Hurt on the job in Lexington, Mauldin, or elsewhere in the surrounding area in South Carolina? If your injury is especially serious, you may need surgery. Any operation should be covered by workers’ compensation insurance. This raises an important question: What to do if workers’ comp denies your surgery? The answer depends on your specific situation. With that being said, you have the right to appeal an unfair denial of medical services. Here, our Lexington workers’ compensation attorney provides a guide to the steps to take if your surgery is denied.
Work Accidents Happen in Lexington, and Victims Need the Proper Medical Care
Workplace accidents are an unfortunate reality in South Carolina. Even in jobs that seem relatively safe, injuries can occur without warning. There are approximately 30,000 work-related injuries reported to authorities each year in South Carolina (Bureau of Labor Statistics). When an injury is severe, timely and effective medical care can make a major difference in your recovery. For some workers, surgery is more than just an option; it is the only viable path to restore function and return to daily life. If your injury requires an operation, you deserve prompt access to the required care.
Workers’ Comp Covers All Reasonable and Necessary Medical Care
In South Carolina, workers’ compensation insurance exists to cover all reasonable and necessary medical care. You have the right to seek full coverage for any treatment deemed reasonable and necessary by an authorized treating physician, including hospital stays, medications, rehabilitation, follow-up care, and, importantly, surgeries.
The key is whether the procedure is medically justified for your work-related condition. If your authorized doctor recommends surgery as the best course of action, the insurance carrier should approve and pay for it. Unfortunately, disputes arise when the insurer questions whether the surgery is truly necessary, whether it relates directly to the workplace injury, or whether a less costly alternative would suffice.
Steps to Take After a Workers’ Compensation Surgery Denial
Are you having trouble getting a surgery covered by workers’ compensation insurance in South Carolina? You should take action to protect your rights and your interests. You can challenge a denial of benefits. Here are the steps to take to challenge a workers’ comp surgery denial:
- Carefully Review the Denial Letter: You should start by reading the insurer’s written explanation for the denial. The letter should detail the reasons they believe the surgery is not covered. Understanding their stated rationale helps you and your lawyer address the specific points in dispute. A clear grasp of the insurer’s objections allows you to prepare a focused, evidence-based response to the workers’ comp denial.
- Get Organized (Save Records): Evidence is key to a successful workers’ comp claim, including in a denial of surgery case. Your medical file will be central to your appeal. Among other things, this may include diagnostic imaging, physician notes, surgical recommendations, and any prior treatment history. Keeping your records in order ensures that no crucial piece of evidence is overlooked during the appeals process.
- Seek Professional Representation: A top Lexington workers’ comp lawyer can assess your case, identify weaknesses in the insurer’s reasoning, and take steps to challenge the denial. They can also coordinate with your doctors to obtain supporting medical opinions that back up the claim that you actually need surgery. An attorney’s expertise can mean the difference between a prolonged delay and a swift approval of your procedure.
- File a Formal Appeal with the South Carolina Workers’ Compensation Commission: If the insurance carrier will not reverse its decision voluntarily (which does happen in some cases), you can request a hearing before the South Carolina Workers’ Compensation Commission. A lawyer can help you with an appeal for medical care. An appeal is a formal process that allows you to have your case evaluated by an impartial decision maker who can overrule the insurer’s denial. Be proactive.
You May Be Able to Get a Workers’ Comp Settlement in Lexington After Surgery
In some cases, approval for surgery can lead to negotiations for a settlement of your workers’ compensation claim. If your operation successfully treats your injury but leaves you with some level of permanent impairment, you may be entitled to additional benefits. In South Carolina, a workers’ comp settlement can provide a lump-sum payment that compensates you for future lost wages, ongoing medical needs, and other covered losses. How much could your case be settled for? The answer depends on many different factors. The value of such a settlement depends on factors like the severity of your injury, your ability to return to work, and your long-term prognosis.
Workers’ Comp Tip: You should never accept a settlement without first understanding the full implications of signing the agreement. A top-rated Lexington, SC workers’ comp lawyer will help you ensure that a settlement is truly in your best interests.
Why Trust Our Lexington Workers’ Comp Lawyers for a Denial of Medical Services
The denial of coverage for a surgery that you need after a work-related accident is deeply frustrating. It is normal to feel stressed out and overwhelmed. You do not have to go it alone. A top-rated Lexington, SC workers’ comp lawyer can help. At Smith & Jones Law, LLC, we have the case results that you can count on. Our team is ready to help you challenge a denial of necessary medical benefits. We offer free, no obligation, and completely confidential initial consultations.
Schedule Your Free Consultation With Our South Carolina Work Injury Attorneys Today
At Smith & Jones Law, LLC, our South Carolina workers’ comp lawyer is standing by, ready to protect your rights and your interests. If workers’ comp has denied your surgery, we can help. You have the right to challenge a denial of a reasonable and necessary surgery. If you have any questions or concerns, please do not hesitate to contact us today for a free, no-obligation consultation.