A second opinion can be a useful tool, sought by either party, during the course of authorized treatment. While there is no provision for second opinions under the Workers’ Compensation statute, insurance carriers are often willing to provide a second opinion when surgical intervention is contemplated or the employee fails to show improvement under the care of the original medical provider. Lack of improvement can be due to poor doctor/patient relationship or lack of a clear diagnosis. A second opinion can provide assurances that surgery is the appropriate course of treatment or provide alternatives to surgery. If an employee’s request for a second opinion is refused, it should be done in writing. With a written denial, an injured worker is usually able to obtain a second opinion using their private health insurance. The employee must be clear when scheduling the appointment and speaking with the doctor that they are only seeking a second opinion for a work related injury.
However no treatment should be undertaken through the private health plan based upon the second opinion until and unless the workers’ compensation carrier is given an opportunity to once again direct care. The appropriate course of action is to seek additional treatment from the workers’ compensation carrier. Failing that, a petitioner may advance his cause through motion practice. It is the petitioner’s burden to establish all elements of the case. The requested treatment must be curative in nature and not just a last ditch effort to “try” something without a reasonable basis to believe the procedure will improve the petitioner’s condition.