Getting a second opinion on surgeries – Who pays, and can you turn one down?

On Behalf of | Oct 13, 2023 | Workers' Compensation |

Certain work-related injuries are so severe that they require surgery for treatment. These include severe back injuries, fractures, internal organ damage, and traumatic brain injury.

But before any surgery can happen, the injured employee must first secure the surgical opinion of a medical professional. It’s essential to understand if surgery is the proper treatment for an injury and whether there are any risks or complications to the process.

There may be cases when the employee or their employer may request a second surgical opinion. While workers’ compensation covers the first surgical opinion, who covers the costs for a second opinion? Can an employee turn down their employer’s request for a second opinion?

Employers must furnish the cost of a second opinion

By Minnesota law, the employer must pay for the costs of a second surgical opinion, whether they or the employee have requested the second examination.

When does an employee request a second surgical opinion?

An employee may request a second surgical opinion if the first medical professional they inquired had discouraged surgery. Alternatively, an employee may also request a second opinion to reconfirm the medical opinions and diagnosis of the first doctor.

When does an employer (or insurer) request a second surgical opinion?

Because the employer and their insurer will pay for an employee’s surgical treatment, they’ll want to confirm if the procedure is medically necessary. They might ask the employee to seek a second opinion.

What happens if an employee turns down their employer’s request?

For instance, let’s say an employee’s first surgical opinion approved the procedure, but the employer requests that the employee get a second opinion. Can the employee turn that request down?

Employees can turn it down. However, per state law, employers can deny payment for the proposed surgery if their request is denied. To do this, the employer must present medical information proving the surgical treatment is unneeded.

If there’s any conflict over whether an employee needs to seek a second surgical opinion or if the surgery is medically necessary, employees should consider discussing the issue with legal counsel. Claim denials can be tricky to handle, so having an expert at hand can help.

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