Can Workers' Comp Deny Benefits for a Surgery You Already Had?

Can Workers’ Comp Deny Benefits for a Surgery You Already Had?

If you’ve been injured at work in Wisconsin, you might assume that once your workers’ compensation claim is accepted, your medical treatment will be covered.

But what happens if you undergo surgery for your work injury and, afterward, the insurance company argues that the surgery was not actually related to your workplace accident?

That question was addressed in Kimberly Brown v. Shirley Gregory & Jose Vaz, Sangria’s Mexican Grill, a 2025 decision from the Wisconsin Labor and Industry Review Commission.

The Key Takeaway

The Brown decision reinforces an important protection for injured workers:

An insurance company cannot necessarily wait until after an invasive procedure has occurred and then rely on a later medical opinion to avoid responsibility for that procedure.

Wisconsin workers’ compensation law provides specific protections when an injured worker undergoes an invasive procedure in good faith based on medical advice.

Under Wis. Stat. § 102.42(1m), an employer or insurance carrier may still be responsible for compensation related to the procedure and its effects, even if a dispute about causation arises later. Importantly, § 102.42(1m) applies only to benefits owed to the injured worker and does not prevent the insurance company from disputing medical expenses.

Timing Matters

One of the most important issues in Brown was when the medical dispute arose.

At the time of the invasive procedure, there was no medical opinion disputing the connection between the procedure and the work injury. The procedure had been recommended by the injured worker’s doctors, and the worker underwent the procedure in good faith based on that medical advice.

The dispute came later

LIRC determined that a medical opinion obtained after the procedure could not be used to go back in time and undo the responsibility that existed when the invasive procedure was performed.

In other words, a later disagreement about causation does not automatically erase responsibility for an invasive procedure that was performed when there was no medical dispute about its connection to the work injury.

What Injured Workers Should Know

If your doctor recommends surgery or another invasive procedure following a work injury, it is important to understand:

• Whether your workers’ compensation claim has been accepted;
• Whether your treating doctors have recommended the procedure;
• Whether the procedure is related to your work injury; and
• Whether the insurance company has raised a medical dispute about that connection before the procedure takes place.

These issues can significantly affect your rights and benefits under Wisconsin workers’ compensation law.

Bottom Line

The lesson from Brown is straightforward: an employer or insurance company cannot necessarily avoid responsibility for an invasive procedure simply because it obtains a favorable medical opinion after the procedure has already been performed.

For injured workers, the timing of a causation dispute can make all the difference.

Have questions about your workers’ compensation claim or medical treatment? Don’t hesitate to contact our Madison workers’ comp lawyers or Milwaukee workers’ comp team for help understanding your rights.