Surgery in Process After an Insurance Company Approval

With everything that you have to worry about after a car accident, the insurance company’s refusal to pay for your surgery may seem like just another inconvenience.

Unfortunately, if you don’t know how to handle the insurance company’s refusal to pay for your surgery, you could have a significant problem.

Why the Insurance Company Is Refusing to Cover Your Surgery

The insurance company may try a variety of different tactics to avoid paying for the reasonable and necessary surgery recommended by your doctor. For example, the insurance company may claim that:

  • You don’t need the surgery because of your car accident injuries. The insurance adjuster may not dispute that you need surgery, but the adjuster may claim that the operation is necessary because of a condition that has nothing to do with your car accident injuries.
  • You made a mistake. The insurance adjuster may say that you didn’t submit the right paperwork or make your claim within the required timeframe.
  • You didn’t get the right medical treatment after the crash. The insurance adjuster may suggest that if you went right to the hospital, saw a different specialist, or attended all of your medical appointments that the surgery would be unnecessary.
  • Your surgery is not reasonable or necessary to treat your injuries. Your doctors, not your insurance company, should make medical decisions.

All of these tactics are used for the same reason. The insurance company wants to maximize the profits it keeps for itself and its shareholders by paying out as little as possible to you and other claimants. The insurance company is looking out for its own best interests rather than yours.

Don’t Accept a Car Accident Insurance Settlement Yet

The fine print on most insurance settlements indicates that once you accept an insurance settlement, that settlement is payment in full for your car accident injuries. You can’t later go back and ask the insurance company or the court for more money. Therefore, if you accept an insurance settlement that does not include compensation for the surgery that your doctor recommends, then you will remain financially responsible for that surgery. You can’t go back and get the insurance company to pay for it once you have accepted any kind of settlement.

For this reason, it is essential that you do not accept any proposed insurance company settlement—either verbally or in writing—until you consult with an experienced Iowa car accident lawyer.

How to Get the Insurance Company to Pay for Surgery

The insurance company knows what it is doing.  Many car accident claimants just accept what the insurance company is saying without finding out the truth about their rights. Remember, regardless of how empathetic and kind the insurance adjuster seems, the insurance adjuster wants to pay you as little as possible to settle your claim. The insurance adjuster is not on your side, but a car accident lawyer is on your side.

Instead of negotiating directly with the insurance adjuster, you should direct the insurance adjuster to your car accident lawyer. Your lawyer can represent your interests in negotiations and make sure that you are treated fairly. If the insurance adjuster insists on denying a surgery that you need, then your lawyer can appeal the insurance company’s decision or take your case to court.

Hupy and Abraham has represented more than 70,000 clients and recovered more than $1 billion in damages for our clients. Insurance companies know who we are and that we mean business. Our reputation, work ethic, and experience make insurance companies more likely to settle with us, but if they remain unwilling to cover your surgery, then we will not hesitate to take your case to court.

If you’ve been hurt in an Iowa car crash, please call us or start a live chat now to schedule a free consultation with one of our car accident lawyers. We welcome your visit to our Cedar Rapids, Des Moines, or Quad Cities, office by appointment or we are happy to come to you if you can’t come to us!

Jason F. Abraham
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Managing Partner, Hupy and Abraham