What Happens When You Refuse Treatment on Your Work Comp Claim

By Jason Weinstock on July 1, 2013

 Nevada injured workers with neck or back injuries frequently ask about what will happen to their claim if they refuse a particular treatment recommendation.   Usually those Nevada injured workers have not noticed improvement in their neck or back injuries after several sessions of physical therapy, medication  and job restrictions. Their treating doctor may then refer the patient for an epidural injection, an invasive procedure.  Or, perhaps the injured worker already  had one or more epidural injections that did not help, and the treating doctor next recommends surgery.  What happens to the claim if the injured worker doesn’t want an epidural injection or surgery? 

An injured worker has the right to refuse injections or surgery.  The adjuster or treating doctor cannot threaten to cut off benefits if the claimant doesn’t want to risk the side effects of an injection, or simply doesn’t like needles, or does not want to undergo surgery. 

However, be aware that there are only several treatment options for neck or back injuries that are routinely authorized by industrial insurers. (Treatment guidelines rarely allow for experiemental or controversial treatments.)  A treating  doctor cannot keep a claim open indefinitely if  the patient is not getting any active treatment and the  injury isn’t getting any better or any worse. Therefore,  If there isn’t anything else your doctor has to offer you  after you decline particular treatment, your doctor will have to state that you have reached a point of maximum medical improvement (MMI).   

Once you are MMI, the doctor checks a box on the physician progress report to let the adjuster know whether you have a likely ratable impairment and whether you have permanent work restrictions.  The claim then closes because there is nothing left to be done medically for you (except perhaps to prescribe more pain medication).  

I have seen cases where a treating surgeon has reported to the adjuster that the injured worker should not get rated for permanent impairment because the patient refused surgery.   Surgeons are wrong to report that there is no ratable impairment  solely because the patient declines surgery.  If the patient has continuing pain and loss of range of motion,  with positive findings of an injury on a MRI, the patient has a likely ratable impairment, regardless of whether surgery is declined. 

While an injured worker can choose whether or not to have particular treatment, he or she cannot prolong getting compensation benefits if there isn’t anything else the doctor can do.  The doctor will usually allow the patient a reasonable period of time (2 to 4 weeks) to decide whether or not to get an epidural injection or to have a surgery.