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WORKERS COMP SURGERY – Baltimore Workers Comp lawyer

Workers Comp Surgery – Is a surgery being recommended in your Maryland workers compensation case?

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If your workers comp surgery has been DELAYED, DENIED, or if you are not getting a response from the adjuster  Call Us Click to emailor fill out the contact form below!

THIS WEBSITE IS THE PRODUCT OF A WORKERS COMPENSATION ATTORNEY AND IS NOT AFFILIATED WITH  ANY WORKERS COMPENSATION INSURER.  FURTHER IT IS NOT AFFILIATED WITH THE STATE OF MARYLANDNOR ANY GOVERNMENT ENTITY WITHIN THE STATE OF MARYLAND.  Information contained herein is provided for informational purposes and expresses opinions and information best known at the time it was written.  This information and does not create an attorney to client representation.

 

If you are about to undertake a workers comp surgery there are a number of important events that may take place before the surgery takes place.  The procedure must be authorized by the workers comp adjuster before the workers comp surgery can occur.  Before the authorization is provided the adjuster may want an Independent Medical Evaluation.  If the Independent Medical Evaluation comes back with a finding that the surgery is needed a hearing before the Workers Compensation Commission may be needed.  While waiting for a hearing date the injured workers health insurance may be willing to pay for the surgery.  As these complications arise the necessity for a Baltimore workers comp lawyer often become increasingly apparent to the injured worker.

 

Has the adjuster provided authorization for the workers comp surgery?

Attending a doctors appointment using health insurance is usually as simple as scheduling it and showing up to the appointment with their insurance card.  Attending a doctors appointment using workers comp insurance is a process many find frustrating because it is a new and different process involving the need for authorization from the workers comp adjuster before the appointment.  Many doctors offices want the patient to obtain this authorization before an appointment can be made.  This leaves the leg work up to the injured worker.  When attempting to undergo a workers comp surgery calling and asking for authorization from the workers comp adjuster is the first step in a potentially long process.  Adjusters will often want all the medical records from the treating doctor as well as complete diagnostic records before considering authorizing the surgery.    

After the medical records are received and reviewed the adjuster may decide to approve the workers comp surgery based on the doctors records.  Specifically the doctor would need to have included language about the work accident, a description of the medical findings, and language that speaks to the necessity of the operation. 

Assuming the medical records include the necessary information the workers comp adjuster may feel so inclined to approve the workers comp surgery.  How often are surgeries approved at this stage?  Not often at all.  The preliminary investigation is at this point done however in most cases they then want an opportunity for a second opinion regarding the need for surgery.    The second opinion, however, is usually done by a doctor of the adjusters choosing, one who is carefully selected based on their past opinions and their past medical conclusions.  The goal for the adjuster is to avoid authorizing the surgery!    

 

Does the adjuster want to have an Independent Medical Evaluation done before she will authorize the workers comp surgery?

Independent Medical Evaluations (IME’s) are obtained for numerous purposes in workers comp cases.  They can be requested for the purpose of avoiding the workers comp claim in its entirety, to avoid paying lost wages to the injured worker, to reduce the amount of the workers comp settlement, or provide the adjuster a reason to deny pending medical treatment or surgery.

When an IME is scheduled to address a pending workers comp surgery there is often a substantial waiting process involved that can be frustrating for the injured worker.  There are limited doctors who perform IME’s in the state of Maryland and many of them have a waiting list of 1-2 months before an appointment can take place.  Once the appointment takes place it can then take another 3 weeks or so to generate the medical report, and an additional week for the adjuster to respond with his or her ultimate decision about authorizing the workers comp surgery.  When an IME is scheduled this is the time an injured worker should consider hiring an attorney if the goal is to get the medical treatment as timely as possible.  Some delays can be streamlined by a competent Baltimore workers comp lawyer because they will be able to order and obtain medical records and file for a hearing while waiting on the IME appointment and report.  

