My Insurance Company Is Refusing to Pay for Surgery. What Do I Do?


After being in a car accident, you need to focus on getting well, but what if your insurance company is fighting against you? Unfortunately, situations like this are far too common and as a car accident attorney, I receive a lot of questions about them. Here are some frequently asked questions that may clarify your options:

What is my insurance company supposed to pay for?

After an accident, you can open a claim with your insurance company and they will provide you with a claim number that can be used by your doctor for billing purposes. The doctor’s office will then submit the bills to your insurance company for payment. However, each insurance policy typically has limits regarding what they will or will not pay for and to what extent. Many accident victims reach one of these thresholds long before they have recovered.

How will I get a procedure paid for that has not been approved?

If you have reached a limit where the insurance company is not paying anything further, or they are simply denying your request for a procedure, the best way to handle it is to call an attorney. You can schedule a consultation with my office and I can review your case and your options. I can start by trying to negotiate with them, but very often, you will have to file a lawsuit in order to receive the full compensation you deserve. However, if the procedure is urgent for your health, you may want to have your current health insurance pay for it. We can then seek reimbursement for your expenses through the lawsuit later. The bottom line is that your health is what is most important, so you need to follow your doctor's advice and receive the care they recommend.

Will the other driver's insurance pay for my procedure?

As a car accident attorney, I am constantly working to prove negligence. This is the legal theory for who is at fault or to blame for the crash. If the other driver was more negligent than you, their insurance company should have to pay for your medical bills, lost wages, and other damages related to the accident. Typically this is sorted out during the trial. As an attorney, my job is two-fold. I need to prove that the other driver was negligent (at fault) and the extent of your injuries and financial damages so that the value of your claim can be established. Through this process, your medical bills should be paid for by the appropriate party, and whatever your insurance company has paid to date may then be reimbursed by the other driver’s insurance company.

How long is this going to take?

That really depends on the details of your specific situation. As a car accident lawyer, I encourage people to hire an attorney immediately after an accident so that if something like this comes up, the case is already proceeding and negotiations have begun, making it both faster and easier to work through the process of either getting the surgery approved or going to court. When you come in for a consultation, I can give you an idea of how long it may be before your case can go to trial.