Second view

The difference between a Second View from a Company Doctor, a Second Opinion from a Company Doctor and an Expert Opinion

Because the legislation surrounding second opinions is unclear to many employees and employers, and we are often asked to explain it “simply”, we thought it would be useful to draw up the following text for you.

The expert opinion is carried out by the UWV. It can be requested by the employer and the employee.
One of the tasks of the UWV is to implement and monitor the implementation of various social insurance laws such as the WAO, WW and Sickness Benefits Act, under which employees are compulsorily insured for illness. These are in place to protect employees and ensure a proper reintegration process in accordance with the requirements of the Gatekeeper Improvement Act. One of the instruments in the social security palette and for the protection of employees is the expert opinion. It concerns income and working capacity.

The application has only four options:

1. Expert opinion “sick-not sick”.
2. Expert opinion “employee reintegration efforts”.
3. Expert opinion “suitable work”.
4. Expert opinion “employer reintegration efforts”.

Items 2, 3 and 4 are occupational health issues assessed by an occupational health expert. Only in the case of “sick/not sick” is there a medical claim assessment carried out by a (insurance) doctor. The answers to the questions are brief indications, often limited to “sufficient” and “insufficient”.

The second opinion occupational physician examination

This offers the employee an independent, renewed occupational medical examination. In practice, we see employees who disagree with the advice of the occupational physician or the case managers working for their occupational health and safety service. Employees often present complex cases, with a subsidiary labour dispute resulting in wage sanctions due to advice given in the absence guidance. They request clarity and transparency regarding their employment options, the adequacy of treatment, prognosis and possible interventions by means of a second opinion from a company doctor. This is done in order to gain more insight into their own work capacity, often with an explanation of the social system and subsequent appropriate reintegration, but also to substantiate their ability to challenge (impending) financial measures on the grounds that the advice given regarding their fitness for work is incorrect. The second opinion company doctor is a combined company and insurance doctor who, on the basis of research and medical information, draws up evidence-based advice that must be able to withstand legal scrutiny. This takes a relatively large amount of professional time.

Second Opinion Company Doctor, an occupational health assessment

The employer disagrees with the opinion of their own occupational physician and wants a new independent occupational medical examination. The employer has a complex case, sometimes involving legal issues, and sees no way out. Often, there is the threat of a wage penalty from the UWV (Employee Insurance Agency), and the employer regularly wants the employee to receive the right support during their recovery and reintegration. The employer is not allowed to request a second opinion from the company doctor. The second opinion, occupational medical expertise, provides clarity and certainty about the employment possibilities for both the employer and the employee in the same independent manner. A report is only drawn up on the employee’s ability to work. The medical information obtained is recorded in the medical file. This is subject to medical confidentiality and the content is not shared and is only disclosed to the employee upon request.

The employee:

If an employee reports to the employer that they are unfit for work, the employer can ask the employee to see the company doctor. These days, a company doctor’s consultation and assessment of unfitness for work often takes place by telephone. The company doctor then assesses the degree of unfitness for work and, with that, the employer’s obligation to continue paying wages. The company doctor also gives reintegration advice. It sometimes happens that the employee disagrees with this advice to the employer. For example, a reintegration plan that the employee thinks will not work in terms of building up work capacity. In the employee’s opinion, the company doctor has not conducted sufficient research to arrive at this advice. No information has been requested from the treating physicians. The employee feels that the doctor has not listened properly.

The employee disagrees with the company doctor’s advice. What now?

Since the introduction of the “new Working Conditions Act” on 1 July 2017, every employee is entitled to a second opinion from an independent company doctor, i.e. not a second opinion from a company doctor affiliated with the organisation or its own occupational health and safety service. Incidentally, no one other than a company doctor or insurance doctor may assess medical capabilities, work capacity and fitness for work. This cannot be done by a case manager, a task-delegated case manager or a person calling themselves a reintegration specialist. Even the manager themselves, solicitors and even GPs are not legally permitted to assess anything in the personal sphere of the degree of incapacity for work. In the telephone assessment that has become commonplace due to Corona, the advice is to make sure that you are assessed by a registered company doctor or insurance doctor. And employers, if you pay for an expensive company doctor, make sure that your employees are supervised by a registered company doctor. (An “Arboarts” is a newly qualified general practitioner, not a medical specialist, company doctor or insurance doctor. A task-delegated case manager is someone with knowledge of the procedures, who would then be supervised in writing by a company doctor. This can never involve substantive medical specialist guidance. After all, this requires a full-time course of study lasting around 12 years after VWO/Gymnasium).

When to seek a second opinion?

Under the new Working Conditions Act, employees are entitled to a second opinion from 1 July 2017 onwards if they have doubts about the advice given by a company doctor. A second opinion may concern the advice given by the company doctor in the context of:

• Consultation with the company doctor regarding health issues related to work (conditions), open consultation hours
• Sickness absence support
• Occupational health examination (PAGO or PMO)
• Pre-employment medical examination

Who requests a second opinion?

