Often, a medical opinion will be needed from a doctor other than the injured worker’s treating physician. There any many reasons why this would be. However, not all second opinions are required to be covered by the workers’ compensation insurance carrier.
A second opinion can be needed because your treating physician wants the second opinion. He or she may want confirmation that his or her diagnosis is correct, or, the treating physician may just not know what the diagnosis is and is looking for assistance but does not want to transfer treatment to another provider yet. If your treating physician asks for the second opinion, then the workers’ compensation insurance carrier will be responsible for paying for the second opinion. It is always best if your treating physician makes a referral to a specific doctor so there is no question as to who your treating physician intended for you to see. It is more likely, if your treating physician just suggests a second opinion from a specific specialty, but does not give you the name of a doctor, that the workers’ compensation insurance carrier will either just schedule the appointment with a doctor of their choice or give you a list of doctors off of which you can pick. If you have an attorney, be sure to let your attorney know so the attorney can be sure that a list of doctors is given. You want to be sure to avoid having the workers’ compensation insurance carrier pick the doctor, as they will pick a doctor they would normally use for an Independent Medical Exam.
A second opinion can also be had because the injured worker wants a second opinion. Whether the workers’ compensation insurance carrier has to pay for the opinion depends on whether the carrier agrees to the opinion. Believe it or not, there can be times when the workers’ compensation insurance carrier and the injured worker agree on treatment. One such example is when the treating physician has recommended surgery but the injured worker wants to be more cautious. For the most part, workers’ compensation insurance carriers want to save money and not paying for a surgery will save them money. Another example of when the workers’ compensation insurance carrier will agree to a second opinion is when the treating physician’s treatment does not appear to be making much progress in returning the injured worker to work. Again, workers’ compensation carriers save money when they can get you back to work, so they will often agree to a second opinion if they think it will get you back to work sooner.
The injured worker can always get a second opinion if the injured worker intends to pay for the doctor’s opinion on his or her own. However, if the workers’ compensation insurance carrier does not agree to the second opinion and the treating physician does not agree with the recommendations made by the second opinion doctor, the workers’ compensation insurance carrier will never have to pay for the recommended treatment or the treatment from that physician.
The risk involved in getting a second opinion, regardless of whether the workers’ compensation insurance carrier pays for the second opinion or not, is that the recommendations may not be what you want to hear. If it is not, then there will be a written medical opinion for the workers’ compensation insurance carrier to rely on when taking positions on what treatment you can have. This can result in lengthy litigation.
Consider whether a second opinion is truly what you want. If so, be sure to talk to your attorney about how best to proceed with getting it.
The Injured Workers’ Law Firm is a Richmond, Virginia based firm solely focused on serving clients with workers’ compensation claims in Virginia. If you have questions about your benefits or if you would like more information on the Virginia workers’ compensation system, order our book, “The Ultimate Guide to Workers’ Compensation in Virginia,” or call our office today (804) 755-7755.