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How to Get Workers’ Comp to Pay for Your Post-Surgical Appointments in CA

If you have recently undergone surgery after a work injury, you may think that the worst is behind you. Unfortunately, your fight to recover may have just begun, as many patients struggle with the insurance companies even before they leave the recovery room.

The Ledgerwood Law Group hopes to clear up some confusion about which medical visits may be covered under a workers' compensation plan. Here are just a few questions clients may have about healthcare after surgery:

When will California workers' comp cover postsurgical treatment?

Under California law, injured workers who require surgery for a work injury are also entitled to postsurgical physical medicine as long as the treatment has been deemed medically necessary.

How long will workers' comp pay for my postsurgical visits?

In most cases, your treatment period begins on the date of your surgery and ends within the time interval for the specific surgery covered by treatment regulations. Your postsurgical physical medicine treatments and rehabilitation services should be covered until your treatment period ends, and any additional therapy may be denied coverage. If your specific surgical procedure is not addressed in the postsurgical treatment guidelines, the postsurgical treatment period is six months.

Can I get payments for physical therapy after surgery?

While you may be eligible for physical therapy appointments, treatment guidelines impose a 24-visit cap for chiropractic, occupational and physical therapy coverage.

Who determines when postsurgical appointments are medically necessary?

Members of the surgical team who performed the surgery, such as nurse practitioners, physicians, or the operating surgeon, can make a determination of medical necessity. However, any postsurgical physical medicine prescribed may be subject to utilization review.

The problem that most patients face in getting postsurgical treatment is utilization review. Generally speaking, this process involves proving that your treatment is necessary to the medical insurer in order to have your costs covered. Unfortunately, many services are denied coverage, delaying a patient’s recovery or even contributing to long-lasting health effects.

One of the benefits of hiring an attorney is that your representative can bring in a medical evaluators to confirm your course of treatment is necessary, and deal with the insurer on your behalf. To find out how you can get workers' comp payment for post-surgical appointments, contact us today at 888-761-7383, or click the link above to request a FREE copy of our report, The Northern California Workers’ Compensation Survival Manual.

Thomas Ledgerwood
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Proprietor Ledgerwood Law Group