Are You Entitled to a Second Opinion in a Workers’ Compensation Claim?

So you’ve been hurt on the job in New Jersey and, as required by law, you’ve filed a workers’ compensation claim through your employer. Your employer’s workers’ compensation insurance provider will require that you be examined by a physician they have selected. The doctor either concludes that your injury doesn’t prevent you from working or recommends a treatment plan that you believe is inappropriate. Do you have a right to a second opinion?

The key word here is “right.” In New Jersey, if you disagree with any assessment made by the examining doctor, you can ask the workers’ compensation insurance company to allow you to obtain a second opinion, but it’s entirely within the discretion of the insurer to decide whether or not such an action is warranted. There’s nothing to prevent you from seeking or obtaining a second opinion on your own, and you can submit the findings of the second opinion to the workers’ compensation insurance carrier. However, you’ll most likely have to pay for the costs of the second opinion. In addition, the insurance company has the exclusive right to accept or reject the second opinion.

Not surprisingly, whether the insurance company will allow (and pay for) a second opinion depends on the potential cost to the insurer. Where the company-selected doctor has concluded that you don’t need treatment, it’s highly unlikely that the insurer will agree to a second opinion. However, if the prescribed course of treatment involves expenses that must be paid by the insurer—the doctor may recommend surgery or other procedures—there’s a greater chance the insurance company will agree to a second opinion.

It is important to understand that, while a workers’ compensation insurer may choose not to take a second opinion into consideration when initially determining the validity of your claim, the findings of a second opinion can be introduced into evidence in any appeal of a denial of a workers’ compensation claim.

Contact the RAM Law Office

At RAM Law, we offer a free initial case evaluation to anyone who has been hurt on the job. To arrange a meeting, contact us online or call us, in New Brunswick at 732-247-3600 or in Somerville at 908-448-2560.