Is Knee Surgery Covered By Workers Compensation?
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.
Does 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:
- The insurance company claims that your work injury did not cause the need for medical treatment; or
- 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.
- Talk to your doctor to address any concerns you have about the surgery
- 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.
- 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.
I 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. You can read this article to find out more about how a free consultation works.
If you decide you want to set up a free consultation, just call us at (770) 214-8885 or complete the form on this page.
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.
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