When someone is injured at work or develops an occupational disease, he or she may collect workers’ compensation benefits, including medical benefits that pay for care and treatment. This requires seeking medical attention from a physician. However, when there are concerns about the diagnosis, disagreements regarding the severity of the worker’s condition, questions regarding treatment or when the worker can return to work, it may lead to the employee seeking a second opinion.
It’s important for employees to understand the impact this could have on a claim, especially if seeking a second opinion turns into doctor shopping (seeking care from multiple physicians with no coordination of care).
Choosing Medical Care for a Work-Related Illness or Injury
Iowa workers’ compensation laws allow employers to choose the medical care an employee receives when injured at work. But there may be circumstances in which this isn’t possible, for instance, if emergency medical care is necessary.
But in all other cases, it is the employer’s right to choose the doctor. Sometimes an employee isn’t happy with the choice, for any number of reasons. This doesn’t mean the employee can seek a second opinion without first talking to the employer or carrier. And if the employer or carrier refuses to allow for alternate care, then the employee can petition to the Workers’ Compensation Commissioner.
There is one specific circumstance in which an employee has the right to seek a second opinion. That is when the employer-approved physician gives a permanent impairment rating that is lower than what the employee anticipated. At the employer’s expense -- and the employee’s choosing -- a second opinion can be sought from another doctor.
When Seeking a Second Opinion Turns into Doctor Shopping
There is the risk of workers’ compensation benefits being denied when an employee navigates the process incorrectly. As mentioned, this could include not seeking care from an employer-approved physician or seeing another physician without approval.
A claim could be subject to denial when the employee requests or goes ahead with seeking care from multiple doctors. It’s hard to put a number on what would be an unreasonable number of doctors, but if it looks like the employee is doctor shopping, it will certainly raise a red flag.
One of the assumptions that an insurer might make is the employee is attempting to avoid returning to work. The original doctor’s recommendations may be an earlier return than the employee feels is reasonable, and going from one doctor to the next may appear as if the worker is trying to find a doctor to tell the worker that he or she can stay out of work.
Other concerns may be raised as well, such as an employee trying to make his or her injuries appear more severe than they really are, or the employee attempts to get a much more serious diagnosis. Doctor shopping could be attributed to an employee’s hope of collecting benefits for a longer period than necessary.
Handling Disputes Over a Medical Condition the Right Way
The problem is that even if the employee’s intentions are legitimate, it could look bad. It’s certainly not unheard of that an employer-approved physician would downplay someone’s injuries, assign a permanent impairment rating that is lower than deserved, try to indicate an illness has nothing to do with the work environment, or even force the individual back to work sooner than ready.
But the best way to handle these types of concerns isn’t to go shopping around for a doctor. The next step should be to seek legal counsel. With the risk of a claim being denied or not receiving the appropriate types of benefits, it’s best to talk with an attorney if there are concerns about a doctor’s diagnosis or the level of care provided.