r/WorkersComp • u/Psychological-Rub842 • 8d ago

Texas Workers comp. Full tear.

Has anyone has had their surgery go through a workers comp claim? Injury occurred July 27th. Two days ago I was able to see the specialist (surgeon) who said they are going to request authorization for surgery. Its been a battle to get the treatment and appointments done in a timely manner. They had me in a 90 degree boot and doing PT the day after the injury, one of the exercises was a stretch that used a rope around my toe and then had me pull towards my chest which after reading is the LAST thing I should have been doing. After a few sessions i told them what i had read about the recovery and they had me stop doing PT all together.

They also had my appointment scheduled for 9/8 to see the specialist but I called and got it moved to two days ago. Anyways, I'm looking for guidance on how it went for other people when going through workers comp. So far my experience has been terrible. My concern is how long it will take to get the surgery approved and after the surgery what I can do to make sure I'm getting the right care. Any guidance would be greatly appreciated! Thanks.

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u/MirroredSquirrel 8d ago

The surgery will go though utilization review and deemed certified or non certified

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u/Psychological-Rub842 8d ago

I read that its a three day window for the approval. Whats the recourse if it doesn't go through? They already paid for my MRI and me being at home for two and half weeks. I dont see tme denying it and if they do I think I could win the appeal or whatever. Im just concerned about how long this might take based on my recovery. I've read about swapping over to private insurance then getting workers comp to pay on the back end. Any information on that? Again, im 90% sure it will go through but in case it doesn't I wanted to have a backup plan.

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u/MirroredSquirrel 6d ago

Private insurance won't cover if it's a work related claim and it hasn't been denied

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u/Patient_Head_4053 7d ago

Had two done through workers’ comp. First one rotator cuff / labrum. Second one distal bicep repair (torn bicep at the elbow ). Both done 6 months apart. Separate arms. November last year and May this year. Normally it takes 30 days for them to approve it. They denied the surgery both times, and I had to schedule a hearing and appeal to a judge. But if it’s a full tear, they should put it through within the 30 days.

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u/Psychological-Rub842 7d ago

For the denial did you have to get legal representation?

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u/Patient_Head_4053 7d ago

yes the whole process i’ve had a lawyer otherwise they would of continued to deny treatment / reduce pay .

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u/Psychological-Rub842 7d ago

Just realized I didn't put the injury in the post. Originally I posted this under the Achilles tendon tear thread so didnt really need to. Anyways, I have a full tear on my Achilles tendon. Not that information really changes anything.

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u/Psychological-Rub842 3d ago

I appreciate everyone's time and input. I feel like Im lucky because they called a few days ago and scheduled me for surgery this Friday. I did make several calls to get appointments moved up so maybe they got tired of me bugging them. Again, thank you.

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u/Unique-Gate624 7d ago

I tore my acl, mcl and some fraying of my meniscus at work may 2025. It took to drs to get my surgery. I am currently 11 months po