his case for further permanency. With a surgery case the injured worker is likely to reopen for not only treatment but also more permanency compensation. This could feasibly go on for years.
Maryland workman’s comp adjuster may schedule an IME in an attempt to avoid paying for surgery
If surgery is denied it is likely because the adjuster wants to get an independent medical evaluation (IME) performed. If the IME doctor indicates the need for surgery is not related to the accident the surgery will not be authorized without going to a hearing before the Maryland Workers’ Compensation Commission. For the injured worker to prevail at a hearing a qualified Maryland workers compensation attorney will be needed.