Why is it so hard to get my surgery approved?
One of the biggest problems people have with workers compensation is getting their surgeries approved. It’s a continual problem because, in Texas, the insurance company uses a one size fits all approach to medical care. They use a book called The Occupational Disability Guidelines. Your doctor has to go by the treatment protocols that are in that book. It means that your medical care is more expensive. It means that it takes a lot longer for you to get treatment.
Your doctor will have to send in justification to the insurance company saying that the ODG has been followed and you’ve been sent out for the appropriate treatment prior to doing the more expensive option, which is always surgery. It does have important legal ramifications for you if don’t do things correctly. That’s why it’s always important that you have a lawyer if you going to be involved in any type of legal proceeding.