Visitor Question

Fell off a ladder and now workers’ comp is denying my hip surgery?

Submitted By: Morgan (San Mateo, California)

I feel off of a ladder 2 years ago (8/2012) at work and tore the Labrum cartilage and fractured the bone in my hip. After seeing 4 different orthopedic surgeons, all who requested hip surgery, Workers’ Comp refuses to approve my only option of treatment – hip surgery.

My question is, if Workers’ Comp is supposed to treat the injured worker, why do they continue to deny my treatment? What can I do to get them to pay for my hip surgery? Thank you.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Morgan,

It’s truly unfortunate workers’ compensation denied your surgery, especially in the face of repeated medical opinions suggesting hip surgery.

The reasons why your claims adjuster has consistently denied coverage for your hip surgery are difficult to comprehend. While adjusters are well-schooled in medical terminology, they aren’t physicians. In most cases, claims adjusters must rely on physicians’ opinions when deciding whether or not to authorize medical procedures. They don’t have much else to base their decisions on.

At this point your options are limited. We assume the workers’ compensation claims adjuster is in possession of all four doctors’ medical narratives indicating surgery is your only option.

Your options are:

1) Continue to argue with the adjuster in an effort to persuade her to authorize surgery

2) Ask the claims adjuster to refer you to yet another physician

3) Ask for an administrative hearing so you can argue your position

4) Contact a workers’ compensation attorney and place your claim in their hands

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published: July 8, 2014

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