If you suffer an injury at work, you may have questions as to what types of medical treatment would be covered under your claim. While the employer’s insurance company is required to pay for relevant medical care, that doesn’t mean you have carte blanche to seek expensive treatments or unnecessary surgeries.
You don’t want to be surprised by medical bills when the insurance company refuses to pay for services you received, so how can you be sure that your surgical operation to fix a problem caused by a work injury will be covered? Below, we explain how to make sure your surgical care is covered by workers’ compensation for your Minnesota injury case.
Work Comp Surgery Coverage
Under Minnesota Statute 176.135, subd. 1a, your employer and/or their insurance company are required to offset the cost associated with any surgical treatment you receive after a work injury that is “reasonably required” to cure, fix or address the effects of the occupational injury. In other words, if your doctor says that surgery is the only way to fix your injuries or it is a medical emergency, you will not have to pay for the services you receive.
More commonly, surgery is just one of many options for the injured party, which means the treatment is considered non-emergency. However, just because it is considered a non-emergency surgery, doesn’t mean the operation won’t be covered. If it still meets the threshold of “reasonably required,” the insurance company will have to pay for the services. There just may be a few more steps before you receive the green light to have the surgery performed.
For example, let’s say you suffered a herniated disc as a result of your work duties. Your doctor may recommend physical therapy or surgery as treatment options. You may decide to have the operation performed, and the doctor may agree, but the insurance company may decide that since other options are available, that they’ll request you seek a second medical opinion. Although the employee is not technically required to get this second evaluation, you’re going to have a tougher time getting compensation because the insurance company will almost assuredly contest the reasonableness of the operation if you don’t go get a second opinion.
The good news is that getting a second opinion usually works out just fine for the injured party. You can choose what doctor provides the second opinion, so don’t go to one that is hand picked by your employer, as they may be less likely to give a neutral opinion. Instead, consult with your lawyer about which doctor or care facility you should schedule your second opinion with. Let that doctor know that you are seeking a second opinion for your work injury.
Regardless of whether the employee is seeking a second opinion about the necessity of surgery, or the employer is requesting that the employee seek a second opinion, the employer will be the one footing the bill for this second evaluation, so don’t worry about getting dinged for more medical bills. Your employer’s insurance company will be picking up this tab.
If the second opinion finds that surgery is reasonable recourse for your injuries, the insurance company will be required to pay for the operation and associated costs. As we mentioned above, you can refuse to get a second opinion even if your employer requests that you get one, but this allows the insurance company to deny payment of the surgery if the employer can provide medical information to dispute the reasonableness of the proposed treatment. Don’t roll the dice and assume a workers’ compensation judge will side with you. Talk to your lawyer, get a second opinion if they suggest it and ensure that your surgery is covered by the insurance company before you go under the knife for non-emergency surgeries.
If you want help ensuring your surgery after a work injury is covered by your employer, reach out to Hey Workers today.