Does Workers’ Compensation in Vermont Pay for Surgery?
In Vermont, if you suffer an injury on the job, you can recover workers’ compensation benefits. But does workers’ compensation pay for surgery? The short answer is yes. When you suffer a job-related injury in Vermont, workers’ compensation covers all reasonable and necessary medical expenses related to the injury, including surgery. However, understanding how the process works can help you avoid delays and ensure you get the care you need. Read on!
When Does Workers’ Compensation Cover Surgery?
In Vermont, workers’ compensation covers surgery, but not in all instances. Under 21 V.S.A. § 640, surgery is only covered when the procedure is considered reasonable, necessary, and directly associated with the work injury. Workers’ compensation will not pay for a surgery if it is deemed unreasonable, unnecessary, or unrelated to your work injury.
Apart from surgery, workers’ compensation covers, among others, the following essential medical expenses;
- Doctor visits
- Prescription medications
- Hospitalizations
- Medical equipment
Getting Surgery Approved Under Vermont Workers’ Compensation
Once a Vermont workers’ compensation claim has been approved, it is not automatic that you will recover all benefits. Some benefits may still be denied, such as surgery. After surgery has been recommended, there may be conflicting physician opinions as to the reasonableness and necessity of the surgery. Your employer’s workers’ compensation insurer may submit medical evidence on the issue. If the insurance company’s evidence outweighs your evidence, you may be denied the benefit.
So, how can you increase your chances of getting an approval? If your treating physician recommends surgery, take the following steps;
- Get documentation from your treating physician explaining why surgery is necessary and how it will improve your condition or allow you to return to work.
- Prepare for an independent medical examination (IME), which is a medical assessment with a doctor of the insurance company’s choice. An IME is used to evaluate whether the surgery is truly necessary and related to your work injury.
- Respond promptly to requests, as delays in paperwork can cause suspicion.
- Consult a qualified Vermont workers’ compensation lawyer for help gathering strong evidence.
What if the Insurance Company Denies Surgery?
If your employer’s workers’ compensation insurance company refuses to pay for surgery, it does not necessarily mean you are out of options. You have the right to challenge the decision through the dispute resolution process, which typically includes discussing the denial with the insurance company to try to resolve the matter, requesting mediation or a review through the Department of Labor (DOL), or attending a hearing before an administrative official who will review the evidence and make a decision.
Will I Pay Anything if Surgery Is Approved?
Unlike with health insurance, you should not pay any deductibles, copays, or out-of-pocket costs if surgery is approved. If you receive a bill, it may indicate that the insurance company is disputing your claim or that the paperwork was not processed correctly. In either case, notify your attorney immediately or the Vermont Department of Labor.
While workers’ compensation in Vermont covers surgery when it is reasonable and necessary, sometimes it can be challenging to get approval. That is why it is vital to enlist the help of a knowledgeable workers’ compensation attorney. A skilled lawyer can help you fight for the medical care and benefits you need and deserve.
Contact Us for Legal Help
If you need help recovering the benefits you deserve after a work-related injury, contact an experienced Vermont workers’ compensation attorney at Sluka Law PLC.
Source:
legislature.vermont.gov/statutes/section/21/009/00640
