When an injury occurs on the job, you are usually covered under the workers’ compensation insurance policy paid for by your employer. You are also typically required to visit a physician selected by the insurance company to assess your condition and get treatment. But what if you don’t agree with the doctor’s assessment or treatment plan? Can you go somewhere else for a second opinion? In New Jersey, the answer is almost always “No.” You can request it, but are not “entitled” to get it. The insurance company has the right to decide whether or not a second opinion is warranted.
There are two common situations that prompt patients to seek a second opinion in workers’ comp claims:
- When the doctor says you no longer need treatment and you don’t agree with him/her; and,
- When the doctor recommends surgery or an invasive procedure and you want to be sure it is the best option.
In the first example the insurance company is highly unlikely to approve a second opinion that might result in more treatment. They want you to get back to work to keep expenses down. The insurance company will almost always side with the doctor and deny your request. In the second case the insurance company may say “yes” to a second opinion in order to avoid paying the high expense of a surgery—but that is not guaranteed.
If you are in New Jersey and a workers’ compensation insurance company denies your request for a second opinion, you should consult an attorney before doing anything else. Don’t go to your own doctor or a specialist without seeking assistance. If you go forward without legal advice, you may be on the hook for unexpected medical bills. Once your private health insurance realizes your injury is from a workers compensation claim, it may not pay for the second opinion or treatment and you may be personally responsible for the bill. An experienced attorney is more likely to get approval from your insurance company or justify the use of an outside physician who may then be paid under your claim. Attorney’s fees for workers compensation claims are done on a contingency basis so you can concentrate on your health during the legal process and not on paying attorney’s fees.
The best way to be responsible for your own health when injured is to know your options and to consult an experienced workers’ compensation attorney to work with the insurance company on your behalf.
