Start with the issue actually in dispute
Surgery denied is mainly a problem of medical necessity and review process. Build the file around the written notice, dated record, or event that created the problem.
Documents to gather
Surgical recommendation, denial/utilization-review notice, imaging, prior treatment, and specialist rationale.
Questions to answer before acting
- What changed, on what date, and who made the decision?
- Is there a written notice or only a phone conversation?
- Which medical, wage, employment, or incident record directly addresses the dispute?
- What state or federal agency procedure controls the next step?
- Is there a separate employment, third-party, leave, or discrimination issue that should not be mixed into the workers’ compensation question?
Important caution
Identify the exact medical-review reason and the procedure for challenging it.