Being injured on the job is bad enough. But what happens when you feel like you’re not recovering as quickly as you should?
If you’re an injured employee in South Carolina and your claim for workers’ comp benefits is approved, the workers’ comp insurance company chooses your doctor and must approve your treatment. If you feel the medical care you’re receiving is inadequate for any reason, you might want a second medical opinion.
In South Carolina, you’re not guaranteed a second opinion for your workers’ compensation claim, but if you request one from the insurance company, you’ll probably get it. The way you do it matters, though.
When to request a second opinion is an important strategic decision for your workers’ compensation case.
In this article, I’ll discuss why the doctor’s opinion is so important for your workers’ compensation injury claim, how your workers’ comp attorney can help you pursue a second opinion when needed, and what pitfalls you want to avoid.
The Importance of the Doctor’s Opinion in Workers’ Compensation Injury Cases
The insurance company’s doctor will make several key determinations that can make or break your case, including:
- The appropriate treatment plan for you, including whether you need surgery
- What work duties you’re able to perform as you recover
- When you’ve reached maximum medical improvement, the point at which you have healed as much as possible
- Your impairment rating for any permanent disability
These factors are crucial for determining your treatment and the resulting medical expenses, as well as any settlement amount you may ultimately receive for your workers’ compensation injury claim.
After your eligible workplace injury, your employer’s worker’s compensation insurance company will likely send you to one of the treating doctors with whom they have long-term relationships. This doctor is obligated to diagnose you and define a treatment plan for you objectively, but they’re only human.
Sometimes, your workers’ comp doctor may make determinations that are more favorable to the insurance company. The result of misdiagnosed injuries or inadequate treatment plans can be severe, both for your health and your case.
Should I Get a Second Opinion on an Injury?
There are some instances in which it may be in your best interests to pursue a second opinion, such as:
- You feel your medical treatment is unsatisfactory, or you just don’t feel good about the interaction you’ve had with the treating physician and you want peace of mind.
- Your doctor recommends surgery, or rules it out, and you disagree.
- Your doctor clears you to work before you feel ready.
- Your doctor says you’ve reached maximum medical improvement when you don’t feel you’ve healed as much as you can.
- Your doctor assigns you permanent work restrictions you disagree with, or doesn’t assign you restrictions when you think they should.
- Your doctor assigns you an impairment rating you disagree with.
- The workers’ compensation insurance company refuses to pay for some of or all your medical treatment.
If any of these describe you, consult with an experienced workers’ comp attorney before you make any more moves.
How to Pursue a Second Opinion if You’re Not Satisfied with Your Medical Treatment
You must tell the workers’ compensation insurance company that you want a second opinion, and it is up to them whether they’ll allow you to get one. However, in my experience as an attorney, it’s rare for an injured worker in South Carolina not to be allowed a second opinion, either by the insurance company or the South Carolina Workers’ Compensation Commission (the agency in charge of workers’ comp in the state).
A reason why a second opinion might not be granted could include actions such as not following the first treating physician’s recommendations or seeking employment that violates your permanent work restrictions.
If you’re able to get a second opinion, the second doctor will again be chosen by the insurance company. However, an experienced workers’ compensation attorney can help fight for a doctor you feel will diagnose and treat you better than the first.
Requesting a Second Opinion: Real-world Example
We once had a client whose hand had been severely injured in a work-related accident. The workers’ compensation doctor cleared them to return to work, but it was too soon.
The client requested a second opinion and, with our help, was granted one.1 The second doctor gave them a more correct diagnosis requiring surgery. Our client also received work restrictions together with an impairment rating that accounted for their ongoing disability.
As a result, our client was able to receive medical treatment that was more specific to their actual injury, and their settlement amount increased to reflect their need for medical treatment and lost wages.1
Seeking a Second Opinion: Dos and Don’ts
If you need a second opinion for your workers’ compensation injury claim, there are some things to keep in mind about how you pursue it:
- Do seek a second opinion when you have concerns directly related to your diagnosis or treatment plan, even if the insurance company’s doctor seems like a nice person.
