How Long Does It Take Workers' Comp To Approve Surgery?
Getting hurt at work can be a stressful experience, especially if you need surgery. One common question workers have is, "How long does it take for workers' compensation to approve surgery?" A workers' compensation insurer is generally required to approve or deny surgery within 7 business days. There are some exceptions which are fully explained below.
Understanding the workers' compensation process in Minnesota can help ease some of this stress. Workers' compensation is a type of insurance that provides benefits to employees who get injured on the job. These benefits include covering medical bills, lost wages, and other related expenses.
When your doctor says you need surgery because of a work injury, getting approval from your workers' compensation insurance can take time. There are specific rules and steps that both the treating physician and the insurance company need to follow. Knowing what to expect can help you prepare and get the necessary treatment without unnecessary delays.
Minnesota Workers' Compensation Laws
In Minnesota, workers’ compensation claims cover lost wages, medical benefits, rehabilitation benefits, and permanency. This means that if you get hurt at work, you can receive money to replace the wages you miss out on while recovering, and your medical bills related to the injury will be paid. The insurance also covers programs to help you get back to work, known as rehabilitation benefits. If your injury is permanent, you can receive additional permanent partial disability compensation for that.
Minnesota workers' compensation laws are designed to protect both employees and employers. Under these laws, employees get help quickly without needing to sue their employer and employers are protected from lawsuits because the insurance takes care of the costs.
To make a claim, you need to report your injury or illness to your employer as soon as possible. Then, your employer will file a report with the insurance company, which will start the workers’ compensation process. If the treatment relates to an old admitted work-related injury, it may be necessary for the insurance company to reopen the claim.
Minnesota Workers' Compensation Medical Treatment Guidelines
Workers' compensation insurers are required to cover medical treatment that is reasonable and necessary to cure and relieve the effects of a work-related injury. This includes doctor visits, hospital stays, physical therapy, medications, and even surgery. There is no deductible or copay. The treatment must be related to the injury you sustained while working.
Minnesota has specific guidelines to make sure the medical care you receive is appropriate and effective. These guidelines help doctors and insurers determine what treatments are covered and how long they should last. For example, there are rules about how many physical therapy sessions you can have and what kinds of surgery might be needed for different injuries.
To get approval for certain treatments, your treating physician might need to provide information about why the treatment is necessary. The insurance company reviews this information to decide if they will pay for it.
If there's a disagreement about the treatment, you can appeal the insurance company's decision. Understanding these guidelines helps ensure you get the right health care for your injury and can return to work as soon as possible.
MN Workers’ Compensation Rules For Prior Approval of Surgery
Unless it is an emergency surgery, the treating physician has to give the work comp insurer prior notification before completing a surgery. The insurance company reviews this information to decide if they will pay for it. The insurance company has to respond within 7 business days. There are 5 ways that the insurance company can potentially respond:
1) Approve the surgery.
2) Deny the surgery.
If the insurance company denies the surgery, you have the right to dispute the denial. Injured workers can generally submit the surgery to health insurance while the denial is being disputed.
3) Request additional information.
If the insurance company reasonably requests more information from the treating physician, then they are allowed another 7 days after that information is provided.
4) Request a second opinion.
The insurance company can request that you get a second opinion from a different doctor about the surgical recommendation. If they request that, then they are allowed another 7 days after they receive the second opinion.
5) Request an adverse medical examination.
Insurance companies often call them "independent" medical examinations. In any event, the insurance company can pick a doctor and pay that doctor to examine the employee. That doctor will then provide an opinion to the insurer about whether the surgical recommendation is reasonable, necessary, and caused by the work-related injury. If the insurance company requests an adverse medical examination, then they are allowed 45 days from the date of the request to approve or deny the surgery.
According to Minnesota law, if the insurance company tells the worker and their doctor about this examination within seven working days after being notified about the surgery, the surgery has to be put on hold until the examination is done. However, if 45 days pass after the insurance company asks for this examination and the surgery still hasn't happened, the worker's doctor can decide to go ahead with the surgery.
Whether the insurance will cover the surgery depends on a decision made by the Minnesota Department of Labor and Industry or a judge.
Does Surgery Increase the Workers' Comp Settlement?
Surgery does typically increase the amount of a workers' compensation settlement. A surgical recommendation typically means the injury is more severe and likely to be permanent. Medical expenses, permanency, and lost wages all tend to be higher when there is a surgical recommendation.
When a worker needs surgery, it usually means they have a serious injury that requires a lot of medical attention. This leads to higher medical bills for things like the surgery itself, hospital stays, and follow-up care. Additionally, the recovery time after surgery is often longer, which means the worker might miss more work and therefore need more wage replacement benefits.
Moreover, a severe injury that needs surgery can lead to a permanent disability. This can result in higher compensation for permanent partial disability to help cover the long-term impact on the worker's life.
Overall, because surgery indicates a more serious and costly injury, it often leads to a larger workers' compensation settlement to cover all the additional expenses and losses.
Conclusion
In Minnesota, workers' compensation laws ensure that injured workers receive the medical care they need to recover from work-related injuries, including surgeries when necessary. It's essential to be proactive in advocating for your rights and ensuring that you receive fair treatment and compensation for your injuries.
If you find yourself facing challenges or disagreements with your employer or the insurance company, consider seeking legal advice from a workers' compensation law firm who can help navigate the process and protect your interests.
LawSmith PLLC is a Minnesota legal practice that represents injured employees in workers' compensation cases. A free consultation with an experienced work comp lawyer is available to Minnesota injured workers on request.
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