Getting injured on the job can be difficult to navigate alone. Between managing pain and filing paperwork, it’s easy to get overwhelmed. In serious cases, surgery may be necessary to help you fully recover. But can you refuse surgery under workers’ compensation? You may not know what rights you have within the parameters of workers’ comp.
You can explore your legal rights and obligations under workers’ compensation claims in North Carolina with the help of an experienced employment lawyer.
Workers’ Compensation and Medical Treatment
The point of workers’ compensation is to provide financial support and medical care to employees who get injured or sick as a result of their jobs. In 2023, the U.S. Bureau of Labor Statistics reported 68,000 private industry work-related injuries and illnesses. Meanwhile, state and local government cases reached 17,100. Of the overall workplace fatalities in North Carolina, 90% were made up of wage and salaried employees.
Workers’ comp laws vary by state, but they all cover the same basic areas, including:
- Wage replacement, either temporary or permanent
- Medical treatment
- Disability benefits
- Vocational rehabilitation
- Death benefits if the incident is fatal
Your employer—or their insurance provider—must approve the claim and cover all necessary and reasonable medical treatments. This should include your doctor visits, physical therapy appointments, medications, and surgeries, if necessary.
Sometimes, surgery is recommended when the patient may not agree or feel it’s necessary. In these instances, you might wonder if you’re legally allowed to decline the surgery or if doing so would risk your workers’ comp benefits. The simple answer is, yes, you’re legally allowed to refuse surgery, but some considerations still apply.
Refusing Surgery Under Workers’ Compensation
No one can force another person to undergo medical care as major as surgery without their full permission. However, refusing recommended surgery under a workers’ comp case may come with consequences. This decision could impact your benefits, recovery, and your future ability to work.
Employees may refuse surgery for many reasons. Some of these reasons include:
- Fear of surgical risks, such as anesthesia problems, surgical complications, or possible infections
- Concerns about permanent disability or disfigurement
- Religious or cultural beliefs
- Preference for alternative or less invasive treatment
- Previous bad experiences with surgery
What Happens if You Refuse Surgery
Refusing surgery from your treating physician may set a few things into motion. These include:
- Evaluation of reasonableness. The workers’ compensation system will evaluate if your refusal is reasonable. If they believe it is, your benefits shouldn’t change. This is most likely in the event that surgery comes with very high risks. If they feel your choice is not reasonable, such as refusing a simple, low-risk procedure, you could lose some or all of your allotted benefits.
- Independent medical examination. The insurance company may ask you to get a second opinion, called an independent medical examination. A doctor other than your treating physician then evaluates your condition and determines if the surgery is medically necessary, if an alternative option is available, and if your refusal makes sense.
- Impact on benefits. If the alternate doctor determines that your refusal is unreasonable, the insurer may terminate your temporary benefits or reduce your permanent disability rating by claiming your condition would improve with surgery.
What To Do if You’re Considering Refusing Surgery
If you’re considering refusing the surgery recommended by your treating physician, there are specific steps to follow to protect yourself in the process. Begin by getting a second, or even third, medical opinion.
Be sure to document everything throughout the process. Note why you’re refusing the surgery and what risks concern you the most. Include any treatments you’re pursuing and recommendations you’ve gotten from other doctors.
Even if you refuse surgery, continue with other medical treatments, such as physical therapy, medication, and other non-surgical treatments. This demonstrates that you’re still committed to recovery and not just rejecting all medical care.
FAQs
Q: What Not to Say to a Workers’ Comp Doctor?
A: When seeing the workers’ comp doctor, you should not say anything that would exaggerate your symptoms or downplay your pain. Never say you’re alright if you’re not, and don’t suggest the injury happened outside of work. Don’t lie about your medical history. Also, avoid discussing legal or financial motivations if you have them.
Just stick to the facts about your condition and how it affects your ability to work. Whatever you say when you meet with the workers’ comp doctor will be used to determine your benefits and the legitimacy of your claim.
Q: Can Workers’ Comp Force Me to Have Surgery?
A: Workers’ comp cannot legally force you to have surgery. However, if surgery is recommended and you refuse, it could impact your benefits, arguing that refusing treatments shows non-compliance. You do have the right to a second opinion. Ultimately, you can make your own choices for your health, but they may come with legal or financial consequences with the workers’ comp system.
Q: Why Do Employers Not Like Workers’ Compensation?
A: Employers may not like workers’ compensation because it can increase insurance premiums, lead to decreased productivity, and expose them to legal risks. Claims might indicate unsafe working conditions, which prompts inspections or penalties.
Some employers may believe claims are exaggerated or fraudulent, which can impact the employer/employee relationship. Additionally, managing claims requires time, administrative work, and potential temporary or permanent staffing replacements.
Q: Which Body Part Has the Highest Value in a Workers’ Compensation Claim?
A: In many workers’ compensation claims, a back injury tends to have the highest value. Back injuries generally require the most treatment, including lengthy physical therapy, surgeries, and longer recovery times. These injuries can also lead to permanent disability, making them costlier for insurers. Other body parts with high-value claims include the head and neck, especially if neurological damage is done.
Contact a Workers’ Compensation Lawyer Today
When considering refusing surgery under workers’ comp, hiring a Charlotte workers’ compensation lawyer can help ensure you meet all legal requirements. They can make sure you understand the implications of your choice and prepare you for any possible hearings, representing you in disputes with insurance companies.
Call the office of M. Reid Acree Jr., Attorney at Law, today to schedule a consultation to better understand whether you can refuse surgery under workers’ compensation.