Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 27 - Utilization Review Procedures
Section I-2711 - Second Surgical Opinion

Universal Citation: LA Admin Code I-2711

Current through Register Vol. 50, No. 9, September 20, 2024

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.

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

Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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