Only an employee can request a second opinion. An employer cannot request a second opinion if they disagree with the advice of the company doctor. However, an employer does have the right to request a re-examination or expert examination by another authorised registered company doctor. It is more appropriate not to refer to this as a second opinion. We refer to it as a second opinion or expert assessment. This assessment is also carried out by an independent company doctor. In principle, both assessments should be an independent assessment of the workload and reintegration possibilities, or provide an independent opinion on the aforementioned subjects.

The occupational physician may offer a second opinion to the employee if the situation so requires. This may be the case, for example, if the occupational physician does not have the specific knowledge required to diagnose an occupational disease. In that case, the employee also has the choice of deciding whether to consult another occupational physician. The occupational physician cannot therefore impose a second opinion on the employee.

Conversely, a request from an employee for a second opinion must in principle always be granted. A second opinion can only be refused if there are compelling reasons for doing so. For example, in a situation where an employee threatens to make improper or repeated unnecessary use of the second opinion. If a company doctor refuses to cooperate, the primary company doctor will be subject to a statutory fine. The disciplinary court has also ruled on this matter.

The Inspectorate SZW (formerly the Labour Inspectorate) checks whether employers and employees comply with this Health and Safety Act.

Requesting a second opinion?

As an employee, you can request a second opinion from your own company doctor. This is regulated in Article 14 of the Working Conditions Act.

An employer may also request a second opinion from another occupational physician for an employee, provided that the employee agrees to this. Who pays for a second opinion? According to the Working Conditions Act, the second opinion must in principle be paid for by the employer. If an employee chooses to have a second opinion carried out outside the agreed procedure and the employer has not given permission for this, the costs will be borne by the employee.
If an employer requests an expert opinion or second opinion from a company doctor, the employer will pay the costs. If an employer has insured the employee against incapacity for work, the employer may sometimes be able to claim all or part of the costs of this examination from the insurer. It is necessary to check with this insurer in advance. Can an employee choose their own company doctor for the second opinion? In principle, the contract between the employer and the occupational health and safety service or company doctor specifies which other company doctor(s) or occupational health and safety service(s) can carry out the second opinion. The two industry organisations and the scientific association of company doctors NVAB have set up a special desk from which the employee can choose: National Pool of Company Doctors for Second Opinions, https://www.bedrijfsartsensecondopinion.nl

What is the difference between a second opinion and an expert opinion from the UWV?

A second opinion differs from an expert opinion from the UWV. The UWV assesses predefined questions. Three of the four questions to be selected are assessed by an occupational expert. The answer is brief and limited; there is no advisory function. The expert opinion is communicated to the employer and employee. The expert opinion from the UWV assesses:

• The employee’s fitness for work
• The availability of suitable work in the employer’s company or
• The reintegration efforts of the employer or employee.
  The expert opinion is a snapshot, often with legal consequences.

A second opinion is usually requested when there is still uncertainty about complaints, questions and causes of health problems in relation to work, reintegration and work capacity. A second opinion leads to an advisory report to the company doctor. This report contains the research results, the available information consulted, a consideration, conclusion and advice on how to proceed. The new Health and Safety Act does not provide a basis for communication with the employer. No feedback is given to the employer, case manager, solicitor, etc.

The second opinion advice to the company doctor varies from: advice on working conditions, requesting additional medical information, initiating an intervention, to substantiating the employee’s work and reintegration options. It is therefore a much more extensive examination, report and advice to the primary company doctor. It is much less of an assessment. It is noteworthy that the employee has the right to block access to the report.

Medical data and exchange of advice: how does that work?

Medical data for a second opinion from a second opinion company doctor is transferred by the first company doctor to the second opinion company doctor when the employee submits the request, by means of an authorisation. The second opinion company doctor may only share medical data that has been processed in the report with the first company doctor after the employee has given their consent. After all, there is a right of blocking. Any questions from the primary company doctor after the reports have been issued to the second opinion company doctor are also subject to the right of blocking. This means that the second opinion company doctor cannot communicate freely with the primary company doctor, even if there is an authorisation. In the case of a company doctor expertise/second opinion examination, authorisation from the employee is also required to obtain medical data for the company doctor expertise. The expert company doctor advises both the employee and the employer simultaneously on the employee’s work capacity. No medical or privacy-sensitive terms are used in this advice. The degree of fitness for work can be specified. The employee does not have a right of blockage. The accumulated medical file can be transferred to another doctor at the request of and with the authorisation of the employee.

Does a second opinion have a suspensive effect on reintegration and possible legal measures?

A second opinion does not have a suspensive effect. An employee is legally bound by the agreements made by the employer based on the advice given by the first company doctor. This remains the case until the first company doctor decides to follow the second opinion and communicates this advice to the employer. After all, the second opinion company doctor has no right to communicate with the employer. However, the report can be used later by the employee in any legal proceedings or when applying for WIA benefits.

The Employer:

Second Opinion Company Doctor, a company medical expertise examination. Employer does not understand the advice given by the absence counsellor. Employer has doubts about the stated work capacity, prognosis, etc. given by the company doctor in the feedback report, the current assessment.
In accordance with Article 14(1)(b) of the Working Conditions Act, the employer may not make its own assessment of the right to continued payment of wages; it must engage a company doctor for this purpose. If there is any doubt about the primary assessment, the employer has no choice but to obtain an independent second opinion.

W.G.J. Berkhout, registered company doctor, legal expert – October 2025