- Do consult an attorney if you are considering pursuing a 2nd
- Do seek a second opinion when your attorney believes it will lead to a significant difference in your diagnosis, treatment, impairment rating, and ultimately, the settlement you may receive.
- Don’t disregard the treatment recommended by the first treating physician, even if you disagree with it or feel you were misdiagnosed. If you refuse treatment, your benefits may be discontinued.
- Don’t seek a second opinion unless you and your attorney are confident that it will lead to an outcome in your favor. Otherwise, you could get less compensation, not more.
Don’t Risk Your Health – Seek a Second Opinion When You Need One
Even if you disagree with the doctor’s opinion about your workplace injury or illness, you still might feel reluctant to seek a second opinion. For example, maybe you have a good relationship with your employer, and you don’t want to risk damaging it by appearing difficult to work with.
An experienced workers’ compensation attorney can help you determine the best course of action for you. Your attorney helps you decide whether seeking a second opinion is a waste of time and a tactical error or is needed to try to protect you from:
Misdiagnosis or under-diagnosis
The first doctor’s diagnosis may be inaccurate or may not account for the full extent of your injuries. It’s crucial that the doctor understands your injury and how it impacts your job.
Inadequate treatment
Your treatment plan may not fully address your injuries or you could be cleared to go back to work before you feel ready. If you go back to work, you risk reinjuring yourself or having ongoing symptoms – you can also hurt your case and weaken your ability to file a new claim.
Insufficient compensation
An inaccurate permanent impairment rating, for example, can prevent you from getting everything you may deserve in a final settlement.
An experienced workers’ compensation attorney helps you with your second opinion by:
- Dealing with the insurance company and, if necessary, filing a Form 50 to request a hearing with the South Carolina Workers’ Compensation Commission for you. It is highly recommended that you do not move forward with a hearing without a lawyer because hearings can be highly complex.
- Possibly helping you seek an insurance company-approved doctor who’s experienced in workers’ comp cases and you trust to provide an objective, fair diagnosis and treatment plan.
- Using a favorable second opinion, if you get one, to show why you may need a different diagnosis, more extensive treatment, or a different impairment rating than you originally received.
Contact us for a free case evaluation today if you’re thinking about pursuing a second medical opinion in your workers’ compensation injury case.
Can You Seek a Third Opinion?
If you seek a second opinion but are dissatisfied with it as well, it is more difficult, but not impossible, to get the carrier to approve a third opinion. If there are truly circumstances that call for another opinion, it’s not out of the question that you could get another evaluation.
A workers’ compensation lawyer can also help you seek an independent medical examination from a doctor of your choosing. The results could be used in a hearing with the Workers’ Compensation Commission, which could then order the insurance company to provide you with additional treatment.
Get a Free Evaluation of Your Workers’ Compensation Case
Our goal is to get you as much as possible, as quickly as possible. Since 1997, we’ve recovered more than $1.6 billion in total compensation for more than 60,000 people. And counting.1
In 2023, we were recognized for the 8th year in a row on the U.S. News – Best Lawyers “Best Law Firms” list. We achieved a Tier 1 ranking (the highest) for workers’ compensation law.3
Here’s what one of our happy clients had to say about working with us:
“They were a tremendous help! They worked incredibly quickly and efficiently to get me a fair settlement in my workers’ comp claim. I would and will recommend them to anyone! They were amazing!” – Reggie S., Google review
Cases and testimonials referenced do not represent the law firm’s entire record. Each case is unique and must be evaluated on its own merits. The outcome of a particular case cannot be predicated upon a lawyer’s or a law firm’s past results.
To get clarity on your case at no cost and with no obligation to hire us afterwards, call us today at 1-866-900-7078 or contact us online!
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