What to Do When Workers’ Compensation Denies Your Surgery

Upset patient at doctor with folder and files about the patient due to being denied WC

In North Carolina, most employers must carry workers’ compensation insurance to protect employees injured on the job. If you are a covered employee and get hurt at work, workers’ compensation insurance should pay for all your necessary medical care and provide certain other benefits. But what happens when the insurer won’t approve a surgery you need?

If it has happened to you, you can appeal the insurer’s decision. The dedicated attorneys at the law firm of Poisson, Poisson & Bower, PLLC, have over 40 years of experience guiding clients through the tricky appeals process. Contact us today for a free consultation about your unique case.

Can Workers’ Compensation Deny Treatment in NC?

In some cases, the workers’ compensation insurance company may be able to deny surgery or other types of treatments for workplace injuries. Assuming their argument is true, the following could be valid reasons for denying surgery:

  • The surgery is not medically necessary to treat the workplace injury.
  • The surgery is actually intended to treat a pre-existing condition or an injury that is not related to work.
  • The surgery is needed only because you failed to follow valid medical advice that would have made the operation unnecessary. 

However, just because a workers’ compensation insurance company makes these sorts of claims does not mean they are accurate in your case. You can appeal the insurance company’s denial of treatment like surgery with assistance from an experienced workers’ compensation attorney at the law firm of Poisson, Poisson & Bower, PLLC.

Keep in mind that workers’ compensation insurance companies are in the business of making money. If they can deny a claim for costly medical procedures, they can keep more money for their profits. They aim to minimize what they have to pay out on any claim. You need an attorney who will fight for your right to receive the medically necessary treatments you need for your workplace injuries. 

Steps to Take if Workers’ Compensation Denied Your Surgery

Once you are informed that the workers’ compensation insurer denied surgery, your first and most crucial step is to call an experienced attorney who can advocate for you throughout the complicated appeals process. 

You only have a limited window to file a notice of intent to appeal with the North Carolina Industrial Commission. Once you have filed notice, you will have the opportunity to pursue your claim in mediation, and subsequently at a hearing with an administrative law judge. If that doesn’t produce a favorable result, you could potentially appeal all the way up to the North Carolina Court of Appeals and Supreme Court.

How Our Lawyers Can Fight a Denied Surgery Claim

A qualified attorney is best at knowing what to do if a workers’ compensation insurer denies your surgery claim. The caring and knowledgeable attorneys at Poisson, Poisson & Bower, PLLC can:

  • File your paperwork within the short timeframe allowed by the law.
  • Communicate with your employer, the insurance company, your doctor, and any experts or other parties on your behalf to properly collect evidence to support your claim.
  • Offer professional advice on your options. 
  • Negotiate with insurers.
  • Fight for your interests at Industrial Commission hearings and in court, if necessary.

Contact Our NC Workers’ Compensation Lawyers for Help

Don’t let the insurance company get the final word on whether you can receive medically necessary surgical procedures to treat your workplace injury. Contact Poisson, Poisson & Bower, PLLC, today for a free consultation about your best legal options.

Stewart Poisson focuses her practice on litigation. Stewart opened the Wilmington office of Poisson, Poisson & Bower, PLLC in 2006. She assists clients in both of the firm’s offices in the fields of Workers’ Compensation and Personal Injury and handles all appellate work for the firm. She particularly enjoys helping clients who have been injured in workplace accidents caused by the negligence of a third party. She represents clients in the both the personal injury claim and the workers’ compensation claim and is skilled at maximizing her clients’ recovery in these complicated cases.