Had surgery 3 years ago, now having problems, is WC still responsible?
by Jenna (Gray, Maine)
Three years ago I had an Umbilical Hernia Repair Surgery that was covered through Workers' Comp. They repaired the hernia with a mesh cover to hold the it back. I was told that it takes time for the mesh to embed and stay in place, and that scar tissue may also make it a bit uncomfortable for some time too.
But these last 4-5 months I've been having more consistent episodes of pain, soreness, and severe tenderness in the area. This is after being pain free for over a year. I'm still at the same employer and just curious if Workers' Comp is still responsible for medical coverage, or if I should just go to my own doctor? How long is WC responsible for an injury, and what do they HAVE to cover? Thank you.
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ANSWER for "Had surgery 3 years ago, now having problems, is WC still responsible?":
Jenna (Gray, Maine):
You shouldn't have any problems having workers' compensation pay for any reasonable medical care required to treat lingering effects of an on-the-job injury.
Workers' comp exists primarily to pay for any and all reasonable medical and therapeutic expenses directly related to a worker’s on-the-job injuries. In your case it appears your recent pain and discomfort is directly related to your previous Umbilical Hernia Repair Surgery. Even though the insurance company may have “closed” your file, you should be entitled to seek medical care for your recent pain and discomfort.
Notify your employer and explain your predicament. Ask that he or she refer you back to the insurance company so they might approve your seeking a medical consultation. They really shouldn't have a problem with that. If they do, you can always seek a consultation from your own doctor.
If your doctor determines your pain and discomfort is directly related to your previous Umbilical Hernia Repair Surgery, then the insurance company will have a hard time denying coverage.
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