Timely intervention and recovery is beneficial to patients with chronic disabling occupational musculoskeletal disorders (CDOMD). Therefore a Surgical Option Process (SOP) was developed for use in a functional restoration program (FRP) to allow CDOMD patients who were undecided about elective orthopedic surgery to participate in interdisciplinary rehabilitation, rather than suspending treatment, until the surgical option could be resolved. A consecutive cohort of 295 CDOMD patients with an unresolved surgical option was admitted to a FRP, and determined their surgical preference at FRP midpoint. The majority of patients declined surgery (DS, N=164) and were invited to complete the FRP. The remainder elected to pursue surgery and either underwent surgery (US, N=43) or had their surgical request denied (RSD, N=38). In the post-FRP year, only 0.8% of patients reversed their original decision and underwent surgery. Patients whose surgical preferences were accommodated (i.e., the DS/US groups) demonstrated significant psychosocial improvement and excellent socioeconomic outcomes; which were similar to those of FRP patients without a surgical option. RSD patients had poorer outcomes than the other groups, but still outperformed FRP dropouts. This suggests that the addition of a formal SOP to an interdisciplinary FRP facilitated the surgical decision-making process and helped prevent delayed recovery.