Have you ever been in a situation where your insurance adjuster recommended a second opinion after the doctor that they gave has already recommended surgery? It can be frustrating and confusing to understand why this is necessary. But don’t worry, you’re not alone.
It’s important to understand that insurance adjusters are not medical professionals, and their job is to ensure that the insurance company is not paying for unnecessary medical procedures. In some cases, a second opinion can help confirm the necessity of surgery and ensure that the insurance company is making a justified payment.
In this article, we will dive deeper into why insurance adjusters may require a second opinion and how it can affect your medical treatment and insurance coverage.
Can An Adjuster Ask You to Get a Second Opinion?
They shouldn’t, but under the current set of laws there really isn’t much of a limit to what the adjuster can request. It rarely works to simply refuse to attend a second opinion. On the other hand, we’ve had some success convincing the Industrial Commission that the adjuster is abusing their privileges.
And under a law which escaped revision by Gov. McCrory, if an adjuster wants a second opinion on a surgical recommendation they must move quickly. While the Industrial Commission generally grants additional time the law requires that the second opinion be scheduled (but not necessarily completed) within ten days of the original recommendation for surgery. We are very aggressive about scheduling expedited hearings over this issue.
Why Would the Adjuster Need a Second Opinion?
There are several reasons why an adjuster may need to seek a second opinion, even if their own doctor has recommended surgery. First and foremost, it is important to understand that insurance adjusters have a responsibility to the insurance company to ensure that claims are valid and necessary. Seeking a second opinion allows the adjuster to gather additional information and ensure that surgery is indeed the best course of action.
Additionally, seeking a second opinion helps to mitigate the risk of unnecessary surgeries or potential medical malpractice. Surgery is a major decision and it is important to have multiple medical professionals review the case to ensure that it is the most appropriate and necessary treatment option.
Lastly, seeking a second opinion can also help to build trust and credibility with the claimant. By taking the time to gather multiple medical opinions, the adjuster is demonstrating a commitment to fairness and thoroughness in the claims process.
Does the Second Opinion Have an Impact on the Claim Outcome?
Insurance companies have a responsibility to thoroughly evaluate claims and make informed decisions. By seeking a second opinion, they can verify the necessity of the recommended surgery, assess the potential risks and benefits, and determine if alternative treatments or therapies are available.
The second opinion also helps to mitigate the risk of unnecessary surgeries or procedures, which can be costly for both the insurance company and the claimant. It ensures that the recommended treatment aligns with established medical standards and guidelines.
Can You Refuse When the Adjuster Recommended a Second Opinion?
While it is common for an adjuster to request a second opinion when a doctor recommends surgery, it is important to understand that you have the right to refuse getting a second opinion. However, it is essential to consider the reasons behind the adjuster’s request before making a decision.
