If you have ever had surgery, you know that you’ll likely have a wound scar and additional scar tissue will develop. For most people other than the visibility of it, it’s not a problem. Every now and then though it can cause excessive itching and some pain. In those cases where the surgery is from a work injury, under Illinois work comp law you’d be entitled to plastic surgery to try and stop the problem.
This happened in a recent case where a woman severely injured her arm when it was trapped in a machine. She suffered a really deep laceration and had a surgery and then had two more revision surgeries after that. Those treatments were all accepted and paid for by the insurance company.
The insurance company, however, didn’t want to pay for another surgery to relieve her pain and itching from the scar and got the opinion of a hired gun doctor to say her problems could be solved with desensitization therapy. The problem was that she had already tried that and it didn’t work as she still had pain and an ugly scar. This additional surgery would remove scar tissue. Fortunately the Illinois Workers’ Compensation Commission used common sense and found that this treatment recommended by the treating doctor was reasonable and approved it. They also ordered the insurance company to pay her for her time off work following this additional surgery.
I’ve been involved in other cases where insurance companies have told injured workers that cosmetic surgeries aren’t covered. This isn’t you asking for a boob job or butt lift or something like that. This is you asking for them to improve the look of a work related scar or reduce the discomfort of a work related scar. If your doctor says it’s reasonable and necessary, it should be covered.
Bottom line is that you shouldn’t be surprised if they fight a cosmetic or plastic surgery, but like any other bogus denial, if the facts are in your corner you should ultimately prevail.
