When workplace injuries occur, the workers’ compensation system can provide financial support to employees. One common question that arises is whether workers’ compensation covers surgery as part of the treatment process.
Workers’ compensation typically covers medical treatment expenses resulting from work-related injuries or illnesses. These can include physician visits, hospital stays, prescription medications and, in many cases, surgical procedures. The main factor determining coverage for an operation is whether the surgery is necessary and directly related to the work-related injury.
Types of covered surgeries
Workers’ compensation generally covers a variety of surgeries, ranging from minor to major procedures. For instance, if an employee injures his or her hand while operating machinery and requires surgery to repair the damage, he or she will not need to pay for the surgery. Similarly, if a worker hurts his or her back while lifting heavy objects and requires spinal surgery, workers’ compensation will likely cover the operation.
Authorization and documentation
In 2021, according to the Bureau of Labor Statistics, 1,062,700 nonfatal workplace injuries and illnesses resulted in private industry employees missing at least one day of work, and some of these injuries and illnesses required surgery. To ensure coverage for surgery through the workers’ compensation system, it is important for employees to follow proper procedures following the accident. For example, employees should promptly see an approved healthcare provider and their physician should create a medical report that confirms their condition requires surgery.
While workers’ compensation generally covers surgeries that meet approved criteria, a denied claim can still occur. If an employee’s surgery is not approved for coverage, he or she has the right to appeal the decision.