Getting a Second Opinion is Recommended
In California, a worker’s right is to get a second medical opinion, and cannot be denied.
California’s Workers’ Compensation system allows for a second opinion if you are unhappy with your primary care doctor’s assessment. A second opinion involves consulting with a different doctor from the one the patient has been seeing. The decision may concern surgery, impairment, limits, or even the appropriateness of providing conservative treatment as part of a workers’ compensation claim.
When your employer’s insurance company agrees to pay for your medical care after an on-the-job injury, they can dictate which doctors you see. Some insurance providers have been known to send you to doctors who may rush you back to work before you feel ready, all so they may cease paying your benefits and pocket the difference. Hence the need for a second opinion.
Instructions For Seeking a Second Opinion on Your Workers’ Compensation Case
If the insurance company’s doctor suggests surgery as a treatment for your work-related injury, only then are you entitled to a second medical opinion as part of the workers’ compensation process. This second opinion is something the insurance company should cover.
Tell your employer or insurance provider you want a second opinion and specify which physician you want to see before surgery. Before you show up, they’ll have to give the appointment the green light.
The workers’ compensation physician will coordinate with the insurance provider to secure a second opinion from an IME if your primary care physician requests one. Your workers’ compensation case adjuster will direct you to the appropriate location for the IME.
One should not confuse a second opinion with an IME
A medical examination your insurer orders may be required (IME). A conventional IME, however, is designed to profit the insurance company. The firm chooses whose doctor you will see; often, this doctor routinely collaborates with the business and may be financially incentivized to provide favorable results.
Insurance companies can utilize IME results to justify a claim denial. Before consenting to such an evaluation, you should consult with an attorney. You are permitted to bring an attorney or witness to the examination, and you may videotape the entire process if you so choose.
Select a competent specialist, and arrange a visit to review your medical history and injuries. In other words, this medical professional will be financially motivated to take excellent care of you. It would help if you used this expert opinion to support your case to receive a reasonable settlement.
Can you pick your medical provider?
Under the guidelines set by the California workers’ compensation legislation, you can select the physician who treats you. There are, however, limitations and constraints to this privilege; it cannot be exercised without regard to these. The initial condition is that the treated injury falls under the purview of workers’ compensation insurance. An injury suffered on the job or while performing official business for your company outside the office is considered. They pay for everything that comes from those wounds, too.
Immediately after an accident, you will not have the opportunity to choose your favorite doctor at the last minute. It would be best to predesignate a physician before you can legally see them. That doctor’s name and contact information must be communicated annually in writing to your employer.
A company’s insurance provider may impose limits on the company’s private network size. Further, if you end up seeing that doctor, you’ll need your own health insurance to pay for your care outside the scope of your employer’s policy.
Signed statements, employer-supplied forms, or DWC Form 9783 need only be submitted if you meet the requirements to predesignate your doctor. The DW form 1194 may be required of you in certain scenarios. In addition, there are requirements that the doctor you select meets before you can predesignate them as your primary care physician.
Your claim for workers’ compensation may be denied if you do not follow the required procedures. Although, you shouldn’t blindly believe whatever your employer or doctor tells you. Always consult a workplace injury lawyer to ensure you are well-informed of your legal options. When a client needs a second opinion from a workers’ compensation doctor, Personal Injury Lawyers have dealt with these cases before.
California employment cases can be complex. Your employer will likely fight back. You need someone on your side to protect your rights and get the money you deserve.
Call Setyan Law at (213)-618-3655 for a consultation.