The insurance company will generally make strategic decisions to save themselves money.
In Missouri, workers’ compensation laws are designed to bring some comfort to workers who might get injured or sick on the job. They state that should workers have a medical need directly resulting from their work, then the costs will be fully covered by these benefits.
However, Missouri also has a rule that many other states do not; it allows the employer to choose the doctor who will be treating you. In a best-case scenario, this would not pose much of a problem, and the workers would continue their treatment until they are ready to resume their work. However, what happens when the workers want a second opinion?
Getting a Second Opinion
Even if the law says your employer has the right to choose the doctor, you should know that in most cases this choice is given to the insurance company which ultimately pays the costs of your medical treatment. For your boss, it’s one less hassle to worry about. For the insurance company, it’s a strategic move that allows them to control, at least in part, how their money is spent.
Though they will choose the doctor, the insurance company cannot suggest what kind of treatment or medical interventions you should get, nor can they try to persuade the doctor in altering their medical advice based on what’s more cost-effective for them. If you suspect the insurance company gets a say in your treatment this should be discussed with your attorney as soon as possible.
However, even if the insurance company is doing things by the book, it doesn’t mean you’re in for smooth sailing. For instance, if you do not agree with the diagnosis or treatment plan the doctor decided, in normal circumstances you’d get a second opinion. However, to have that reimbursed by the insurance company (under workers comp benefits), you first need their approval.
And frankly speaking, it’s very unlikely they will approve this move, as it can be seen as an unnecessary extra cost.
You’re Not Without Options
If you go at it alone, you are going to have a tough time getting anywhere with the insurance company. However, you should consider hiring a St. Louis workers compensation attorney for additional help. With a strong case, you may be able to convince the insurance company of approving a second opinion, but even if you don’t, there is another option.
The Missouri Workers Comp Division routinely weighs in on cases where there is an issue, such as not agreeing with the recommended treatment. With the help of a lawyer, you can take your case in front of an administrative judge. The judge, upon reviewing the evidence, can then order a second medical opinion which you do not have to pay for. Additionally, you won’t face any repercussions for this either, as you are well within your right to do so.
If you have been injured on the job in the state of Missouri, give us a call 24/7 at (314) 361-4300 to learn more about your legal options.