If you suffer an injury at work, in most instances, you will have coverage provided by the workers’ compensation insurance policy that is financed by your employer. In addition, you are usually required to consult a doctor chosen by the insurance company to evaluate your condition and provide treatment. And, in New Jersey, if you disagree with the physician’s evaluation and course of treatment, you will be unable to obtain a second opinion. Only the insurance company can determine whether a second opinion is justified.
In workers’ compensation claims, there are two typical scenarios in which patients try to get a second opinion:
- when the physician states that you do not require further treatment and you disagree with this assessment, and
- when the physician advises you to have surgery or an invasive procedure and you wish to be certain that it is the best choice.
In the initial instance, it is very unlikely that the insurance company will approve a second opinion that could result in more treatment. The insurer would like you to return to work in order to reduce expenses. In almost all cases, the insurance company will support the doctor and decline your request. In the second situation, the insurance company might approve your request for a second opinion in hopes of avoiding the costly payment for surgery. However, there is no guarantee that they will grant your request.
If you are located in New Jersey, and a workers’ compensation insurance company declines your request for a second opinion, prior to taking any further steps, it is recommended that you consult a lawyer. Do not visit your own physician or a specialist before obtaining legal counsel. If you move ahead without securing advice from an attorney, you may incur medical expenses for which you will be responsible. When your private insurance realizes that your injury is associated with a workers’ compensation claim, it may not finance the second opinion or treatment, and you may be required to pay for that expense.
It is likely that an experienced attorney will receive approval from your insurance company or provide a rationale for the use of an out-of-network doctor who may be compensated under your claim. If you are injured at work, consult an experienced workers’ compensation attorney who will work with the insurance company on your behalf.