Per the Illinois Workers’ Compensation Act, you have the right to two medical opinions when it comes to your care. As long as the medical care is “reasonable” the insurance company has to pay for it.
This comes up a lot from clients/callers who want to know how to get a second opinion and more specifically, how to make sure that bill gets paid.
The most recent call I had on this issue shows that some Illinois work comp insurance companies just play ridiculous games. The caller had hurt his shoulder at work and had a recommendation for surgery. He wasn’t sure if he wanted the surgery or if he wanted his doctor to do it, so he found a different orthopedic doctor and made an appointment. He called the insurance adjuster as a courtesy and was told that he couldn’t get a second opinion because he hadn’t been on the job long enough to earn that right.
Uhm, that’s not how it works. It was a completely illegal and shady thing for the insurance company to do, but fortunately an easy problem to solve.
Another caller in recent months wanted a similar second opinion, but was told by the insurance company that the IME doctor (who found that her problem was work related) was the second opinion and that no approval for another opinion would be given. Again, that’s just not how this works. You get to choose two chains of referrals (unless your employer fits in to a very rare exception) and the IME is not one of them.
The one time when getting approval for a second opinion isn’t automatic is if your treating doctor says your problem is not work related. Essentially their opinion is held against you and getting a new doctor is usually seen as doctor shopping which hurts the credibility of the 2nd opinion doctor. That doesn’t mean you can never get a second opinion but it does make it much harder.
Bottom line is that you shouldn’t get pushed around if you are hurt at work, especially when it comes to your medical care. If you don’t get better nothing else matters and you have a right to seek out the best care possible. If you have questions or are having trouble getting medical care approved, please contact us any time for a free consultation.
