What If My Insurance Company Denies my Work Injury Claim?

Q: I was in a serious accident when I fell off a ladder at work. Now my doctor wants to do back surgery to repair a ruptured disc. He says any more delay may leave me with permanent damage. The insurance company refuses to approve surgery, because their doctor says I have “pre-existing conditions.” My doctor disagrees. Is there anything I can do?

A: Yes, there is. If the insurance company denies any part of your claim or refuses to pay for treatment, you can appeal that decision, usually to a workers’ compensation judge. There is often a strict deadline to take action, so getting help quickly is in your best interests. If your doctor believes surgery is necessary, and sooner rather than later, you should be able to have your health insurance pay while you appeal the workers’ compensation denial. If you don’t have health insurance you may be able to receive help from the Oregon Health Plan or the Seniors and Disabled Services Division of the State of Oregon. Since the insurer will be represented by an attorney, you should get legal advice as well. State law requires workers’ compensation insurers to pay attorney fees for injured workers.

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