The employee who is incapacitated for work has the right to a second opinion from another company doctor. (The employer has the right to an extra medical expertise, a “second view” from a company doctor).
For the employee:
If an employee reports sick (incapacitated for work) to the employer, the employer can have the employee summoned to the company doctor. Currently, an occupational health consultation and assessment of the incapacity for work often takes place by telephone. The company doctor then assesses the degree of incapacity for work and thus also the employer’s obligation to continue paying wages. The company doctor also provides reintegration advice. It sometimes happens that the employee disagrees with this advice given to the employer. For example, a reintegration plan where the employee believes the build-up in work will not succeed. In the employee’s opinion, the company doctor has not conducted sufficient investigation to arrive at the advice. No information was requested from the treating practitioners. The employee feels that the doctor did not listen properly.
Employee disagrees with the company doctor’s advice. What now?
Since the introduction of the “new Working Conditions Act” (nieuwe Arbowet) on July 1, 2017, every employee has the right to a second opinion from an independent company doctor, i.e., a second opinion company doctor not affiliated with the organization or its own occupational health service.
Incidentally, no one other than a company doctor (bedrijfsarts) or insurance doctor (verzekeringsarts) may assess medical capabilities, work capacity (belastbaarheid), and fitness for work (arbeidsgeschiktheid).
This cannot be done by a case manager, a task-delegated case manager, or a person calling themselves a reintegration specialist. Even the manager, lawyers, and even general practitioners (huisartsen) are not legally permitted to assess anything regarding the personal sphere of the degree of incapacity for work. In the telephonic assessments that have become common due to Corona, the advice is: make sure you know for certain that you are being assessed by a registered company or insurance doctor. And employers, if you are paying for an expensive company doctor, ensure that your employees are supervised by a registered company doctor. (An ‘arboarts’ is a recently graduated basic doctor (basis arts), not a medical specialist, not a company or insurance doctor. A task-delegated case manager is someone with knowledge of the procedures, who is supposed to be supervised in writing by a company doctor. This can never involve substantive medical specialist guidance. After all, this requires a full-time education of about 12 years after pre-university education (VWO/Gymnasium)).
When to request a second opinion?
According to the new Working Conditions Act, an employee has had the right to a second opinion since July 1, 2017, if they doubt the advice of a company doctor. This is not a non-binding request for the primary company doctor. They are legally obliged to follow up on it (Disciplinary Law ECLI:NL:TGZCTG:2021:83). A second opinion can concern the company doctor’s advice in the context of:
- Sickness absence guidance
- Occupational health assessment (PAGO or PMO).
- Pre-employment medical examination
- Consultation with the company doctor regarding health issues related to work (conditions), the open consultation hour.
What about the second opinion?
An AIOS (Doctor in Training to be a Specialist), Arboarts (basic occupational health doctor), i.e., a basic doctor, is not a medical specialist. This doctor may perform occupational health consultations under task delegation from a senior company doctor. (Company doctor is a registered medical specialty, a four-year postgraduate training.)
The scientific association of company doctors, the NVAB/KNMG, states in professional guidelines that a task-delegated basic doctor must consult with a regular supervisor, a company doctor, on all (complex) cases. The Supervisor must therefore always be aware of the actions, decisions, and advice of their task-delegated basic doctor. The basic doctor performs tasks in the name of and under the responsibility of this company doctor. They effectively form a unit with the company doctor in whose name the basic doctor acts.
The request for a second opinion company doctor is thus a request for an objective assessment of a ruling by the company doctor working under task delegation, whose actions and conduct should be known to the supervisor/registered company doctor.
The supervisor has thus already been involved in the primary assessment.
If an employee requests a second opinion after an assessment by a basic doctor, it must also be granted. A renewed extra assessment by the supervisor is, in fact, an admission that the task delegation is not working. And it can be unnecessarily experienced as intimidating by the employee.
This is certainly not what the government intended with the New Working Conditions Act. This could have disciplinary consequences for both the supervisor, company doctor, and the basic doctor if an employee brings this before the disciplinary tribunal.
Who requests a second opinion?
Only an employee can request a second opinion, but this must/can only be done via their own company doctor. The company doctor is not allowed to refuse a request for a second opinion under the new Working Conditions Act. According to the same law, the employer bears the costs of the second opinion. A second opinion investigation is independent, extensive, and often costly for the employer afterward. An employer cannot request a second opinion if they disagree with the company doctor’s advice. An employer does have the right to request a re-examination or an expertise investigation by another authorized registered company doctor. It is more convenient not to call this a second opinion. We call it a “second view” (tweede mening) or expertise investigation. This investigation is also carried out by an independent company doctor. Both investigations should, in principle, be an independent assessment of the work capacity (arbeidsbelasting) and reintegration possibilities, or provide an independent judgment on the aforementioned topics.
