How Long Does It Take Workers’ Compensation to Approve Surgery?

When a workplace injury requires surgical intervention, the last thing an injured worker wants to hear is that they must wait weeks or months for their workers’ compensation insurance to approve the procedure.

Unfortunately, the approval process for surgery under Minnesota workers’ comp can be frustratingly slow, leaving employees in pain while navigating a complex system of medical reviews and administrative hurdles.

The timeline for surgical approval varies based on several factors, including the necessity of the procedure and the strength of your claim.

In situations like this, consulting with a Minneapolis workers’ compensation lawyer can make a critical difference.

Does Workers’ Compensation Pay for Medical Care in Minnesota?

Minnesota workers’ compensation covers reasonable and necessary medical treatment to cure or relieve the effects of your work injury.

This coverage includes surgical procedures, hospital treatment, psychological care, and even chiropractic services and podiatric treatment. You are entitled to this medical care as long as it is directly related to your workplace injury. 

When Does Surgery Need to Be Approved in a Workers’ Comp Claim?

Minnesota has established strict guidelines to ensure that medical treatments are appropriate and effective for work-related injuries. These guidelines help both doctors, employers, and insurance companies determine which treatments are covered and how long they should continue.

When you need a non-emergency surgery, your treating physician must provide detailed information about why the procedure is necessary before your employer or their insurance company will approve it. This documentation needs to show that the proposed surgery is both reasonable and necessary for your recovery. 

The Process of Getting a Surgery Approved for a Work-Related Injury 

Your employer or insurer will review your doctor’s report and the medical evidence to decide whether they will cover your surgery. Once they are notified, they have seven business days to respond in one of five ways:

• Approve the surgery: You can proceed with the necessary treatment immediately without further delays or administrative hurdles. 
• Deny the surgery: You have the right to dispute this denial through the appeals process. 
• Request additional information: If they reasonably need more documentation from your treating physician, they receive another seven days after obtaining that information to make their final decision. 
• Request a second opinion: They can require you to obtain another physician’s evaluation of the surgical recommendation, giving them seven additional days after receiving that second opinion to approve or deny coverage. 
• Request an independent medical examination: The insurance company can select and pay an independent doctor to examine you and provide their professional opinion about whether the proposed surgery is reasonable, necessary, and directly related to your work injury. They have up to 45 days from the examination request to make their decision.

What to Do If Your Surgery Is Unfairly Denied by Workers’ Compensation

When delayed or denied surgical approvals threaten your recovery, a Minnesota workers’ compensation attorney can take decisive action to expedite the process and protect your interests.

A lawyer has the experience to challenge unreasonable delays, file necessary appeals, and ensure medical decisions are based on your actual needs rather than cost-cutting measures. 

If your employer or their insurance carrier continues to deny or delay essential surgery, an attorney can help protect your health and defend your rights.

Contact a Minnesota workers’ compensation lawyer as soon as possible to discuss your workers’ compensation claim and begin building your case for benefits.