Denying coverage for a hernia surgery?
I had a hernia repaired in January 2013. In May 2013 I injured the same hernia again while working. My employer said I needed to get a work release to keep working, so I went to the doctor that did my surgery. He said he thought I had hurt myself again, but could not be certain with out a CT scan. I told him I did not want to pay for one, and he said I could return to work and that things would not get worse.
After being laid off in September, I wanted to have the hernia repaired. After three months of dragging out the claim, the workers' comp carrier agreed to do a CT scan. In December, I finally had the CT scan. The doctor that did the original surgery said I have a hernia, and the workers' comp medical adviser says I do not have a hernia.
I need to have my hernia repaired. I am going to be out of unemployment it two weeks, and have no other source of income. So what do I do? If I file an appeal I am sure the workers' comp carrier will drag this out for months. How can I get them to approve this surgery? Is there any way to speed up the appeal process? Any info you can give would be much appreciated. Thanks.
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ANSWER for "Denying coverage for a hernia surgery?":
While we can understand your frustration, you must not wait until your workers' compensation matter is remedied before seeking medical care. The good news is, as long as you filed your claim prior to your being laid off, you will have the same rights to workers' comp benefits as if you were still employed.
Your only recourse at this time is to retain a workers' compensation attorney. He or she may be able to influence the workers' compensation board to authorize your surgery, and do so immediately. Workers' comp boards do not like to have attorneys involved in the process. They know an attorney will make the claim more confrontational, and may include administrative hearings, depositions, and other pre-hearing discovery.
Fortunately, most workers' comp attorneys do not charge for initial office consultations. Speak with several in your area and bring along along your documentation to your meetings. You may be pleasantly surprised at the impact an attorney can have.
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.
Best of luck,
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