Getting MRI and Surgery Approved Under Workplace Injury Workers Comp

## When Workers Comp Denies Medical Treatment After a Workplace Injury

One of the most frustrating experiences for injured workers is when the workers compensation insurer denies authorization for MRIs, specialist referrals, or recommended surgery. These denials are common because medical costs represent the largest expense category in workers comp claims, and insurers routinely deny treatment to limit payouts — even when the treatment is medically necessary.

Insurance companies have utilization review nurses and physicians whose explicit job is to find grounds to deny or delay your medical treatment — regardless of what your doctor recommends.

How to Fight Workers Comp Medical Treatment Denials

When a workers comp insurer denies your requested treatment, you have the right to challenge that decision through your state's workers compensation appeals process. In most states, you can request an expedited hearing specifically for disputed medical treatment, which places the insurer's denial before a workers comp judge relatively quickly.

• Obtain a written denial with the specific reason for rejecting your treatment
• Ask your treating doctor to write a detailed letter of medical necessity supporting the treatment
• Request an independent medical review through your state's workers comp system
• File a formal appeal — insurers often approve treatment rather than defend denials at hearings

Surgical denials for conditions like herniated discs, torn rotator cuffs, torn ACLs, and spinal stenosis are among the most contested medical disputes. Your attorney can compel the insurer to authorize necessary treatment by threatening litigation or requesting an emergency hearing. Delays in surgery caused by insurer obstruction are sometimes used to support claims for additional damages.