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Does workers’ compensation cover the cost of a second opinion?

On Behalf of | Apr 24, 2024 | Workers' Compensation |

A medical professional assisting with a workers’ compensation claim plays a very important role. They diagnose someone’s condition, determine their functional limitations and recommend a course of treatment.

A doctor’s opinion can be what helps someone obtain certain workplace accommodations or a leave of absence from their job. A physician can prescribe someone medication or refer them to a physical therapist to help them overcome health issues related to their employment. Every doctor has a slightly different approach to their medical practice, and patients may sometimes question the decisions and recommendations of the doctor handling their case.

Workers’ compensation but typically covers the treatment costs for necessary care until someone recovers or reaches maximum medical improvement. Can workers’ compensation also help when an injured employee wants a second opinion?

Some second opinions are eligible for coverage

When a patient is unsure of whether they trust a treatment plan or diagnosis, they can sometimes obtain an appointment with a different medical professional. A second opinion could lead to a better diagnosis or a less invasive treatment plan in some cases. However, workers’ compensation does not always cover the cost of a second opinion when someone needs medical support because of a job-acquired health challenge. Typically, workers’ compensation only pays for a second opinion if the recommended course of treatment involves surgery.

Given the risk of surgery, the long recovery period and the expense involved, an employee seeking care using workers’ compensation can expect their benefits to cover a second opinion if their doctor says that is what they require. If a worker questions a treatment plan involving physical therapy or a doctor’s determination that they have improved as much as they are likely to, then workers’ compensation may not cover the second opinion that they require.

Even though the worker may need to cover the cost of that appointment on their own, doing so could be a worthwhile expenditure. In some cases, that second opinion could give someone a reason to appeal an unfavorable decision or propose an alternate treatment plan while retaining their benefits.

Employees who are navigating complicated workers’ compensation claims involving serious injuries often need assistance. Receiving support when learning about workers’ compensation benefits and navigating a complex claim can help an employee focus their energy on their medical recovery instead of on their concerns about benefits.

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