Does Workers’ Comp Pay for Surgery in Virginia?

Virginia workers’ compensation lawyer

Yes.  Virginia workers’ compensation law requires employers (and their insurers) to pay for all necessary and reasonable medical treatment administered for a work-related injury, including surgery.

According to the Bureau of Labor Statistics, over 2.5 million nonfatal workplace injuries and work-related illnesses occur each year, many of which require surgical intervention. For an individual who is already missing work due to an on-the-job injury, the thought of incurring exorbitant medical expenses can be overwhelming.

If a work-caused injury or illness requires surgery, the cost for the surgery must be paid by the employer or insurer.

To qualify for benefits, an injured worker must prove that their injury or illness was job-related and that surgical intervention is necessary to treat the condition. Unfortunately, unscrupulous insurers and employers often work to find reasons to delay or deny valid claims.

As a result, having an experienced and tenacious Virginia workers’ compensation lawyer by your side can be highly beneficial. At The Law Offices of Mark T. Hurt, we zealously advocate for injured workers, helping to secure every dollar to which they are rightfully entitled, and we demand that workers receive the medical treatment (including surgery) to which they are entitled.

If you or a loved one was injured at work, we invite you to call our offices to schedule a free consultation to learn more about your rights and options for maximizing workers’ compensation benefits and medical treatment.

What Types of Compensation Does Virginia Workers’ Comp Provide?

Under Virginia workers’ compensation, injured workers may be entitled to compensation for the following:

• Doctors’ visits;
• Specialist appointments;
• Surgery;
• Rehabilitation;
• Therapeutic intervention;
• Prescription drugs;
• Durable medical equipment (DME);
• Other reasonable and necessary medical care;
• Mileage reimbursement (for travel to and from physician visits);
• Temporary Partial Disability (TP);
• Temporary Total Disability (TTD);
• Permanent Partial Disability (PPD);
• Permanent Total Disability (PTD); and
• Death benefits (if an individual succumbs to their injuries).

I’m in Pain and Need Surgery Now.  How Can You Help Me?

Insurance companies understand that injured workers may be in great pain and need surgery as soon as possible.  Unscrupulous insurance companies can take advantage of this situation by trying to make a “low-ball” offer to injured workers to try to resolve their claim for significantly less than what is due.

At The Law Offices of Mark T. Hurt we are experienced in the use of these techniques.  An injured worker should never have to choose between giving up a large amount of their claim in order to get the immediate surgical treatment that is due to them.

If you find yourself in this position, please call us as soon as possible to learn how we can help you.

Can I Recover a Lump-Sum Workers’ Compensation Settlement Before Surgery?

Yes, it may be possible to recover a lump-sum workers’ compensation settlement before proceeding with surgery; however, settling a claim has potential advantages and disadvantages.

Virginia Workers’ Compensation Settlement Advantages

• A larger settlement amount may be awarded based on the estimated costs of future surgical care, which can exceed the actual cost of care if medical expenses ultimately are not as high as originally anticipated.
• Injured employees can bypass the insurance authorization process and choose their own surgeon.

• Injured workers needn’t worry about insurers denying a claim later, as the awarded benefits will be paid up front.

Virginia Workers’ Compensation Settlement Disadvantages

• Surgical care will have to be paid out-of-pocket from the settlement received.

• If future impairments related to an injury arise, these will no longer be compensable after a settlement acceptance.

• If unforeseen surgical complications arise, a claimant will be unable to obtain compensation or post-surgical disability payments after accepting a workers’ compensation settlement.

• If the actual medical costs are higher than expected, an injured worker will not be able to collect additional damages for the excess costs.

As a Virginia workers’ compensation lawyer with over two decades of experience, firm-founding attorney Mark Hurt can evaluate the facts of your case and provide guidance on whether a settlement may be in your best interests.

How Do I Get Workers’ Compensation Surgery Approval from An Insurance Company?

To obtain approval for a surgical procedure through Virginia workers’ compensation insurance, an injured worker must demonstrate that his or her condition is compensable under Virginia law and the surgery is a necessary and reasonable treatment for the condition. Unfortunately, despite having qualifying workplace injuries and Award Orders, many insurance companies still refuse to authorize surgical procedures.

If you or a loved one was denied access to surgical care, we invite you to call our offices to schedule a complimentary consultation. As an experienced Virginia workers’ compensation attorney, Mark Hurt can evaluate your case and tenaciously advocate for the full and fair workers’ compensation benefits to which you are rightfully entitled.

How Long Does It Take to Get Surgery Approval from A Workers’ Comp Insurer?

Insurance companies do not have specific deadlines to approve or deny surgery requests. As such, many insurers will delay approvals, hoping that injured workers will abandon their claims.

If an employer and its insurer refuse to properly consider a claim, as a dedicated and tenacious workers’ comp firm, The Law Offices of Mark T. Hurt will not hesitate to file with the Virginia Workers’ Compensation Commission in seeking to obtain authorization for surgery. If a claim is submitted, the Commission will require the insurance company to respond within thirty days. Thereafter, if the request is rejected, a hearing can be conducted by the Commission to make a determination regarding the procedure.

Can I Have Surgery If My Virginia Workers’ Compensation Insurance Claim Is Pending?

Yes. An injured worker may have surgery while a claim is pending. If the treatment is approved, workers’ compensation will pay for the procedure. However, if a claim is denied, the individual will be responsible for shouldering the cost of the surgery.

Obtaining full and fair workers’ compensation benefits can be challenging, but having an experienced workers’ compensation attorney by your side to advocate for your rights can help increase the potential of securing the full compensation you deserve. Call The Law Offices of Mark T. Hurt today to schedule a free consultation to learn more about your rights. Check out our worker’s comp reviews.