Most industrial insurers will schedule injured workers for a second opinion before authorizing an orthopedic surgeon or a neurosurgeon’s request to do a spinal fusion. It is a good idea, even if the insurer isn’t requiring it, to get a second opinion on whether a spinal fusion is the best treatment for you. Many injured workers immediately agree with their treating physician’s recommendation for a fusion because they are still in pain after physical therapy and a course of medication, or because injections didn’t work. A fusion surgery is not something that should be done simply because a patient is still in pain and the doctor doesn’t know else to do. It should be done only after careful consideration of all treatment options and only if there are clear-cut objective indications for this surgery.
Some injured workers mistakenly believe that that their benefits will be terminated if they don’t agree to have surgery. An adjuster cannot terminate benefits solely because a claimant decides not to have a surgery. The adjuster may close a claim because the doctor has exhausted all treatment options. The adjuster will not let a claim remain open indefinitely while a claimant takes months to decide whether to have surgery or not. However, most adjusters will agree to allow a second opinion if the adjuster hasn’t already decided to get one.
If you feel that you are being pressured into making a rushed decision on having a spinal fusion by your treating doctor, discuss this with the adjuster and request that he schedule a second surgical consultation. Remember that you may request a copy of the insurer’s provider list to see what other spine surgeons are on the the insurer’s provider list. Do some research so that you are informed about the surgeons before you request a particular one, or before the insurer chooses a second opinion physician for you.
