After having a surgery for a work injury, you are entitled to a period of 100% Total Disability and the pay that matches that “Degree of Disability” at 100%. However, in most cases, the insurance carrier will not immediately pay that rate until the operative report associated with the surgery has been submitted to both the Workers’ Compensation Board and to the carrier. Even at that point, it is usually a “Request for Further Action,” or an “RFA1,” that signifies to the Workers’ Compensation Board and to the carrier that the claimant has had a surgery, and that the carrier should commence payments to the claimant going back to the date of the surgery.
The operative report will probably not be posted by the surgeon's office immediately after the surgery. Even if it has been filled out and completed, it can take awhile for it to be posted. Therefore, you may need to access it via your Patient Portal and/or submit a formal request for medical records to the surgeon’s office in order to obtain the report in a timely fashion. After receiving and processing the operative report and the RFA1, the Workers’ Compensation Board will schedule a hearing. The carrier will then either begin making payments to you proactively, or it will wait for the hearing and a court direction to do so.
How long it will take the carrier to pay you Total Disability lost wage benefits after the surgery will ultimately depend on whether the carrier waits for a hearing and a direction to pay, whether the carrier proactively decides to pay based on the details in the operative report instead of waiting for a hearing, and whether the Workers’ Compensation Board issues a Proposed Notice of Decision (in lieu of a hearing) directing the carrier to pay at the Total Disability rate.
The best case scenario is that the carrier is “proactive”, looks for the operative report, and pays the appropriate rate without a hearing or direction of the Court. However, relying upon the carrier to be “proactive” may leave you waiting weeks for your lost wage benefit check. You can move this process forward by making sure your doctor’s office posts the operative report as soon as it is available. That way, at least you’ve commenced the process.
The experienced Workers' Compensation lawyers at MCV Law are here to help. If you are looking to have the insurance carrier pay you the full amount of benefits that you deserve after a surgery, connect with our office today. We can inform you of the necessary steps you will need to take, and inform you of ways that you may be able to quicken the process.