Can a Pennsylvania Employer Require a Second Medical Opinion for Workers' Compensation?

Legal framework in Pennsylvania

Pennsylvania law permits an employer to request a second medical opinion (SMO) for a workers' compensation claim, but the request must follow specific procedural rules. The employer must submit a written request to the insurer, who then notifies the injured worker. The worker can accept the SMO, choose a different qualified physician, or contest the request through the Bureau of Workers' Compensation.

When an employer can request an SMO

An SMO is allowed when the employer believes the treating doctor's diagnosis, treatment plan, or prognosis is questionable, or when the claim involves a high cost or complex injury. The request cannot be used to delay benefits or to pressure the employee into returning to work prematurely.

Worker's rights and options

The injured employee has the right to:

• Receive written notice of the SMO request, including the reason.
• Choose a physician from the insurer's approved list if the employer's chosen doctor is not acceptable.
• Request a hearing before the Bureau of Workers' Compensation to dispute the necessity of the SMO.

If the worker refuses a reasonable SMO without a valid objection, the employer may claim non‑compliance, potentially affecting benefit eligibility.

Procedural steps

1. Employer submits written SMO request to insurer.2. Insurer notifies worker and provides a list of qualified physicians.3. Worker selects a doctor within the list or files a dispute.4. If disputed, the Bureau holds a hearing to decide.

Potential outcomes

The Bureau may uphold the employer's request, require a different physician, or deny the SMO if it finds the request unreasonable. Workers who comply with an approved SMO retain full benefits; those who non‑comply without a valid reason risk suspension of benefits.

Key considerations

Understanding the distinction between a legitimate medical review and an employer's attempt to undermine a claim is crucial. Workers should consult a qualified workers' compensation attorney to evaluate the reasonableness of any SMO request and to protect their right to appropriate medical care.