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Do I Need a Second Opinion for My Work Comp Case?

Do I Need a Second Opinion for My Work Comp Case?

Workers’ compensation insurance companies do not want to pay out your claim. After all, the fewer claims paid, the more money they get to hang on to.

Unfortunately for you, this means your claim (even a legitimate one) may be denied.

When you file a workers’ compensation claim, the insurance provider will give you a list of approved doctors for your treatment. These doctors and medical professionals work with them for all their claims. Insurance adjusters know that you will get a more conservative opinion regarding your necessary treatment and disability rating with these doctors.

Unfortunately, these “conservative opinions” aren’t always accurate or fair. If you request a second opinion, it may be possible to address some of these potential issues.

Related Article: Workers Compensation Case: Can I See My Own Doctor?

Do You Have the Right to a Second Opinion for Your Florida Workers’ Compensation Case?

In Florida, the law states that you have the right to receive a second opinion if you are not satisfied with your treatment. However, it is not called a second opinion in the state. Instead, this is referred to as your “one-time change in treating physicians.”

You may think the doctor has sided with the insurance company instead of listening to your questions and concerns. Or you may not be improving, even though you have undergone a lengthy treatment.

You may also think that the recommendations made by your doctor are overly aggressive and want to see if a less aggressive treatment method would be sufficient.

No matter why you are thinking about a second medical opinion, it is smart to know your rights. Learn more here.

Related Article: Can I See My Own Doctor In A Florida Workers’ Compensation Claim?

Reasons to Seek a Second Opinion for Your Florida Workers’ Compensation Claim

There are several reasons to seek a second opinion for your Florida workers’ compensation claim. If you are unsure if you need one or if your employer denies this, you can contact our workers’ compensation lawyers at Sternberg | Forsythe, P.A. to learn more about your rights and options. Our goal is to help injured workers secure the benefits they deserve after an on-the-job accident and injury.

Your Treating Physician Requests an IME (Independent Medical Exam)

Sometimes, your treating doctor will request a second opinion. This may be because your condition does not fall within their area of expertise, or you need an IME.

The independent medical examination allows another doctor to examine you and your work-related injury medical records. Once they have reviewed this information, the doctor can answer questions about causation and how the injury has impacted your functional abilities. A report will be created that is used in your workers’ compensation claim.

An IME provides a functional impairment rating that the insurance company will use to determine if you deserve benefits for the injury. The rating is also used if your case goes to trial. Because of this, the medical options a doctor gives you during the IME are an important part of your workers’ compensation case outcome.

Remember, in America; you have the right to choose your doctor. However, the insurance company only must pay for treatment from the doctor they choose. Also, your health insurance policy may not cover a work-related injury.

If you choose your own doctor, you will likely have to pay for the treatments. Also, the opinions from this doctor will likely be inadmissible for your case. The only doctors who are permitted to provide an opinion about your case are the authorized treating physicians, an Expert Medical Advisor, or an Independent Medical Examiner.

Related Article: How To Deal With Workers’ Comp Doctors: What Not To Say To Your Workers’ Comp Doctor

While this is true, there are several situations when you have the right to choose your doctor. These “exceptions” include:

  • You experienced urgent injuries and must go to the emergency room or urgent care
  • The insurance company offers a “managed care arrangement” for all workers’ compensation claims, which allows you to select an in-network doctor
  • You provide a written request for a change in your treating physician, and the insurance company does not provide you with the name of a new treating physician within five days.

Related Article: Do You Need a Workers’ Compensation Lawyer?

Who Decides if a Second Opinion is Permitted?

As you may imagine, getting opinions from a few doctors can produce contradictory opinions.

There are several issues different doctors may disagree about, including the following:

  • Your diagnosis
  • If your injury  is related to your accident
  • Necessary treatment
  • Your ability to work

If this happens, the judge hearing your case cannot decide this issue. Instead, they must appoint an EMA or Expert Medical Advisor.

An EMA is like an IME, but while you or the insurance company selects the IME, the EMA is an expert the judge appoints. When this happens, the EMA will conduct a medical evaluation, review your medical records, and review the testimony of any other doctors who have treated you.

Once the needed amount of evidence is gathered, it is possible to resolve the dispute between the other doctors. This determination is considered binding for all parties. Since this is the case, you probably won’t have to go to trial because of a medical issue.

Related Article: Worker Compensation Medical FAQs

Common Questions about Medical Treatment After an On-the-Job Injury

You should take note that workers’ comp medical exams are not the same as routine medical exams. The doctor who is handling your exam will be focused on the injuries you claim occurred on the job. They will also probably be an expert in Florida workers’ comp cases.

Usually, there is no doctor-patient relationship nor a confidentiality requirement regarding what a doctor can and can not share with the insurance company. Because of this, you can expect that all details of your case will be made known.

At Sternberg | Forsythe, P.A., our attorneys receive all types of questions related to medical benefits and treatment. These questions are especially common when employees realize they may be required to cover the cost of their medical bills themselves if they make an error or mistake.

Answers to some of the most asked questions are found here.

Related Article: 9 Most Common Questions Asked from My Clients 

What options do you have if you have received emergency treatment from a medical facility that the insurance provider didn’t authorize?

Emergencies are emergencies. Because of this, Florida workers’ compensation rules let you receive the necessary care in an emergency room without going to an authorized workers’ comp provider.

While this is true, letting the hospital staff know your injuries occurred at work is beneficial. You should also provide your employer’s contact information.

What happens if you reported your injury, but your employer has not done anything?

If you were injured at work and requested medical treatment, but your employer’s insurance company did not respond, you should contact our legal team. We can help you with this challenge and help you get the medical treatment you need.

What information should you give your doctor?

When you go to the doctor, they will likely perform several tests. Your list of symptoms is the best and most accurate source of information about your injury.

An example is the severity of your pain. Your doctor needs to know how much pain you are in if there are times when it gets worse, and how the injury has affected your ability to do things and function.

When you make a report about your condition, you should be impartial. Act as if you are reporting on another person’s injuries. You should not exaggerate since the doctor will be aware if you are not being truthful. You should not leave anything out, either. You may believe that you can tough it out, but this is not a good strategy.

If you are unsure, give more information than you think the treating doctor needs. Even details that seem to be unimportant or minor may give your doctor clues about how to treat your injuries. Avoid speculation. If you do not know how to answer a question, say this.

Related Article: Top 5 Mistakes People Make After Suffering a Work Injury 

Are you required to go to all your follow-up appointments?

Our lawyers understand that it is essential that the injured worker goes to all their follow-up appointments for treatment. Your doctor will provide specific instructions, and following them is highly recommended.

If you skip an appointment, it may result in your benefits being canceled. It may also make it easier for the insurer to deny the benefits completely.

What should you do if you receive a bill for your treatment?

If you receive a bill for medical treatment that workers’ compensation medical benefits should pay, you should contact your attorney or the Bureau of Employee Assistance.

Your attorney can help ensure that the insurance provider covers all injury-related medical costs.

Related Article: Protect Your Workers’ Comp Claim by Avoiding These Mistakes 

Discuss Your Treatment Options with Our Workers’ Compensation Attorneys

If you have experienced an on-the-job injury, it is smart to contact our workers’ compensation attorneys. At Sternberg | Forsythe, P.A., we understand the law and your rights. Our legal team will work to protect your rights while making sure you get the benefits you deserve.

The first step is to contact our office to schedule a free initial consultation. We can discuss your situation and claim and create a plan to move forward.

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