AFGE recently helped a member recoup about a half-million dollars in medical fees after the Department of Labor rescinded its approval for the member to undergo surgery to correct an on-the-job injury – after the surgery had already been performed.
The Bureau of Prisons employee had a workplace injury in 2014 and exhausted all other options to address her pain before agreeing with her medical provider’s recommendation in 2023 to undergo spinal surgery.
The Department of Labor approved the worker’s request for back surgery in November 2023 but then rescinded the approval a year later – after the surgery had been performed – claiming that the medical documentation provided by the worker’s medical provider was insufficient to justify the surgery as a response to the workplace injury.
“It’s becoming more common where they’re denying everything, it makes it much harder for us because we have to take everything to hearings,” AFGE Deputy Director of Workers Compensation Joe Mansour said.
The employee had to file multiple appeals challenging the decision before a hearing officer sent the claim back for further review, finding that the claims examiner had failed to share the medical documentation affirming the need for the surgery with the Labor official responsible for reviewing the case.
Due to the denials, the worker accrued more than $500,000 in medical debt and was in danger of having to pay back the workers’ compensation leave she had taken while recovering, Mansour said.
Members in need of assistance filing workers’ compensation claims related to on-the-job injuries can email Joe Mansour at [email protected].
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