I Need A Second Opinion! When You Can Switch Your Worker's Comp Doctor

A staggering 900,000 cases of days away from work—that’s how many occurred in the US in 2018. And all these stemmed from the 2.8 million reported work injuries and illnesses that year.

If you’re a New Yorker who’s suffered a work-related injury, you should report it ASAP. Under the NY law, all employees, even part-timers, should have worker’s compensation coverage. This coverage will cover any work-related injury or illness you have.

However, it’s possible that your first doctor won’t work out. In this case, you should seek a workers’ comp doctor’s second opinion.

The question is, are you even allowed to switch doctors? And if so, why would you even want to do that? Most importantly, will this affect your worker’s comp benefits?

Ready to learn why and when to switch doctors in case you’ve sustained a work injury? Then keep reading, as that’s exactly what you’ll discover in this guide!

The Role of a Treating Doctor

Before we get started on how to change doctors, let’s first discuss the role of treating doctors. This will help you understand why it may be best to switch worker’s compensation doctors.

Treating doctors provide a medical diagnosis that establishes an employee’s work-related condition. They determine whether the employee is able to work and when they could go back. It’s also up to them to determine if the employee’s injuries or illnesses restrict their ability to work.

Treating doctors also come up with the treatment plan. Based on their findings, they may also refer the employee to medical specialists. Moreover, they confirm if an injury or illness permanently limits an employee’s abilities.

All these roles show how critical your treating doctor’s role is in your recovery. More than that—their findings and recommendations will affect your worker’s comp benefits, such as if you’re eligible for the benefits and if so, how much your compensation should be.

Why Do Patients Seek a Second Opinion?

As many as 34% of physicians in the US have had a lawsuit filed against them by their patients. In fact, back in 2015, there were 19.3 medical malpractice lawsuits per 100,000 NY residents.

These stats show that no matter how trained doctors are, they can still make mistakes. Moreover, some doctors prefer more conservative approaches, while others opt for aggressive treatments. This is why their findings, prescriptions, and recommendations can be dramatically different.

This is also the reason why more patients now seek second opinions.

In most cases, patients seek a second doctor’s opinion to confirm the diagnosis of their first doctor. In many others, it’s to determine the effectiveness of the initial prescribed treatment. Others also want to get more information about chronic symptoms or complications.

In worker’s comp cases though, one of the main reasons patients seek second opinions is the fear of bias. There are, after all, cases like Vanessa Sylva’s. With the insurer calling the shots as to who could treat her, she lost 10 years of her life in pain and suffering.

The good news is, New York’s worker’s comp laws are more employee-centered. Switching doctors is much easier compared to other states. You can switch to a new treating doctor to get a second opinion if you’re not satisfied with the first one.

In fact, you can even choose your initial doctor, unlike in many other states. You can do this if your employer doesn’t have a preferred provider organization (PPO).

If it does, however, you’d need to see one of the PPO doctors first. If, after 30 days, the initial treating doctor doesn’t work out, you can then make the switch.

In both cases, you need to choose a doctor who is with the State Workers’ Compensation Board though.

How Often Does a Second Opinion Yield Different Results?

Studies have found staggering differences in the rate of second opinion requests. In one review, the researchers found a rate of between 1% and 88%. Another analysis indicated that between 6.5% to 36% of patients requested a second opinion.

As the reviews of literature found, a change in diagnosis or treatment occurred in 12% to 69% of cases. Many cases also had a change in both diagnosis and treatment.

A separate study also found that only 12% of second opinions were the same as the final diagnoses. Two-thirds of the final diagnoses were also better defined or refined. Over a fifth of second opinions, however, had different final diagnoses.

As you can see, there is a stark difference in many cases of initial, secondary, and final diagnoses. That should be enough reason to find another worker’s comp doctor. While the second diagnosis may be the same as the first, there’s still a one-in-five chance that it won’t be.

Should You See a New Worker's Comp Doctor for a Second Opinion?

Unless you feel really comfortable with your current doctor, then you should. Besides, it’s your right as a New York employee covered by worker’s compensation.

Here’s a more detailed look at the benefits of getting a second opinion.

For Your Own Peace of Mind

The statistics above should already make you realize how important second opinions are. Even if your current doctor is completely unbiased, you should still go for a second opinion. This way, even if the findings are the same, the confirmation will make you feel more at ease.

Moreover, getting a second or even third opinion can help reduce your stress levels. Keep in mind that too much stress can affect your overall health significantly. Scientists have even found stress to cause brain atrophy!

You’re already injured or ill, and you don’t need even more stress to deal with. So for your own sake, it’s best to see another worker’s comp doctor.