 There are a number of outcomes that could potentially result from the performance of the IME:

Workers comp surgery denied–  The doctor may find that surgery is not needed.  The doctor may also find that surgery is needed but the cause for the surgery is something other than the accident such as arthritis, a prior accident, a prior medical condition, or a subsequent accident.

Workers Comp surgery approved– Less often is the case of the IME doctor indicated that surgery is reasonable, necessary, and causally related to the work place accident, however sometimes IME doctors do agree with the treating doctor.

Workers comp surgery denied and no further treatment is needed– Often the most shocking to injured workers is this result.  They are not only told that the surgery is denied but are also told that no further treatment will be approved.  This results when the IME doctor also indicates in the report that the need for any further treatment does not exist.  The result is an abrupt stop of the medical treatment including pain medication, physical therapy, diagnostics and any other medical treatment.

Workers comp denied surgery and the injured workers is able to work– The workers comp adjuster may ask the IME doctor to comment on the need for surgery but also the injured workers ability to work in the event the injured worker is being held out of work by their treating doctor.  The result- surgery could be denied and workers comp lost wages could also be stopped abruptly.

Learn more about IME’s- What to expect, Do’s and dont’s, who performs them, and more!

Has the workers comp surgery been denied because of the IME?

If the workers comp operation is denied by the insurance company then the only way to force them to pay for the surgery is by way of a hearing before the Maryland Workers Compensation Commission.

Once the hearing is requested by way of filing the “issues” form a hearing is scheduled anywhere from 3 to 6 months, ordinarily closer to 3 months.  To file for a hearing a claim must have been previously filed with the Maryland Workers Compensation Commission, otherwise an addition 1-2 month wait may take place.  Again, a claim must be filed, not only with the workers comp insurance company, but also with the Maryland Workers Compensation Commission.

The wait for the workers comp hearing can be more frustrating than the denial of the surgery.  To alleviate any further frustration and the potential postponement of the hearing, the injured worker must be fully prepared by the  hearing date.  Workers comp hearings are legal proceedings which require the injured worker provide evidence to be successful.  Attending and arguing that the surgery is needed is not likely going to result in the preferred result- workers comp surgery approval.  

Complete medical records should be obtained and copied for the Commission and the defense.  In addition to medical records, an exhibit packet should be created which include relevant medical records as well as any correspondence or evidence that is legally relevant to the needed for surgery.

Most importantly the treating doctor who is recommending the surgery must indicate in his reports that the surgery is needed, is reasonable, and related to the date of the accident.  This is the very basic language needed to be successful and workers comp hearings are often lost despite this information being provided.  In addition to the doctors language there should be positive diagnostic findings that support the need for surgery.  An MRI report indicating tears in the right knee ACL are helpful but only if the surgery that is to be performed is to repair the ACL and not some other portion of the rigth knee!  

Has the injured worker contacted their health insurance to attempt to get the surgery paid?

Even tho the workers comp surgery is a result of a work place accident many health insurance providers will pay for the operation as long as some preliminary steps are taken by the injured worker.  A letter from the workers comp insurance adjuster denying the surgery will often lead to the health insurer paying for the surgery.  A conversation between the injured workers Baltimore workers comp lawyer and the health insurance representative may also prove fruitful.  An attorney can provided some insight on the workers comp process that the representative may not have.

 

If your workers comp surgery has been DELAYED, DENIED, or if you are not getting a response from the adjuster  Call Us,   Click to emailor fill out the contact form below!

 

Mr. Rodabaugh exemplifies the best in our profession.  he is a caring, dedicated, highly regarded, and widely respected attorney.  With Andrew as your advocate you are in excellent hands.  I endorse this lawyer.
Jeff GPersonal Injury Attorney

 

 

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Workers Comp Surgery -
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Workers Comp Surgery -
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Authorization for workers comp surgery is not always easily obtained. Before the workers comp surgery an IME and a hearing may take place. To get timely authorization for the workers comp surgery a Baltimore workers comp lawyer is necessary!
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Work Injury Maryland
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