One of the fall-outs of Covid has been the rising hospitalizations of patients causing non-Covid patients to have a delay in some treatments.
In one case we were consulted on, a person who needed a relatively routine meniscus surgery, couldn’t get one scheduled for five months. That’s a really long time to have to walk around with pain, but these are crazy times.
He is unable to return to work until the surgery takes place because his job requires a lot of squatting, bending and walking on uneven ground. The insurance adjuster wasn’t happy about this and yelled at both the doctor and the worker for events that are beyond their control. She is threatening to cut off TTD benefits unless the injured worker convinces his doctor to move up the surgery date or he finds a new doctor to do the surgery.
Everything she has done and wants to do is illegal. An Illinois workers’ compensation insurance company can’t dictate when a surgery takes place. They can’t tell you which doctor to use, especially for a surgery. And they can’t cut off your TTD benefits if a surgery doesn’t happen as fast as they want.
It sucks for the worker and the insurance company that the surgery is delayed. But it’s not delayed so he can go on vacation or because he doesn’t feel like having it right now. It’s delayed due to Covid and matters beyond his control.
This is essentially an insurance company temper tantrum. And just like when a child whines for no good reason, you don’t reward them. The only reason to get a new surgeon would be if you are happy with a new one or the pain is so bad you can’t wait. But it’s you that gets to make these decisions, not some insurance company.
And it doesn’t matter if the delay isn’t Covid related or not. We’ve been involved in cases over the last 25 years where a doctor was set to perform a surgery and something happened last minute that caused it to be delayed and have to happen two months later. It could have been a family emergency. It could have been the doctor was sick. It could have been he felt like playing golf. Whatever the reason, an injured Illinois worker isn’t going to get punished because a doctor can’t perform a surgery as soon as everyone would like.