There’s no simple answer to this but here are a few possibilities. First, she’s lazy or procrastinating or overworked. Maybe.

Second, she’s in denial that the test is actually necessary. She may be hoping that you spontaneously get better without the test. That occasionally happens but not often. Most experienced workers’ compensation doctors aren’t just ordering tests randomly. They don’t order tests they don’t think are necessary. But some adjusters act like they know more about modern medicine than someone who went to medical school.

Third, she may have an internal review that has to be done before the tests can be authorized. Some insurance companies have an internal “utilization review” performed by an in-house “doctor” to second guess the doctor who ordered the tests.

Fourth, the adjuster may be trying to line up a second opinion with another doctor who may say the test isn’t necessary. You may ask yourself: would an adjuster really pay an extra month of weekly benefits, pay hundreds of dollars to a rehabilitation nurse to set up a second opinion, and pay hundreds more outside of the Industrial Commission medical fee guidelines, just in the hope of avoiding a $750 test? The answer is yes.

She 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 her privileges. And under a law which escaped revision by Gov. McCrory if an adjuster wants a second opinion on a surgical recommendation she 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.

Sometimes, and, if they can get away with it. A while back a well-known neurosurgeon based in Raleigh spoke at a closed-door meeting with adjusters at a meeting sponsored by a law firm, which represents mostly insurance companies and employers. During the course of his presentation he stated that he believed a lot of injured workers underwent unnecessary surgeries and ended up being out of work longer than necessary as a result. What happened next? Clients who lived in Mount Airy, in Lexington, even in Charlotte were being sent to him for second opinions.

This happens more often than you would believe. In this particular case we objected to the Industrial Commission. The defense attorney, coincidentally a partner in the firm that sponsored the private meeting, argued that the law regarding second opinions didn’t require that the doctor be fair or neutral. The only limitation was in terms of geographical reasonability. The Industrial Commission seems to have bought into this theory. Your best defenses against a second opinion are that it’s too far away and that the adjuster has already had a couple of second opinions. At some point the adjuster has to concede that she’s only shopping for an opinion that she wants to hear and isn’t really looking for sound medicine anymore. While that seems patently obvious to some people it’s considered bad form to admit to it when you’re at the Industrial Commission.

To be fair, we have our own lists of doctors as well. One advantage of our law firm is that we’ve been keeping records and notes on doctors, adjusters, rehabilitation nurses, etc., for years now. We know which ones tend to unnecessarily favor the employers and insurance companies and we know which ones put their patient’s interests first. So when it’s our turn to pick a doctor we know who we’ll recommend.