One of the basic principles of the law is that everyone is entitled to their day in court.  That includes insurance companies that take ridiculous and even sometimes dangerous positions when it comes to denying you the medical care that you need for a work related injury.  If your doctor says that you need surgery and they send you to an independent medical examination (IME) that says you don’t, they legally have a right to deny paying for that surgery until an Arbitrator orders them to.
For some people a surgery can wait while the legal process sorts itself out, but for others they are living in tremendous pain that can only be relieved by surgery or they risk permanent harm if the surgery is delayed.
A reader of my blog recently asked me if he should put his needed back surgery through his group medical insurance since workers’ compensation had denied paying for it after a seemingly sketchy IME report.  His daily pain is unbearable and prevents him from doing most of his daily activities.  Of course the IME doctor, who saw him for a few minutes, said he’s fine, but that’s what hired guns do.
His concern was that if he did put the surgery through his group insurance it would cause him to forfeit his rights to a workers’ compensation claim.  He also was worried that if the group insurance found out that he was pursuing a work comp case, they’d try to make him pay back what they spent on the case.
We tell people that whenever possible, if you are hurt on the job, work comp should pay for 100% of your medical care without delay.  They want you to go through your group insurance because it saves them money.  That said, there is nothing more important than your health.  I’ve had a back injury and torn rotator cuff myself and the days I spent waiting to be seen by an orthopedic doctor were miserable.  I can’t imagine waiting 12-18 months for a case to finish (not always that long, but could be) while I sat in pain.
So if you have no other alternative, put your bills through your group insurance.  Typically this will require a denial letter from the insurance company.  Getting better is way more important than your case itself.
But this doesn’t mean that you are giving up your rights to a case.  To the contrary, in most instances we’ll push to make sure that group insurance carrier is reimbursed for everything that they paid, that you are reimbursed for anything out of pocket and that you are protected in case the health insurance company ever goes after you.
This is not an ideal way to handle a work injury case, but if you risk permanent damage by delaying your care, you have no choice. We always push to get your case to hearing as fast as possible, but it also has to be ready which could mean taking the depositions of two or more doctors.  This takes time and the truth is that there is no way around it.  So if you can get better and still go after your benefits, that’s the best way to handle most cases when a surgery absolutely can not wait.