When you are injured or become ill on the job, you file a Workers’ Compensation claim. It covers your medical treatment and other expenses. However, you may not get the treatment or care you think you deserve. Consider when and how to get a second opinion.
Roadblocks to a Second Opinion
It’s normal to get a second opinion before a major surgery. However, you may feel uncertain about getting a second opinion regarding a Workers’ Compensation claim.
First, the list of doctors you can see when you file a Workers’ Compensation claim is short, and you may only have one approved option.
Also, your benefits are determined by your employer’s insurance company, and the insurance company could deny your request for a second opinion.
Every state has different Workers’ Compensation laws, too, making second opinions okay in some states but not in all states.
While these roadblocks are legitimate, you could still pursue another opinion as you manage your health and take care of yourself.
When to Seek a Second Opinion
You could consider seeking a second opinion if any of the following conditions apply.
-
- You don’t feel like your doctor listens to you.
-
- Your doctor has recommended surgery, and you’re uncertain about proceeding.
-
- You’re still in pain even though the doctor says you’re fine.
-
- Your doctor wants you to remain on restricted duty even though you feel better.
-
- Your doctor agreed to restriction changes based on recommendations from the insurance company’s Nurse Case Manager.
-
- You don’t trust your doctor for any reason.
How to Pursue a Second Opinion
To pursue a second opinion, first check your state’s Workers’ Compensation statute. It typically states your rights to a second opinion.
You can also contact Human Resources. They can assist you in discerning your rights to a second opinion and then assisting you in starting the process.
If Your Second Opinion is Denied
The insurance company may deny your request for a second opinion. In this case, you can visit another doctor of your choice. However, you could face several challenges.
The insurance company may not accept your doctor’s recommendation. The company may also stop paying your medical bills, especially if the second physician disagrees with the Workers’ Compensation doctor.
Your personal insurance also may not cover the doctor visit because it was originally covered under a Workers’ Compensation claim. You could end up paying out-of-pocket for this exam and other treatment.
Getting a second opinion regarding your Workers’ Compensation claim can be challenging. However, you may have options. Contact your Workers’ Compensation insurance company for more details on ensuring you receive the treatment you need and deserve.
