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Milena Velilla

Getting a second opinion if your care is covered by workers’ comp

On Behalf of | Sep 7, 2022 | Workers' Compensation

People often believe that since they have to follow the California Division of Workers’ Compensation (DWC) regulations while receiving medical care covered by workers’ compensation, they have to stick with one physician whether they believe their diagnosis and treatment are correct or not. That’s not the case.

There is a California Medical Provider Network (MPN) from which you typically have to choose a physician. However, employees have the option to get a second (and even a third) opinion from another doctor within the MPN.

As with so many aspects of workers’ comp benefits, there is no shortage of procedures to follow to seek an opinion from another doctor. For example, you have to let either your employer or insurer know you want a second opinion so they can provide you with the current MPN list. Then you have 60 days to make an appointment with a specialist or other doctor to get a second opinion.

If the physician chosen for the second opinion doesn’t believe they’re the appropriate choice to weigh in with a second opinion based on the medical records they’re provided, they’ll decline and you can choose someone else. That doesn’t count as getting a third opinion.

You can seek a third opinion

However, you can get a third opinion if you believe it’s warranted following your second opinion, using essentially the same procedures. If you disagree with the third opinion on your diagnosis or treatment, you’ll need to file a request for an Independent Medical Review.

It’s in everyone’s best interests for someone who’s been injured or acquired an illness due to their work to receive the appropriate treatment. You shouldn’t hesitate to seek another medical opinion if you believe it’s warranted. If you’re having difficulty getting approval for workers’ comp or getting the benefits to which you’re entitled, it may help to seek legal guidance.