La. Admin. Code tit. 40 § I-2711

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-2711 - Second Surgical Opinion

A. When surgery has been recommended by the treating physician, the carrier/self-insured employer is entitled to obtain a second professional opinion from a physician chosen by the carrier/self-insured employer. Regardless of the second surgical opinion outcome, the claimant remains free to elect not to undergo surgery after the consultation. The carrier/self-insured employer is responsible for informing the claimant when a second surgical opinion is required and for referring the claimant to a second surgical opinion physician. This Program is designed to reduce unnecessary surgeries and to provide the claimant with possible alternate courses of treatment so that he or she can make an informed decision.

B. Second Surgical Opinion Procedures

1. The following is a list of surgical procedures that usually require a second opinion.

Spinal Surgery	Foot Surgery
Gastrectomy	Hemorrhoidectomy
Coronary Artery Bypass	Varicose Vein Surgery
Knee Surgery	Traumatic Cataract Surgery
Nasal Surgery	Joint Replacement

2. The carrier/self-insured employer should have in place a process to waive second surgical opinions on the basis of defined criteria.

3. The carrier/self-insured employer shall develop manual procedures or develop an automated system for administering program requirements, selecting consultants, documenting claimant compliance with the program, and efficiently handling claimant and physician contacts.

4. The second surgical opinion consultation and any tests necessary for the second surgical opinion consultant to render an opinion on the proposed surgery are to be paid by carrier/self-insured employer.

La. Admin. Code tit. 40, § I-2711

Promulgated by the Department of Employment and Training, Office of Workers' Compensation, LR 17:263 (March 1991), repromulgated LR 17:653 (July 1991).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1291.