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Can Worker’s Comp Insurers Force You to Have Surgery?

Employers’ and workers’ compensation programs eager to get people back to work may force employees to undergo surgical procedures against their wishes. Provisions within the law can result in claims denial or a termination of benefits for workers who fail to complete treatment schedules. As a result, many workers are being forced into situations where they risk a significant risk of exposure to COVID-19 simply to satisfy the demands of the workers’ comp insurer.

Resumption of Necessary Treatments

COVID-19 caused healthcare providers across the country to suspend all elective, non-critical procedures. This meant many workers receiving treatment for work-related injuries were forced to delay or suspend treatment for their injury. This exacerbated many injuries and resulted in significant pain and suffering. 

To rub salt in the festering wounds, many workers’ comp insurers are demanding that workers resume treatments even though the pandemic is far from abating. With nearly 2 million infected and more than 100,000 dead, the risks to worker health and safety are obvious to even the most obtuse plan administrator. Even so, they are forcing many to enter healthcare facilities and surgical centers where there is a considerable risk of contracting COVID-19. Moreover, because surgical procedures weaken the immune system, the risk rises exponentially.

Claimants in the Crossfire

Workers’ compensation claimants are obligated to adhere to the mandates of their workers’ comp provider. If they do not, they lose their benefits and right to free medical care. In some cases, they may also suffer termination of their employment. While workers can request judicial review of these actions, it’s a time consuming and lengthy process that could leave workers who refuse ordered treatments in a lurch.  

Workers’ compensation insurers have a financial incentive to return workers to maximum medical improvement as quickly as possible. The longer this takes the longer they pay before a final determination and settlement are reached. Moreover, states are eager to resume the flow of funds through surgical centers and hospitals as quickly as possible to help shore up their diminished revenue streams. This reduction in revenue has caused many to lay off doctors, nurses, and other professionals considered “essential workers.”  

This means that workers injured before and during the pandemic are being forced to serve as guinea pigs for the anticipated provision of elective health care and surgical services to the general public. These workers are being forced into dangerous situations that could severely impair their health, or even cost them their lives.

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