The company doctor can offer a second opinion to the employee if the situation calls for it. This may be the case, for example, if the company doctor lacks the specific knowledge needed to diagnose an occupational disease. In that case, the employee also retains the choice to decide whether another company doctor is actually consulted. The company doctor cannot, therefore, impose a second opinion on the employee.
Conversely, an employee’s request for a second opinion must, in principle, always be honored. A second opinion can only be refused if there are compelling reasons. For example, a situation where an employee threatens to make improper or repeatedly unnecessary use of the second opinion.
The SZW Inspectorate (formerly the Labour Inspectorate) checks whether employers and employees also adhere to this Working Conditions rule.
Requesting a second opinion?
As an employee, you can request the second opinion from your own company doctor. This is regulated in Article 14 of the Working Conditions Act. An employer can also request a second opinion from another company doctor for an employee, provided the employee consents.
Who pays for a second opinion?
According to the Working Conditions Act, the second opinion must, in principle, be paid by the employer. If an employee chooses to have a second opinion performed outside the agreed procedure and the employer has not given permission for this, the costs will be borne by the employee.
The employee can request a company doctor for an independent company doctor who is not included in the basic contract. In agreement between the employee and employer, another company doctor or occupational health service can be chosen. The costs for the second opinion are then for the employee, unless the employer agrees to the choice of another company doctor. If an employer requests an expertise (“second view” company doctor), the employer will pay the costs. If an employer has insured the incapacity for work, there is sometimes a possibility for the employer to declare all or part of the costs of this investigation to the insurer. It is necessary to inquire with this insurer in advance.
May an employee choose their own company doctor for the second opinion?
In principle, the contract between the employer and the occupational health service or company doctor specifies which other company doctor(s) or occupational health service(s) can perform the second opinion. The two industry organizations and the scientific association of company doctors (NVAB) have set up a special counter for this from which the employee can choose: National Pool of Company Doctors for Second Opinions (Landelijke Pool Bedrijfsartsen Second Opinion), https://www.bedrijfsartsensecondopinion.nl. Mr. Berkhout, registered company doctor, judicial expert, is registered with the National Pool.
What is the difference between a second opinion and an expert opinion (deskundigenoordeel) from the UWV?
A second opinion differs from an expert opinion from the UWV (Employee Insurance Agency). The UWV is testing on pre-defined questions. Three of the four selectable questions are tested by an occupational expert (arbeidsdeskundige). The answer is short and limited; there is no advisory function. The expert opinion is communicated to the employer and employee. The expert opinion from the UWV is an assessment of:
- The employee’s fitness for work
- The availability of suitable work within the employer’s company or
- The reintegration efforts of the employer or employee.
The expert opinion is a snapshot in time, often with legal status consequences.
The second opinion is usually requested when uncertainties remain about complaints, questions, and causes of health problems in relation to work and reintegration and work capacity. A second opinion leads to an advisory report for the employee’s own company doctor. This contains the research results, the information consulted, a consideration, conclusion, and advice on how to proceed. The new Working Conditions Act provides no basis for communication with the employer. No feedback is given to the employer, case manager, lawyer, etc.
The second opinion advice to the employee’s own company doctor varies from: working conditions advice, requesting extra medical information, deploying an intervention, to substantiating the employee’s work and reintegration possibilities. It is therefore a much more extensive investigation, report, and advice to the primary company doctor. It is much less of an assessment. It is noteworthy that the employee has a right to block (blokkaderecht) the report.
Medical data and advice exchange, how does that work?
Medical data for a second opinion are transferred by the first company doctor to the second opinion company doctor upon request by the employee via an authorization with the application. The second opinion company doctor may process medical data in the report. This report is shared only and exclusively with the first company doctor, after the employee has consented. There is, after all, a right to block.
For an expertise company doctor / “second view” investigation, an authorization from the employee is also necessary to obtain medical data for the expertise company doctor. The expertise company doctor advises the employee and employer simultaneously on the work capacity possibilities. No medical or privacy-sensitive terms are used in this. The degree of fitness for work can be mentioned. The employee does not have a right to block. The accumulated medical file can be transferred to another doctor upon request and with authorization from the employee.
Does a second opinion have a suspensive effect on reintegration and possible legal status measures?
A Second Opinion does not have a suspensive effect. An employee is legally bound by the agreements the employer makes based on the advice given by the first company doctor. Until the first company doctor decides to follow the Second Opinion advice and communicates advice based on this to the employer. The Second Opinion company doctor, after all, has no communication rights with the employer. The report can, however, be used legally by the employee later in any procedures, or when applying for a WIA (Work and Income (Capacity for Work) Act).
We trust that this has informed you sufficiently and wish you success in a professional and friendly manner.
If the application is received via your primary company doctor, it will be processed immediately and you will be invited shortly. The urgent processing you requested cannot be carried out without an application and instruction from the primary company doctor. As mentioned earlier, this doctor may not refuse.
Sincerely,
W.G.J. (Pim) Berkhout Second opinion company doctor Judicial expert – October 2025