Four Times You Or Your Employer May Seek A Second Opinion In Your Workers' Compensation Case

28 August 2015
 Categories: Insurance, Articles


If you have been injured on the job, you want to make sure you obtain medical care as quickly as possible. This medical treatment, as well as future medical appointments, should be paid for by your employer's workers compensation insurance. Depending on where you live, this may also give your employer the right to choose your doctor. But what happens when you do not feel you are receiving adequate care, or you disagree with the opinion of the doctor? You are entitled to a second opinion, but you are not the only one who can ask for one, your employer can ask for a second opinion as well.

Whose Physician Is It?

Depending on the state you work in, your treating physician may be chosen by your employer, while other states leave the choice of treating physician up to you. Even if you are allowed to make this choice, some insurance companies may still require the physician to be within a certain network, or even on a certain list.

Unfortunately, your personal physician may not always qualify. This is because any physician you see for a work related injury must be approved by the workers' compensation insurance company, and be willing to accept insurance payments from them. Many times the roles of a workers compensation physician goes beyond treating your initial injury. They are often expected to:

  • Dictate work related restrictions
  • Authorize time out of work
  • Fill out forms and paperwork
  • Testify pertaining to your treatment and injury, and more

Many physicians are unwilling, or even unable to do the duties required to treat a work related claim.

When Should There Be A Second Opinion?

No matter who chooses the treating physician, the other party has the right to request a second opinion, and there are times this will happen. 

When you are not making the expected progress - Both you and your employer have a vested interest in you getting better. You want to get out of pain and get on with your life, and your employer wants you to return to work. But in some cases you may not be making the progress that someone with your diagnosis would be expected to make. This may be due to:

  • You have additional injuries that have not been diagnosed and are not being treated
  • Your injuries are more severe than they initially seemed to be
  • You are malingering and are deliberately attempting to stay out of work

In all of these cases, you or your employer may seek a second medical opinion to see if another physician may be able to get you to progress further than you currently are.

When there is a disagreement with your permanent restrictions - One of the roles of a workers' compensation attorney is to determine what job duties someone can and cannot do with the types of injuries you have incurred. This is referred to as work restrictions.

If there are results of your injury that are expected to last indefinitely, these restrictions may become permanent. This may affect not only how you do your job, but whether or not you are able to do your job at all. If you or your employer disagree with these restrictions, or feel that they are unnecessary or unreasonable, it may be necessary to seek a second opinion.

When you are ready for a maximum medical improvement exam - If your treating physician feels that you are at a point in which you will not make any more medical improvements, your employer may require you to submit to a maximum medical improvement exam.

This exam is generally performed by an independent medical doctor and not your treating physician. This doctor will not only perform a physical exam, but will also perform a review of any medical documentation. 

When there is a disagreement with your impairment or disability rating - If you do not fully recover from your injuries, it may be determined that you have an impairment or a partial disability. If this disability is deemed to be permanent, it may mean that you will never be able to perform your job, or participate in life, at the level you did prior to the injury. 

In these cases, a percentage of disability or disability rating is established. This disability rating will determine how much compensation you will be able to receive either through an ongoing, or a lump sum payment. 

Needless to say, if this applies to you, you want your disability rating to be as high as possible. Your employer's workers' compensation insurer will try to keep this rating as low as possible to lessen the amount of payout they will be responsible for. 

Either of you has the right to request to challenge the rating by requesting a second opinion. In some cases this may be in the form of a maximum medical improvement exam.

These are only a few of the times a second opinion may be in order. Each workers' compensation case varies and presents unique challenges that may necessitate a secondary medical opinion. Just remember, you are entitled to receive one.