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Can I Get Workers Comp Second Opinions for Medical Treatment in Iowa?

On Behalf of | Feb 10, 2022 | Firm News

Insurance companies control medical care for work injuries under Iowa law. This means that they get to choose what medical providers that you go to for your injury.  Importantly, they have to follow the medical treatment of whatever provider they choose.

It is not uncommon for injured workers to feel that they need more or better treatment after being released from the medical provider that workers’ compensation has chosen for them. If you go to your own medical provider without the authorization of workers’ compensation, they likely will not pay for that treatment.

Why Should I Get A Second Opinion?

Some of the most common reasons why you may want to request a second opinion regarding your workers’ compensation medical treatment are:

  • Your treating doctor says your injury isn’t work-related.
  • Your treating doctor is downplaying your injury.
  • Your treating doctor does not seem engaged in your treatment.
  • Your treating doctor is not listening to you and addressing your injuries and/or concerns.
  • Your treating doctor has released you when you are still having significant difficulty related to your injury.

There are many other reasons you may want to get a second opinion. In general under workers’ compensation, you don’t have a right to a second opinion, but you should always request a second opinion if you feel that you need one.

A Second Opinion is NOT the Same as an Independent Medical Examination (IME)?

In many work injury cases, you are entitled to a one time evaluation with a doctor of your choice when you are released from care. Generally, the treating doctor has to give you a permanent impairment rating or in some cases, a rating of no impairment to trigger this right under Iowa Code 85.39.

It is important to understand that an Independent Medical Exam is NOT the same as a second opinion. When you request a second opinion, you are requesting that for the purposes of potential treatment of your injury so you can better recover.  An Independent Medical Exam is only a one time evaluation with a doctor to evaluate permanent impairment and restrictions.  A doctor that performs an IME will not treat your injury.

How to Switch My Worker Compensation Doctor?

If you’re reading this, then chances are you are in some way dissatisfied with your medical care from your workers compensation appointed doctor. Changing your medical provider under workers compensation can be difficult. First, you should inform your employer or its workers’ comp insurer that you are dissatisfied with your care. You then may be assigned a new provider or able to negotiate another arrangement  for managing your care. If you cannot reach a satisfactory arrangement or the insurance company denies your request, you can apply to the Workers’ Compensation Commissioner requesting alternate medical care.

You will have to prove that the care that workers compensation is providing you is “unreasonable” or that there is a significant reason that you cannot continue care with the current provider.  A simple assertion that you don’t like the provider or think that they are only working for the insurance company will not compel the agency to allow you to go to another provider.  Just because the doctor is not doing what you would like them to do is not usually a grounds for the agency to grant alternate medical care.

The Workers Compensation Agency will conduct a hearing (via conference call) to determine whether or not you have proven that you can go to another provider at workers compensation’s expense. Because an alternate care hearing has specific standards and rules, it is best to consult with an attorney before filing an alternate medical care petition on your own. If you have questions about alternate medical care, we would be glad to provide a free consultation.

How to Find a New Workers’ Comp Doctor?

If you are granted alternate medical care, the employer will still get to choose another doctor for you to go to for treatment. If you are not granted alternate care and the insurance company is no longer providing medical treatment for your injury, it is often a good option to go to your family physician on your own insurance and see if they have any treatment recommendations or referrals that can help you.

You can then take those treatment recommendations to workers compensation and see if they will approve them. If they are not approved and you are still suffering from your injury, it is time to talk to a lawyer about your case.

Navigating to get a second opinion regarding your workers’ compensation medical claim can be confusing. The experienced lawyers at Platt Law Firm, P.C. are here to help you with workers comp second opinions. So, Call us today at 515-346-6659 for workers’ compensation settlement in Des Moines and Urbandale, Iowa. We will be glad to provide you with a free consultation regarding your case.