5 Things Workers’ Compensation Insurers Consider Before Approving Knee Replacement Surgery
How old is the injured worker? The older the worker is, the more likely he or she will have underlying arthritis in the knee causing the insurer to investigate further or deny authorizing the surgery.
Has the injured worker had previous treatment for any a knee injury? No treatment is better than some treatment. Recent treatment raises red flags.
Has the injured worker undergone a previous MRI of the knee? If so, the insurer will compare the old MRI with the new MRI to see if there are significant changes that could be either accident related or degenerative in nature.
Was the injured worker able to perform a very physical job for a number of years before the work-related accident took place? If he or she can no longer perform the same job duties, the chances of knee replacement surgery being approved are better.
What were the specific details of the work-related accident? Activities that are more knee intensive or an accident that involved significant trauma to the knee affords the injured worker a better chance that total knee replacement surgery will be approved.
In almost all knee replacement surgery cases, the injured worker will want to schedule an Independent Medical Evaluation with a specialist who will support his or her position that the work-related accident aggravated or accelerated the underlying knee condition. The insurer will also send the injured worker to an Independent Medical Evaluation doctor of their choice. They hope that their specialist will conclude that the need for knee replacement surgery is based upon arthritis and surgery would have been required even if the accident had never taken place.