Workers' Comp Won't Approve Surgery—Now What?

Medical team in the operating room.

While many workplace injuries only require rest and physical therapy, some require surgery to make a full recovery. These injuries are often severe and involve a lengthy recovery process. In the meantime, you'll likely be out of work. The lost wages and accumulating medical expenses can be financially devastating. Luckily, workers' comp in Mississippi pays for that if you sustain an injury on the job.

However, getting the workers' comp benefits you deserve isn't always as easy as it should be. Navigating workers' compensation claims, especially those that involve severe injuries requiring surgery and extended recovery periods, can be challenging. The financial burden of lost wages and mounting medical bills can add significant stress during this time. That's where an experienced workers' comp lawyer can make a meaningful difference in the outcome of your case.

Common workplace injuries that require surgery

The most common workplace injuries that require surgery include:

Bone fractures: Fractured bones from work-related slips, trips, or falls can require surgery to realign and stabilize the affected limb.
Rotator cuff injuries: Repetitive strain or lifting often causes rotator cuff tears in the shoulder. These injuries often require surgery to repair the torn tendons and ligaments.
Spinal injuries: Spinal injuries resulting from heavy lifting or falls often require surgery to fix herniated discs or fractures.
Burn injuries: Chemical or heat-related burns often require surgeries for skin grafts and tissue repair.
Crushing injuries: Crush injuries to the feet or legs result in damaged tissue and bones. This often necessitates surgery to reconstruct the affected areas.
Hand injuries: Severe hand injuries are often caused by machinery accidents. These injuries often require surgery to repair tendons, nerves, or bones.
Traumatic brain injuries (TBIs): TBIs in workplace accidents often lead to brain swelling and damaged brain tissue. This often requires surgery to prevent long-term brain damage and other complications.
Eye injuries: Contact with foreign objects and chemicals often cause severe eye injuries. These injuries often require surgery to preserve vision.

What kind of surgery is covered by workers' comp?

Workers' comp in Mississippi covers a wide range of surgeries, including but not limited to:

Spinal surgery: Discectomy or spinal fusion surgeries help alleviate pain and restore stability in the spine.
Hand surgery: Tendon repair, nerve decompression, or fracture fixation helps restore function in the hands.
Neurosurgery: Craniotomy or intracranial pressure monitoring are common surgeries to manage brain damage and swelling from TBIs.
Orthopedic surgery: Open reduction and internal fixation help realign and stabilize broken bones.
Shoulder surgery: Arthroscopic and open shoulder surgery help repair rotator cuff tears.
Ophthalmic surgery: Ophthalmic surgeries such as corneal transplantation or retinal repair help repair eye injuries and preserve vision.
Skin grafting: Autografts or allografts help with skin replacement and wound closure.

Reasons why workers' comp denies surgeries

There are many reasons why workers' comp may decline your surgery. For example, workers' comp might reject your surgery if they believe it to be unnecessary or if they think an alternative treatment is sufficient. They may also reject it if they believe that your injury is linked to a pre-existing medical condition rather than a workplace incident.

Other common reasons include:

Delayed reporting: Your surgery may get denied if you fail to report the injury promptly. This can raise doubts about the legitimacy of your claim.
Inaccurate or incomplete application: If your workers' comp application is missing information or has inaccurate details, your claim will likely be denied.
Disputes over injury causation: There could be a dispute over whether the injury was truly work-related or resulted from a personal activity. This may require an investigation to prove.
Failure to follow medical advice: If you don't follow your doctor's recommendations, workers' comp may deny your surgery claim.
Missed filing deadline: Failing to adhere to deadlines for filing a workers' comp claim for surgery can result in rejection, as timeliness is crucial in the claims process.
Lack of authorization: You have two years to file a workers' comp claim in Mississippi. However, the sooner you file, the stronger your claim will likely be. Failure to file in time can result in your benefits getting denied.

Do I need an attorney to file a workers' comp claim?

Workers' comp claims in Mississippi can be confusing. If you make any errors during the filing process, it can hurt your chances of getting compensation. That's why you need an experienced attorney on your side who can walk you through the process and advocate for you every step of the way.

The Mississippi workers' comp attorneys at Tabor Law Firm, P.A. can handle the complex paperwork for you and help build a strong claim on your behalf. If you've been hurt on the job, contact us for a free consultation. We'll be glad to answer any questions you have.