Will the insurance company pay for a second opinion for a hand injury?

Question Detail: I was just wondering if I should get a second opinion. I had a hand injury at work, I’m at MMI and the doctor gave me a rating of 1%. I am missing part of the ring finger and then the pinky finger had the tip amputated. The surgeon surgically treated the fingers with a finger flap on each finger. The tip of the middle finger was broken, but as you probably know from all your years of experience there was little they could do except to splint and cover it. My hand was pulled through a pulley. It just seems to me 1% is pretty low for a rating. Especially in light of the fact that my hand cramps up in the morning and the fingers with the flap are hypersensitive. I don’t believe the doctor gave a high enough rating. Will the company pay for a second opinion?

Answer: The quick answer is "Yup, they will, they have to, but you shouldn't just ask and then allow them to direct you to a doctor."

Hear the sound of squealing metal wheels on the rails? I do, but then again maybe it's just because after 30+ years of practicing law life to me appears like a slow motion train wreck. Choo-choo! Here it comes!

You have a scheduled member injury case, or so it appears. You may not, but as described I think you do. I could be wrong, but I don't think so.

Scheduled members are not a huge case; scheduled member injury cases never are unless you have a pre-existing permanent impairment to some other scheduled member or you develop RSDS or complex regional pain syndrome.

Confusing huh? Yeah, the law intersecting with medicine can be very complex.

Based on the few facts you’ve given me I can't tell if you have correctly described the type of claim it should be; and if there might be a Second Injury Fund claim. Knowing the type of claim you have is helpful to know what to tell you about how to maximize the money you are owed. But.... it's not possible without knowing more information. And then describing what you should do isn't practical or even ethical because I don’t lend out my law license. You see it is too easy to misconstrue what I'm saying and for you to then go off half-cocked and misuse the advice.

Generally speaking here is all the advice I am able to give you. Yes an Independent Medical Examination needs to be performed, but you shouldn't just get any second opinion. What you need is a second opinion with a doctor who will counter the conservative ratings issued by the company doctor routinely hired by the insurance industry.

At this point you should again hear the sound of the screeching wheels on the train tracks. Because those doctors who act friendly are not your friend. I'm your only friend. 

If you allow the adjuster to steer you to just any doctor they will suggest doctors who support the same conservative views and who resolve disputes in their favor or go with the low or no-rating. Listen up because this is important stuff. What you need is a doctor who will support his patient by resolving the legal questions by giving a fair impairment rating. Let's not fool ourselves into thinking the doctor being hired by the insurance company is being fair with the rating. The insurance industry isn't fair, they hire only doctors who give low or no impairment which allows the insurance industry to improve its bottom line at the expense of the injured person. Hire a lawyer on a contingent fee basis and you will win the right to receive reasonable compensation. And guess what? Even paying the lawyer a fee you should get more dough in your pocket. Yeah, really. Don’t and the insurance industry will smile all the way to the bank.

Did you know both doctors and insurance adjusters can be activists for the insurance industry? Can you hear that train a comin?

Good luck with your case and if we can help you give us a call and stay off the tracks before you get run over.

 

Steve Lombardi
Iowa personal injury, workers' compensation, motorcycle, quadriplegic, paraplegic, brain injury, death
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