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My Doctor Says I Need Surgery, But Workers’ Comp Won’t Approve It

Q: I was hurt at work. Does my employer have to pay for my medical expenses?

A: This is a more complicated issue than it may initially seem. In an Atlanta workers’ compensation case, an employee may be entitled to paid medical care, but only if certain conditions are met, such as the employee giving the employer timely notice of the accident and seeing a physician who is authorized by the employer or its workers’ compensation carrier.

Q: In my situation, I was hurt on the job a few weeks ago and immediately told my employer what happened. They sent me to the doctor, and everything seemed to be going fine until last week, when my doctor told me that I need surgery due to a herniated disc. My employer’s workers’ compensation carrier has refused to authorize the surgery. They say the surgery is related to a pre-existing condition – specifically, a previous work injury several years ago. To my knowledge, that old case was closed, and I didn’t receive anything other than temporary disability benefits and paid medical expenses for a few trips to the doctor back then. Is there anything I can do?

A: A woman in a recent case decided by the State Board of Workers’ Compensation had a similar situation. She had been hurt at work at a previous job but had returned to work without restrictions. She then fell at work, hurting her back, and it was determined that she needed surgery. The second employer did not want to pay for the surgery, insisting that the woman’s need for the treatment resulted from the first injury, rathe than the second. The administrative law judge agreed with the woman and said that the surgery should have been authorized. Unfortunately, the appellate division disagreed.

In denying the woman’s claim for additional medical treatment at the second employer’s expense, the appellate division noted that the employee had the burden of proving that the recommended surgery was related to the compensable injury. The employer had referred the worker for an independent medical evaluation, and that doctor had opined that the employee’s symptoms could be related to her pre-existing low back problems as opposed to the newer injury at the employer’s place of business. Additionally, the appellate division found that the employee was not a credible witness, due to multiple inconsistencies between her deposition and her testimony at the hearings before the board. Thus, the appellate division found that the worker had failed to prove that the surgery was necessitated by the second injury.

Q: How can I contact an attorney to find out more about how an old injury or another pre-existing condition can affect a workers’ compensation claim for a subsequent injury to the same part of the body?

A: At the Law Offices of T. Andrew Miller, LLC, we handle many types of Atlanta workers’ compensation cases, and we’ll be glad to talk to you about your case. Call us at 678-605-9109 to schedule a free consultation.