How to Get Surgery for my Workers’ Compensation Injury
Learn everything your employers don't want you to know! Explore the hidden loopholes that savvy employees use to fast-track their surgery approvals with Workers' Compensation.
It looks like you have a injury from a work-related incident. If you think you may need surgery, you must understand how to get medical treatment through your employer’s insurance company. Whether this be through finding out how to get an authorized doctor, or getting that doctor to understand your injuries, it’s difficult to wade through the steps of attaining Worker’s Compensation medical help alone. That’s what we’re here for—to help relieve the stress of seeking out surgery and give you information that most employers won’t share.
Download my book, Florida Workers’ Compensation, where I meticulously unravel the complex web of worker’s compensation, providing you with step-by-step advice and expert insights to empower you in securing the medical assistance and financial stability you rightfully deserve.
In this article we will discuss:
4) The Process
1. Finding a Doctor
In Florida Worker’s Compensation, you can’t simply find ANY doctor. In order to see what type of surgery you may need for your injuries, you must be evaluated by an authorized and chosen doctor. All initial hospital treatments are deemed authorized. For follow-up appointments, you CAN NOT find your own doctor. Do NOT go to unauthorized treatment because Workers’ Compensation may not pay for it.
Overview:
1) When you get injured, report the incident and injuries to your employer within 30 days of the accident.
2) Collect the doctor information that their insurance company gives you.
3) Go to your assigned doctor.
All medical care following the hospital needs to be authorized. Contact your employer and get their Workers’ Compensation insurance information. Next, call the Workers’ Compensation insurance and speak to the adjuster. The adjuster handles your claim and coordinates your benefits. Ask the adjuster where you can go to the doctor following the hospital. If a hospital visit was not needed, alert your employer and coordinate an appointment with an authorized doctor.
Text or email your direct supervisor when and how the incident occurred. If you report the incident verbally, follow up with a written record. You have 30 days from the date of the accident to inform your employer, the sooner the better.
Your employer’s Workers’ Compensation insurance chooses what doctor you are allowed to go to. You can not coordinate medical care on your own. If your employer tells you to go to a certain doctor’s office, have it in writing and go to that doctor.
Your employer’s insurance company has a list of doctors offices that accept Workers’ Compensation.
Your employer’s insurance company has a list of authorized doctors that they will choose from.
Unfortunately, it can be a slow system. If you don’t get an assigned doctor from your employer or Worker’s Compensation insurance, you can go to the hospital.
If you haven’t heard back from your employer’s insurance company, you can go to the hospital. All hospital treatments are deemed authorized.
- Be nice
- Keep a journal
- Bring a friend or family member to your appointment
- Seek a second opinion from a legal professional
2. Talking To Your Doctor
Helping your doctor understand your injuries for your potential surgery. You have to make sure to mention everything to your doctor because: if the doctor didn’t write it, it didn’t happen. Do not downplay anything to your doctor. Let your doctor know everything you are experiencing.
For an even more thorough look into communicating with your doctor, chapter 3 of my book, Florida Workers’ Compensation, is dedicated to guiding you in effectively discussing your healthcare, offering practical tips, and unraveling essential procedures to ensure your treatment and recovery without falling into traps of unauthorized practices that could jeopardize your claim.
Overview:
1) Prepare for your first evaluation
2) Accurately describe your pain & symptoms
3) Gathering your records
How Do I Prepare For My First Evaluation?
BEFORE Your First Evalutation
- Conduct an objective personal inventory of your injuries.
- Note each of your symptoms and write them down.
- If you have an attorney, alert them of your doctor’s appointment.
- Keep a milage log. Write down how many miles you drive to your appointment round trip. You could get reimbursed for driving to doctors’ appointments.
DURING Your First Evaluation
- Report that objective personal inventory you made prior to your doctor.
- Be honest about everything. Lying or misleading claims is fraud and your entire claim can be denied.
- Make sure to describe your injuries and pain thoroughly.
How Do I Describe My Pain to My Doctor?
When talking about your injury, adhere to the following advice to give the best possible description:
1. Quantify Your Answers
2. Breakdown Your Pain
3. Use Comparative Language
Ex. “I can only stand for 20 minutes. The pain shoots down to both of my legs an hour after I wake up.”