Your Health Isn’t Improving or Has Worsened

Some work-related injuries, such as traumatic brain injuries, can have delayed symptoms. Every year, 1.5 million Americans sustain TBIs, with many arising from fall accidents.

Whiplash, which affects up to 2 million Americans each year, is another example. These neck injuries can also have delayed symptoms.

Both TBI and whiplash are only some of the types of injuries that can worsen over time.

Either way, if you feel that your health isn’t getting any better, then it’s time to see another doctor. Your current one may have missed something, which is why your health isn’t improving. Or it’s possible that the doctor’s treatment plan isn’t the best for your case.

You Want to Explore as Many Treatment Options as Possible

If you feel that your current treatment plan is lacking, go for a second opinion. Sometimes, more aggressive treatment options, such as surgery for wrist pain, are better.

It could also be the other way around, wherein your current doctor wants you to get surgery. If you’re not convinced this is the best way, then seek a second opinion. A new doctor may have other less-invasive treatment plans that could work for you.

Your Situation Warrants a Specialist

Many worker’s compensation doctors are general physicians. Yes, they have the skills and training to provide diagnoses. However, they may not have the experience to provide specialized care and treatments.

Let’s say you’re one of the 20 million Americans with peripheral nerve injury. A workplace accident may have damaged some nerves in your spinal cord.

Because of this, you’re always in pain and may not even be able to make full use of your arms and hands. In this case, a general physician won’t be able to completely treat you.

What you need to do is to see a spinal injury specialist. This way, you can receive all the necessary care and treatment for your special case.

Other cases that may require a specialist are traumatic brain injuries or chronic pain conditions. If your work exposes you to hazardous chemicals, then you may also need to see a specialist. Especially if you’ve had asbestos exposure, which can cause cancer.

Again, just make sure that the next doctor you see is WCB-registered. Otherwise, you may end up with out-of-pocket expenses.

You Don’t Have a Good Relationship With Your Current Doctor

Another reason to switch to a new doctor may be as simple as relationship issues. You may feel that your current doctor isn’t as attentive to your needs. Or your doctor is often not available, so you end up having to delay your checkups.

If any of these is true, then feel free to look for another WCB-authorized doctor. You want to get better as soon as you can, and if your initial doctor isn’t helping, then you should switch.

When Exactly Can You Make the Switch?

The extent of your injuries and your employer dictate when you can switch treating doctors in NY. Below is a more detailed timeline that you can follow.

For Injuries Requiring Emergency Care

If your injuries require emergency care, you can go to any doctor in an emergency department. An example is if you’ve had a serious fall injury at work, resulting in broken bones. Another is if you’ve been in a serious car crash while you’re on the job.

Your worker’s compensation coverage should automatically cover these injuries, regardless of whether the emergency care doctor you see is or isn’t part of the WCB. After your ED treatment, you would have to choose a WCB-registered doctor.

For Employees With a PPO Coverage

In 2018, the NY Department of Financial Services received 5,064 PPO-related complaints. Delayed payments and claim rejections were among the most common complaint reasons.

That’s right: you could face a denial of your worker’s comp claim, even if you’ve truly suffered from an injury at work. This can happen based on the findings of your initial treating doctor.

This is why it’s vital that you choose the right worker’s comp doctor from the very start. However, this could be an issue if your employer has a PPO. In this case, you may feel that the doctor puts your employer’s financial well-being first.

You’d have to wait for 30 days from the time you’ve had your initial appointment before you can switch. But as soon as the waiting period is over, you should start looking for a new worker’s comp doctor. This way, you can get a second opinion to confirm your initial diagnosis and treatment.

For All Other Employees

If your employer doesn’t have a PPO, you can seek a second opinion any time you wish. The important thing is to ensure that the doctor is with the Worker’s Compensation Board.

What’s more, New York allows you to change your treating doctor more than once. Take advantage of this not only to get a second, but also a third opinion.

Get the Best Treatment You Deserve With the Right Worker's Comp Doctor

Granted, all doctors are under oath to treat their patients to the best of their abilities. They shouldn’t have any biases nor should they provide “preferential treatment.” However, this doesn’t mean that your first treating doctor is the best for your situation.

So if you’re not getting any better, use this guide to switch to a new worker’s comp doctor for a second opinion! The sooner you do, the higher your chances of better and faster recovery. Besides, if the law permits you to get a second opinion, then it’s your every right to do so.

Ready to start your search for a new worker’s comp doctor who will give you the best and fairest treatment? Then please feel free to use our search tool to find a workers’ comp physician now! You’ll find specialists in all areas of work and auto accident injuries in our network.