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Is Knee Surgery Covered By Workers Compensation?4 minute read

Your workers compensation doctor tells you that you need knee surgery.  You probably have a number of questions.

  • Does workers compensation pay for the surgery?
  • Will the surgery cost you anything?
  • Do you have to have the knee surgery?
  • Can you get a second opinion?
  • How long will it take to get the surgery approved?
  • What amount of time will it take you to recover from the surgery?

This article will discuss those questions to give you some information about knee surgery in a Georgia workers compensation case.  But first, let me say that I am an attorney, not a doctor.  The information in this article is not intended as medical advice.  You should consult with your doctor for medical advice.

Insurance adjusterDoes workers compensation pay for knee surgery?

The workers compensation insurance company has to pay for the reasonable and necessary treatment that you need because of your work injury.  If everyone agrees you need the knee surgery because of your work injury, the insurance company should just pay for it.

When insurance companies fight paying for medical treatment, they usually do it for one of two reasons:

  1. The insurance company claims that your work injury did not cause the need for medical treatment; or
  2. The insurance company claims that the surgery is not necessary

The first reason is the most common reason the insurance companies fight knee surgery.  They often argue that you had a preexisting knee condition before your work injury.  The insurance company may try to get an opinion from another doctor they choose to support this claim.

Will the knee surgery cost you anything?

No.  In a Georgia workers compensation claim, you pay nothing for your medical treatment.  The insurance company has to pay the whole cost of the treatment.

There are rules to which doctors can treat you.  If you treat with an unauthorized doctor, you could end up responsible for the cost of treatment.  Read this article to find out more about selecting an authorized doctor to provide medical treatment.

Do I have to have knee surgery?

No.  The insurance company cannot force you to have surgery.  You can refuse medical treatment.

It may be best to do a couple of things before refusing surgery.

  1. Talk to your doctor to address any concerns you have about the surgery
  2. Consider getting a second opinion if you still have concerns about the surgery

Can I get a second opinion about my surgery?

You can get a second opinion before having surgery.  There are several different ways to do this.Knee replacement

  • Changing doctors
  • Using your 34-9-202 evaluation also known as an IME
  • Getting your authorized treating physician to refer you for a second opinion

A second opinion could help you decide if surgery is a good choice.  But, you need to consider that you could hurt your case by getting a second opinion.  Also, some of the second opinion options mentioned above can only be used once in your whole case.

Because of that, you need to make sure that it is the right time for a second opinion.  This article I wrote discusses more about getting a second opinion.

How long will it take to get the knee surgery approved?

Unfortunately, you cannot know how long it will take to get your knee surgery approved.  The insurance company may give approval within a week.  But, they could take much longer.

CRPS leg injuryI hope the insurance company will approve your surgery quickly.  However, delay and denial of medical treatment by insurance companies is the biggest problem in Georgia’s workers compensation system.  This article provides some information about the problem and how you can deal with it.

How long will it take to recover from knee surgery?

This is a question that your doctor can answer best.  It will probably depend on many factors including the type of knee surgery you need.

There are many different types of knee surgery.  You could need a knee replacement, a meniscectomy to repair a torn meniscus, or an anterior cruciate ligament (ACL) or medial collateral ligament (MCL) repair.

With some knee surgeries, you will likely have a full recovery.  With other knee surgeries, you will probably have some permanent limitations even if the surgery is successful.

If you have knee surgery under workers compensation, the insurance company should pay you temporary total disability benefits while you are out of work following the surgery (unless you fall victim to one of Georgia’s deadlines on benefits).  If you have work restrictions that prevent you from going back to work, those benefits will probably continue.

What if I have other questions about workers compensation knee surgery?

Georgia’s workers compensation laws are tricky.  Many people fall victim to deadlines that affect their workers compensation benefits.  Be sure that you ask questions if you have them.

A consultation with a workers compensation attorney is usually the best way to get questions answered.  I provide free consultations in workers compensation cases so you can get answers to your questions.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.

To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

Brittney-lee orourkeBrittney-lee orourke
05:23 18 Feb 22
Amazing! Jason and his team were very helpful and had the best communication by far. Walked me though every step with great detail and had answers for any question I had. They handled my case better then I could imagine, it was a weird case and they stayed on top of it and kept me updated every step of the way! Highly recommend this Team! Thanks so much to Jason and his Awesome team!-Brittney
China JonesChina Jones
18:58 08 Feb 22
I absolutely love this group of attorneys, when I was at my lowest they did everything they could to help me get justice for my injury. I believe if I were to have never picked my phone up and called the amazing group that helped me I definitely would not have received my idea of rights. If you have an issue and are just not sure please understand that they will help you, stay in contact, answer any question you have, and for sure get you the justice you deserve I thank them from the bottom of my heart and I will definitely refer them to anyone who has been hurt because they most definitely care about their work and clients.
Luv LocsLuv Locs
16:08 15 Jan 22
The entire law office was attentive and responsive to all of my concerns dealing with my workers compensation case.
moombimoombi
21:14 02 Jan 22
If you must get a lawyer involved, you’d do well to work with Jason Perkins and his team at Perkins Studdard Law.They were thorough in gathering information and in sharing all the steps in the workers comp process specific to my case. Jason and the team were responsive to my bevy of questions and concerns.I appreciated the informative videos and consultations provided by Jason over video meetings and multiple phone calls.I hope I’m never injured on the job again. However, if I am and if my employer responds as my previous employer did, I’ll contact Perkins Studdard Law immediately to handle the case.
Dana BessDana Bess
23:57 10 Dec 21
Everyone at Perkins Studdard was kind and professional. They were always extremely responsive and answered all questions that I had and followed up to make sure I had an understanding of what was going on along with emailing videos to explain every step of my case so I would know what to expect and be prepared. Jason is a very genuine person and I trusted him with my case. He answered so many questions for me even before I retained him as my WC lawyer. I highly recommend him and his associates at Perkins Studdard.
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