POLICY NUMBER: 2. 2. 1R

Effective Date: March 6, 1997
Date Issued: April 30, 1997
Date Approved by Board of Directors: March 6, 1997
Topic: Spinal Fusion - Second Opinion
Section: Health Care
Subsection: Services/Treatments

Policy Statement

1. The Board will accept responsibility for spinal fusions and repeat spinal operations when the following criteria have been met.

1.1 Spinal Fusions

The Board requires a second opinion of its choice in all cases in which a spinal fusion is to be done for conditions other than a spondylolisthesis. No second opinion is necessary regarding spondylolisthesis as long as this is a first spinal operation.

1.2 Repeat Spinal Surgery

The Board requires a second opinion of its choice in all cases in which repeat spinal surgery for any condition is being considered.

2. If the first and second opinion are not in agreement, a third opinion by a physician mutually acceptable to the worker's physician and the Board will be sought. In making a final decision on funding the surgery, all medical evidence including the second opinion must be weighed.

Application

This Policy applies to all decisions made on or after March 6, 1997

References

Workers' Compensation Act (Chapter 10, Acts of 1994 - 95), Sections 102, 104.