When You Should Get a Second Opinion for Your Workers’ Comp Claim

Insurance companies are in the business of saving money. They want to pay you as little as possible for your workers’ compensation claim. Unfortunately, that can also mean denying you medical treatment as well.

Insurance adjusters work with the same doctors and medical professionals over and over again. They know the treating doctors that they have selected to be on their panel of available doctors are likely to give injured workers a more conservative opinion about treatment and disability rating. In some situations, those conservative opinions are not fair or accurate. Getting a second opinion can help you address some of those issues.

Why Should I Get a Second Opinion for My Workers’ Compensation Claim?

Here are some common reasons for getting a workers’ comp second opinion:

  • Your treating doctor thinks that you do not need surgery or further treatment
  • You disagree with your course of treatment
  • Your treating doctor does not think your injury is work-related
  • The treating doctor is underestimating your disability rating
  • Your treating doctor asked for a second opinion

You may also just be uncomfortable with the treating doctor or feel like you could be getting better medical treatment as an injured worker. A second opinion will help you address these issues.

Treating Physician Requested an Independent Medical Examination (IME)

If your treating doctor asks for a second opinion, it is either because your condition is outside of their area of expertise or you are ready for an IME.

An IME or independent medical examination brings in another doctor to examine you and your medical records. That doctor will then answer questions related to causation and how the work injury has affected your functional abilities and create a report that will be used in your workers’ compensation case.

Ultimately, an IME will provide you with a functional impairment rating that the insurance company (and the workers’ compensation judge, if your case goes to trial) will use to determine how much benefits you should receive to compensate you for your work injury. As a result, the medical opinions that a doctor provides during an IME are very important for your workers’ compensation case.

The employer or their workers’ compensation insurance company will not send you to an IME doctor until you reach maximum medical improvement or MMI. However, an insurance company can request a second opinion through an IME every six months under Pennsylvania law.

The Patient (Claimant) Requested a Second Opinion

You can also request a second opinion as well. If, for example, your treating doctor recommends surgery, you have the right to get a second opinion to be sure that the surgery is reasonable and necessary.

Injured workers have a unique ability to choose their treating doctor in Pennsylvania. After 90 days of working with the insurance company’s doctor, you can get medical care with your choice of doctor in many cases. Making this switch sometimes starts with getting a second opinion on your work-related injury, work restrictions, surgery, or another issue.

One of the most common reasons that injured workers get a second opinion is if their treating doctor is telling them that it is time to go back to work, but they do not feel ready. If that is happening to you, then getting a second opinion is probably a good way to help you avoid further injury or damage.

How to Get a Second Opinion for Your Workers’ Comp Claim

You are only automatically entitled to a second opinion in your workers’ compensation case if the insurance company’s doctor recommends surgery. The insurance company must also pay for this second opinion as well. However, you can treat with a different doctor after using the insurance company’s doctor for 90 days.

To get a second opinion about surgery, you should first tell your employer or their insurance company that you want a second opinion and which doctor you would like to use. They will approve of the appointment before you attend.

If your treating doctor wants a second opinion through an IME, then the workers’ compensation doctor will simply make those arrangements with the insurance company. The adjuster for your workers’ comp case will then let you know where to go to participate in the IME.

Questions About Second Opinions? Talk to a Workers Compensation Lawyer

If you want a second opinion about your treatment or any other issue in your workers’ comp case, expect some pushback from your employer and their insurance company. Having a workers’ compensation lawyer to walk you through this process can be a great help. Your attorney can ensure that you follow the right steps to request additional treatment, so you do not get hit with unexpected medical bills.

At Krasno, Krasno, and Onwudinjo, we take our attorney-client relationship with you very seriously, and we provide sound legal advice that will help you get the medical treatment you need for your claim. Call today to get more information or to set up a free consultation.

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