Ex. “My back pain type is shooting, sharp, and aching. I mainly feel this shooting pain whenever I stand, walk, or sit for over 10 minute intervals. The pain increases when I try to stretch my back or bend over.” Add how frequent the pain is.
Ex. “The pain feels like an like an electric shock.”
Questions Your Doctor May Ask:
Describe what part of your back hurts and any other body part that you may experience pain in.
Is the pain dull or sharp? Numbing or resulting in muscle weakness? Describe this and if the pain is centralized or shoots down one or both of your legs.
Is your pain constant or sporadic? Describe how often you get the pain, even if you aren’t experiencing the pain at that given moment.
Does your pain limit your movement? Does it prevent you from sitting, standing or stretching certain parts of your body? For how long? Describe your limitations extensively.
Gathering Your Records
After every appointment, ask the doctor’s office for all medical records, the DWC-25 record (Uniform Medical Treatment/Status Report Form), and any referrals.
3. Seeking a Specialist
Insurance companies will assign you certain specialists if they see that they are needed when the original injuries are declared. However, insurance companies ARE NOT medical practitioners and don’t always assign the doctors you may need at first. For example, if you are experiencing nerve issues, you could ask your doctor if it would be beneficial for you to see a neurologist.
Explore our detailed book, which equips you with the knowledge and strategies to manage the intricacies of finding the right specialist for your unique medical needs.
Overview:
1) What Specialists can I have?
2) How to get proof of referral from your doctor
3) How to get it approved by your employer’s insurance
Specialist FAQ
Upon further evaluation, the doctor you were assigned may discover that you need specialized care that they are unable to provide. In this case, they will refer you to a specialist. Your employer’s insurance should schedule a follow-up exam with said specialist, but follow the steps below to make sure this happens.
Your doctor will send you to a Workers’ Compensation approved doctor for your area of injury.
If you have a pending referral, follow up with an attorney immediately to make sure you get the proper treatment from a specialist.
After every appointment, ask the doctor’s office for all medical records, the DWC 25 record, and any referrals.
Simply forward the email to them. Be sure to forward referrals to the insurance to ensure that it gets scheduled.
No, your doctor will assign you an approved Workers’ Compensation Specialist.
If your doctor sees fit, they will send you to a specialist who is an expert in your area of injury. If you think you might need a specialist, discuss all your options with your doctor.
To secure care from a specialist, make sure that:
- You get proof of referral from your authorized doctor
- Your employer’s insurance approves of the referral
4. The Process
What to Expect from Your Surgical Experience
- Starts with a referral to a surgeon.
- The surgeon will order tests to determine if you are a good candidate for the procedure. For example, an MRI or blood test.
- Follow-up appointments are conducted to discuss options such as medications, pain management, therapy, and finally, if it is necessary, surgery.
- Sometimes another appointment or a call is required to reach a decision.
- Pre-op appointment to discuss dietary restrictions, medications for before and after the surgery, post-op transportation, and hospital stay details.
- The surgery takes place.
- You are discharged with instructions.
- Follow-up appointments for your recovery sometimes involve pain medication or physical therapy.
- If surgery does not go well, sometimes additional surgery or pain management is required.
Leveling the Playing Field: The Importance of Legal Expertise in Workers’ Comp Claims
- Complexities of the Law- Workers’ compensation laws are intricate, varying from state to state, and navigating them without proper legal knowledge can be daunting. A skilled attorney ensures that you understand the nuances of the laws and that your rights are protected throughout the process
- Avoid Costly Mistakes- A small oversight can result in reduced compensation or even denial of your claim. An attorney’s expertise reduces the risk of errors, ensuring you get the compensation you deserve.
- Maximize your Benefits- Insurance companies aim to minimize the payouts. A workers’ compensation attorney will be equipped to negotiate on your behalf, ensuring that you receive maximum benefits
- Representation in Hearings- If your claim is denied or disputed, you might need to present your case before a workers’ compensation judge. An attorney will prepare and present evidence and argue your case more effectively than you could on your own.
- Additional Claims- In some instances, a workplace injury may have been caused by the negligence of a third party (not your employer). An attorney can identify these opportunities and assist in filing additional personal injury lawsuits, potentially increasing your compensation.
- Guard Against Retaliation- It’s unfortunate, but some employers may retaliate against employees for filing a workers’ compensation claim. With an attorney at your side, you’ll be better equipped to handle any potential backlash and ensure that your rights as an employee are upheld.