What If My Doctor Recommends Surgery But the Insurance Company Says It's Not Necessary?

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What Happens When Travelers or The Hartford Denies Surgery Recommended by Your Doctor?

The insurance company doesn't always go according to the recommendation of your treating physician. In fact, one of our clients had to have two surgeries because the first one resulted in a serious condition called frozen shoulder and he struggled to get the second surgery authorized.

If the insurance company is refusing to authorize the recommendation of your treating physician, you should call an attorney. Often the insurance company will hire their own doctor to examine you, who is paid by them and will most of the time find in favor of them.  They call this exam an Independent Medical Examination, or IMEWe call it what it really is - an Insurance Medical Exam paid for by the insurance company and for the benefit of the insurance company.  You're not there for medical treatment and the doctor has no duty to you (most won't even talk to you - they'll say you just have to get the report from the workers' comp insurance company). 

What Can I Do After My Surgery Is Denied By My Workers Comp Insurance Company?

Sometimes the only way to get your treatment authorized is through filing for an informal conference (mediation) or a formal hearing. The informal conference is non-binding but might help to reconcile the differences between the two sides. If that doesn't work or for more serious adjudication issues, a formal hearing will result is a binding decision from an adjudication judge. 

At Donahoe Kearney we use all of the process to your advantage: to pressure the insurance company to do the right thing, or have a judge order them to do the right thing.  There are no insurance company tactics, strategies, or tricks that we haven't seen (and we can see them coming and prepare you for them). We will do everything we can to make sure your treatment is authorized and that you are on the road to healing. 

Order Our Free Report About Insurance Medical Exams TodaySurgery Denied By Workers Comp After a Work Injury in DC

If you have been caught up in an IME battle or the workers' comp adjuster is denying or delaying your medical treatment after a serious work injury, give us a call at 202-393-3320 or email us at [email protected] to get a free copy of our report "Scheduled: A Guide to Appointments with the Workers Comp Insurance Doctor and How to Protect Yourself."

Ready to Hire an Experienced Workers Comp Lawyer Now?

Contact our experienced workers compensation lawyers at 202-393-3320 to get help now. You'll speak to a real person who can help you get started on your road to success.

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer