What Can You Do When L&I Denies Surgery Authorization? 

Even if your doctor has formally recommended a surgery, getting authorization from L&I can be challenging for injured workers in Washington. This is not only frustrating, but the delay in your much-needed medical treatment may pose a harmful risk. Spencer Parr, Partner at Washington Law Center, has provided some clear and actionable steps to help navigate this situation.

Utilize Any Secondary Insurance

If you have a secondary insurance plan, such as Blue Cross Blue Shield or any other medical insurance, injured workers should use that insurance to get the recommended surgery if L&I has not authorized it yet. Communicate to your doctor that they should bill L&I for the procedure first but if L&I denies payment, you will then proceed under your private insurance. The goal is to get the surgery done promptly so you can avoid any further harm caused by delay. You can then deal with the failure of prior authorization later. 

Avoid Delaying Care

Fighting L&I for surgery authorization can be a lengthy process, potentially taking over a year, and during this time delaying surgery will only hinder your healing process. If nerve damage is occurring, you may never recover if you fail to proceed quickly to obtain the care you need. By opting to move forward under your private insurance you can avoid unnecessary delays in your treatment and focus on your recovery. Your authorization contest can then still be decided at a later date. 

Know Your Legal Right to Fight for Authorization

Even after having the surgery you still have the legal right to challenge the denial of surgical authorization. You must challenge any denial in writing within 60 (sixty) days. If you receive a denial, you should continue to preserve your rights in a timely manner by contesting it through the appropriate channel. Consult an attorney on the most appropriate option for your claim. The available options may or may not include:

• Protesting the decision (in writing) to the Self-Insured Employer;
• Protesting the decision to the Department of Labor & Industries;
• Appealing to the Board of Industrial Insurance Appeals;
• Filing higher court appeals.

Washington Law Center Can Help

If you find yourself stuck or lost in the process, do not hesitate to call Washington Law Center and speak to one of our experienced L&I attorneys. As one of the largest workers compensation firms in Washington State we have extensive experience in getting injured workers the medical authorizations they need. 

It can be challenging and disheartening when an injured worker is facing a denial of surgery authorization from L&I, but do not let bureaucratic hurdles stand in the way of your recovery. Know your rights and do not hesitate to call Washington Law Center to ensure that you receive all of the medical treatment and other benefits to which you are entitled. We are here to support you and fight on your behalf.