Can You Get a Second Opinion in Workers Compensation Cases in Virginia?
You are on this site to get information about Virginia workers’ compensation, not to answer questions. But I would like for you to take a quick quiz for me.
Have you ever said or thought any of the following during the workers’ compensation claims process:
- I’m still in pain and experiencing symptoms, but my doctor says there is nothing more that he or she can do for my work injury.
- My doctor changes my work restrictions every time the insurance company’s nurse case manager ask him or her to.
- My doctor recommended surgery but changed his mind when the insurance company’s nurse case manager said that the insurer wouldn’t pay for it.
- I don’t trust my doctor because he won’t spend more than a few minutes with me at each appointment.
- My doctor told me that he has spoken with the insurance company’s attorney about my case.
If any of these thoughts or statements are familiar, then you’ve probably asked, “Can I get a second opinion from another doctor in my workers’ compensation case in Virginia?” In Virginia the answer is yes, but the insurance company may not have to pay for the second opinion from another doctor.
This article explains how you can get a second opinion in your workers’ compensation case in Virginia and how to increase the likelihood that the Workers’ Compensation Commission will force the employer or its insurance company to pay for the second opinion.
If you have any questions about workers’ compensation medical issues, or are looking for help with another aspect of the workers compensation claims process, contact attorney Corey Pollard for a free consultation. We have helped hundreds of injured workers resolve their work injury claims successfully and negotiate valuable workers compensation settlements.
What is a Second Opinion?
So what are we talking about when we refer to a second opinion in workers’ compensation cases?
A second opinion is when a doctor other than your authorized treating physician gives you his or her view about your work injury and how to treat it. The second opinion doctor may give you his or her opinion on a number of issues: whether surgery is necessary; whether you have reached maximum medical improvement and, if so, the date you reached it; the level of permanent impairment you will have and whether you are entitled to permanent partial disability benefits; and, what type of conservative treatment you may need for the remainder of your life because of the work injury.
When Should I Get a Second Opinion in My Workers’ Compensation Case?
A second opinion is useful if you do not feel that your workers compensation doctor is helping you get better following a workplace accident or if you want another opinion about recommended medical treatment before moving forward. It’s common to want a second opinion if surgery has been proposed to treat your work injury.
How Do I Get a Second Opinion in My Workers’ Compensation Case?
There are multiple ways to get a second opinion in Virginia workers’ compensation.
Paying for the Second Opinion Yourself
You can always get a second opinion by going to see a doctor on your own outside of Virginia workers’ compensation. If you take this route, then you have the freedom to see any doctor you want.
You run some risk if you see a second opinion doctor on your own.
First, medical treatment is expensive. The workers’ compensation insurance company is not responsible for the payment of treatment with a second opinion doctor unless certain criteria are met, which we discuss below. And your private health insurance company may refuse to pay for the second opinion appointment if it knows that your treatment is for a work-related injury. Most private health insurance policies contain language that excludes payment of treatment related to a work injury. Therefore, you may be responsible for the payment of medical bills from the second opinion doctor.
Second, the second opinion doctor may render conclusions that are not helpful to your case. Under the Rules of the Workers’ Compensation Commission, you have to turn over all medical evidence, even if it is unfavorable. A negative report from the second opinion doctor may hurt the value of your claim.
Third, even if the second opinion doctor provides a new treatment plan or increased work restrictions, the insurance company may not listen to the second opinion doctor. You will have to persuade your authorized treating physician to adopt the second opinion doctor’s recommendations, ask the authorized treating physician to refer you to the second opinion doctor for all treatment, or file a change in condition claim seeking a change in treating physicians. We recommend contacting an experienced Virginia workers compensation lawyer for help with these issues.
Making the Insurance Company Pay for a Second Opinion
The Virginia Workers’ Compensation Act does not contain any provisions or statutory language that say an injured worker is entitled to a second opinion. The insurance company is only required to offer a panel of physicians, also referred to as a workers compensation list of doctors. If your treating physician refers you to a specialist, then then insurance company may have to offer a panel of specialists as well.
There is, however, a way to get the insurance company to pay for a second opinion: by talking to your workers compensation doctor.
If your authorized treating physician refers you for a second opinion, then the employer and its insurance company will have to pay for that referral. Make sure that your treating physician puts the referral for a second opinion in writing and states the name of the specialist to whom you are being referred. We recommend speaking with an attorney who can provide a list of doctors that you should suggest to your treating physician for the second opinion referral. These are claimant-friendly physicians.
Remember – The treating physician is an important person in your workers’ comp claim. With the appropriate strategy and an experienced workers compensation attorney, you can get the treating physician on your side and force the insurance company to pay for a second opinion evaluation that can also be used to support your claim.
Need Help with a Workers’ Compensation Claim?
We are here to answer any workers’ compensation questions you may have. All you have to do is call, text, or email Corey Pollard for a free strategy session. We’ll explain the workers’ comp system to you and what you can do to get the treating physician on your side so that you maximize the benefits you’re owed. We can make a specific referral for a second opinion to a doctor who is a friend of injured workers. And depending on the facts of your case, we may also pay for you to see an independent doctor for a second opinion relating to surgery or a permanent impairment rating. There are many ways we fight for our clients. Contact us to find out more.
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