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What if you want a second medical opinion about your injury?

On Behalf of | Feb 6, 2020 | Workers' Compensation |

When you are receiving a medical diagnosis, it can be important to get a second opinion. If one doctor tells you she wants to perform major surgery on you, and you’re not sure you need it, it’s a good idea to see if a second doctor agrees before you let them start cutting.

Another common scenario is the opposite: The patient believes they need extensive medical care, while the doctor disagrees.

This is especially common in the area of workers’ compensation. California employers are required to carry insurance that covers medical care for their employees who are injured on the job. Many employers and their insurance providers require workers to go to certain doctors. Often, a doctor who has been pre-approved by an employer’s insurance provider tells an injured worker that their injuries are minor, and this affects how much the worker will receive in workers’ compensation benefits. The injured worker thinks the doctor made a mistake, and that the injury will require more care and a longer period of recovery.

If this is the case, what can the injured worker do?

First, it’s important to know that workers have the right to challenge a medical report. California workers’ compensation law provides that workers can get a second opinion from another medical care provider if they disagree with the first doctor’s report.

If your report comes from a doctor in a Medical Provider Network, or MPN, you can talk to the insurance company or your employer about seeing another doctor within the MPN. You can talk to up to two more doctors within the MPN. If you still don’t have a satisfactory report after that, you can speak to the Division of Workers’ Compensation about arranging for an independent medical review by a doctor outside of the MPN.

The process is somewhat similar if you are receiving care through a Health Care Organization, or HCO. However, California law imposes strict deadlines on HCOs. If you request a second opinion within the HCO, it has five days to provide you with a new doctor.

There is yet another process for workers who are not receiving care through an MPN or HCO.

A lawyer can help in all these situations, and especially for workers who are receiving care outside of an MPN or HCO. Help from an attorney can also be extremely important in cases where insurance providers deny a claim.