Has Your Doctor Recommended Lumbar Fusion Surgery? You’ll Have Some Hoops to Jump Through, But We Can Help!

Help with the BWC for lumbar fusion After years of pain and ineffective treatment for excruciating lower back pain caused by a work-related injury, your doctor is recommending lumbar fusion surgery. You're not considering this option lightly, but if it finally brings you relief, you're ready to try it.

However, for this procedure to be covered by workers’ compensation, you must meet specific protocols.

Why Lumbar Fusion Surgery?

Back pain is often caused by damage to the spongy material between the vertebrae in your spine. When an injury causes these discs to swell or bulge, they can pinch nerves in your back, causing radiating pain or sciatica. When a disc bursts—also called a herniated disc—there's no cushion between the vertebrae, and the pain can be debilitating.

Sometimes, the only way to alleviate the pain is to remove whatever is left of the spinal disc and fuse the two vertebrae. This procedure protects the nerves and stabilizes the spine. When the lower, or lumbar, region of the back is affected, the process is known as lumbar fusion.

What Kind of Workplace Injuries Could Require Lumbar Fusion?

How can you injure your back at work? Let me count the ways! Back injuries are among the most common workers’ compensation claims in Ohio every year. It’s not surprising, given the many ways employees can hurt their backs on the job.

Some typical causes of injury we see include:

  • Lifting and twisting. Any job that requires you to lift and move objects will be hard on your back. Years of labor can take a toll on your spine, but you can also herniate a disc in a single incident. Either way, the pain and loss of motion can prevent you from working.
  • Standing and sitting. The hours of standing that retail clerks and factory workers endure are hard on the spine, particularly the lumbar region. Likewise, sitting at a desk for multiple hours a day can also cause irreversible damage to your lower back.
  • Falls. The most common workplace injuries across most industries are falls. Whether you slip or trip and fall on level ground or fall from a scaffolding or platform, you can suffer a spinal fracture that requires surgery one day.
  • Whiplash. Commonly caused by motor vehicle accidents, whiplash can also result from a fall, forklift accident, or being struck from behind by a person or falling object. Whiplash typically affects the neck, but the low back can also be damaged in a whiplash incident.

While these accidents are common in multiple workplaces, many people with chronic back pain can’t pinpoint a single incident that damaged their back. They are merely suffering after years of wear and tear. However, when the disability can be linked to your job duties, you can build a claim for workers’ compensation to cover your medical treatment and lost wages.

How Can You Get Approved for Lumbar Fusion Surgery?

Two years ago, the Bureau of Workers’ Compensation (BWC) in Ohio made getting workers’ comp coverage for non-emergency lumbar fusion surgery more complicated. This means that even if your doctor thinks this is the best treatment option for you, you must jump through a lot of hoops to get the surgery approved. These rules will not apply if you need emergency surgery for a back injury. However, to schedule elective back surgery, you would have to meet these requirements:

  • You had at least 60 days of conservative treatment, including taking anti-inflammatories, rest, ice, chiropractic treatment, and physical therapy.
  • You were evaluated by the surgeon at least twice before requesting authorization for lumbar surgery. One visit must have been after the 60 days of conservative care.
  • Your evaluations include a long list of tests and assessments.
  • If you haven't had previous lumbar surgery, you must provide documented proof of your medical diagnosis of a lower back injury or disability.
  • If you have a history of lumbar surgery, you must also meet specific criteria to prove that an injury, deformity, failed hardware, or another cause of pain or a physical limitation exists.

These rules complicate the process of getting approval for what may be an essential surgical procedure. Still, at Monast Law Office, we've worked with these requirements for over two years now, and our experience will help you get the relief you need, and your doctor has recommended.

Call Me to Talk About Your Lumbar Fusion Surgery

Whether you're already getting workers’ comp because of a back injury or you need to file a new claim, my team can help. When facing a long and challenging process like approval for lumbar fusion surgery, nothing beats our 30-plus years of experience with Ohio workers’ comp law. Learn more about us and workers’ compensation by requesting a free download of my book, and then call or fill out my contact form today. 

 

James Monast
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Fighting for Ohio’s Injured Workers and their Families