When a work-related injury happens that requires surgery, you expect workers’ compensation to provide financial relief.
Minnesota statutes state that employers must provide surgical treatment if reasonably required to relieve or cure the injury’s effect. Unfortunately, that provides no guarantee of your claim approval. Claim denials happen for three main reasons.
1. Unrelated or exaggerated injury
Claim disputes often occur because of the injury itself. The insurance carrier may consider the injury unrelated to work. Even if it occurred at work, the insurer may consider the surgery unrelated to the work injury. The severity of the injury also factors in. Your need for surgery must prove that it will resolve your condition.
2. Unauthorized provider
Insurers typically have a list of preferred doctors. Surgery recommended by an unauthorized provider may result in claim denial. Insurers may also request you seek an independent medical exam by a preferred provider to determine the necessity of surgery.
3. Missed deadline
The biggest mistake you can make remains not reporting the industry. Minnesota has deadlines for reporting a work injury. You have 180 days from the date of the injury to report it. Your employer has the right to deny your claim if you delay reporting it. Reasons for not reporting run the gamut from being unsure of its cause or considering it not that severe. Report any injury you believe happened at or because of work.
Having your claim denied does not mean the end of the story. Learning more about the appeals process and seeking legal may result in a better outcome.