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Getting a second opinion through workers’ compensation

On Behalf of | Feb 7, 2024 | Workers' Compensation

Can you get a second opinion from a medical care provider if you are going through workers’ compensation? Yes, under New York’s workers’ compensation system you can get a second opinion, but you should be careful about how you do it. You may have to follow some specific rules.

Authorized health care providers

Under New York law, most employers must carry workers’ compensation insurance for their employees. This insurance pays for the medical care of employees who are injured on the job, but this does not necessarily mean that the workers can see any doctor they want.

Unless your treatment is necessary in an emergency, any medical care provider you see through the system must be authorized by the New York Workers’ Compensation Board.  Beyond that, your employer’s insurance company may have other restrictions.

For instance, some insurers use a Preferred Provider Organization (PPO) program involving a network of providers. If your employer’s insurer has a PPO program, you will most likely have to see one of the providers listed in the PPO network.

Why would you need a second opinion?

There are many reasons patients seek out a second medical opinion. In some cases, they just want to learn of all their options to treat a difficult condition.

But in workers’ compensation cases, there may be other reasons. In some cases, workers suspect their doctor is beholden to their employer or their insurer and is therefore not giving them all the care they need, in an effort to keep costs down for the organizations that are paying the bills. In some cases, a second opinion can help bolster a worker’s claim that they need care that the first doctor is not giving them.

Whatever your reasons, you do have the right to request a second opinion through workers’ compensation, but only if you follow the rules.

First, any medical care provider you see for a second opinion must also be authorized by the Workers’ Compensation Board.

Second, if your employer’s insurer has a PPO or similar system, it may require you to see another doctor within its network. If you want to see an out-of-network doctor for a second opinion, you must wait until 30 days after your treatment has begun, and you must first notify your insurer.