Second Medical Opinion for Workers’ Compensation

Were you hurt on the job in South or North Carolina? You have some control over your workers’ compensation case, including the right to request a second opinion if you’re dissatisfied with the insurance company’s doctor’s medical treatment or diagnosis. Exercising your rights might be challenging, but a workers’ compensation lawyer can help. Stewart Law Offices protects the rights of injured workers with dedicated, compassionate legal representation. Call today for a free consultation.

What If I Don’t Agree with My Workers’ Comp Doctor’s Opinion?

Employers pay for workers’ compensation benefits, including an assigned treating physician for your work-related injury or illness. You may get a second opinion if you disagree with the proposed diagnosis or treatment plan recommended by the workers’ compensation insurance company’s doctor.

Workers’ compensation laws vary by state. North Carolina law protects your right to seek a second opinion. You may request one in South Carolina, but it is not a legally protected right. However, the process for seeking a second opinion in either state is similar:

• Notify the Insurance Company — Inform your employer’s workers’ compensation insurance company that you want a second medical opinion. In North Carolina, they must respond within 14 days. This notification sets the process in motion and formally recognizes your request.
• Explain Your Reasons — Clearly state why you are seeking another medical opinion, such as believing the initial doctor’s diagnosis is incorrect or requiring further investigation. Detailed reasons can strengthen your case and demonstrate the necessity of a second opinion.
• Share Doctor’s Information — Provide the name and credentials of the medical provider you want to see. Highlight the doctor’s expertise and experience to justify your choice.
• Prepare for Pushback — The insurance company may require you to undergo an independent medical examination with a second physician of their choosing.

When You Might Need a Second Medical Opinion

There are several situations in which an injured worker might need a second medical opinion for a workers’ comp claim, including the following:

• Disagreeing with the Treatment Plan — You may disagree with your treating doctors about the medical care you need. For example, you may feel that the current treatment plan does not fully address your workplace injury. You may think additional treatment is necessary or that you require surgery. Or, you might want to refuse treatment because you feel that the suggested treatments are unnecessary, ineffective, or even harmful. In such cases, seeking a second opinion can provide alternative treatment options and help you make a more informed decision about your healthcare.
• Believing Your Injury Is Work-Related — If you think your injury is work-related but the treating physician states otherwise, get a second opinion from a medical professional experienced in diagnosing work-related injuries. This can help ensure your injury is accurately assessed and adequately documented, which is vital for your workers’ compensation claim.
• Disagreeing with Work Restrictions — If you disagree with the restrictions placed on your work activities by the treating physician, a second opinion can provide a different perspective on your capabilities and limitations. This is important for ensuring that your work restrictions accurately reflect your physical condition and help prevent further injury.
• Feeling Not Ready to Return to Work — If your doctor has cleared you to return to work but you do not feel ready to do so, you can seek a second opinion. Another doctor might recognize that you need more time to recover or identify underlying issues before you can safely return to work.
• Disagreeing with Your Disability Rating — If you disagree with your impairment rating, especially if the treating physician believes you have reached maximum medical improvement (MMI), you may wish to seek a second opinion. Another doctor may assess your condition differently and provide a more accurate disability rating, which can significantly impact your compensation and benefits.

If you are an injured employee experiencing any of the situations described above, contact an experienced workers’ comp attorney from Stewart Law Offices. We can review medical records, schedule appointments, and discuss possibly seeking another medical opinion regarding your work injury.

Can Workers’ Comp Deny a Second Opinion?

You always have the right to seek a second medical opinion for which you pay. However, if you want your workers’ comp claim to cover the expense, the workers’ compensation insurer can try to limit the scope of the examination or refuse to pay for specific tests or procedures. A workers’ compensation lawyer can help you understand your rights concerning a second medical opinion for your workers’ compensation case, including on the following topics:

• Right to Request — You can request a second medical opinion.
• Cost Coverage — You may request that the employer’s workers’ compensation insurance company pay for a second medical opinion, including examination, tests, or procedures.
• Legal Representation — You have the right to contact an experienced workers’ compensation lawyer to represent you if the insurance company denies your request for a second opinion. A workers’ compensation attorney can handle the claims process, protecting your rights throughout the process, including your right to fair treatment.
• Insurance Company Limitations — Workers’ comp insurance companies may have specific criteria or networks of approved doctors, which could limit your choice of a second opinion provider.
• Appeal Process — If the workers’ comp insurance carrier denies your request, you have the right to appeal the decision through the North Carolina Industrial Commission if you work in North Carolina or the Workers’ Compensation Commission if you work in South Carolina.
• Employer Obligations — In general, employers must inform you of your rights to a second opinion and the process for requesting it, ensuring transparency and access to necessary medical evaluations.

Contact an Experienced Workers’ Compensation Attorney to Learn More About Your Rights

If you’re considering seeking a second medical opinion or have already received one and are still trying to figure out what to do next, contact an experienced workers’ compensation attorney. At Stewart Law Offices, we have 25 years of collective experience helping injured workers exert their rights, including asking for second opinions for work-related injuries. Our team fights aggressively for maximum compensation and charges no fees unless we win money for you.*

Call us today for a free consultation with a workers’ compensation lawyer. We’re available 24/7 and can speak with you by phone, at your home, or in the hospital. Contact Stewart Law Offices today and let us put our skills to work for you.