After having a surgery, you’re entitled to a period of 100% total disability and the pay that matches that “Degree of Disability” at 100%. However, in most cases, the carrier will not immediately pay that rate until the operative report has been submitted both to 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 this claimant has had a surgery and the carrier should commence payments to that claimant going back to the date of surgery.
The operative report isn’t a report that comes out within a day or so after the surgery. With that being said, it is often completed for some time before it is posted, so accessing that report via your Patient Portal or submitting a formal request for medical records to the surgeon’s office is sometimes required. After receiving and processing the RFA1, the Workers’ Compensation Board will schedule a hearing. The carrier will then either begin payments to the claimant proactively or simply wait for the hearing and a court direction to do so.
The differences in how long this takes are based on whether or not the carrier waits for the hearing and a direction to pay, whether the Workers’ Compensation Board will issue a Proposed Notice of Decision (in lieu of a hearing) directing the carrier to pay at the Total Disability rate or if the carrier decides to pay based on the operative report being posted without a hearing.
The best case scenario is that the carrier is “proactive,” looks for the operative report and pays the appropriate rate without 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 help this process by making sure your doctor’s office has posted the operative report as soon as it is available. That way, at least you’ve commenced the process.