If a PLHCP recommends that an employee see a specialist, but the employee does not authorize the PLHCP to include that recommendation in the written medical opinion for the employer, does the employer need to make the specialist examination available?

No. The standard requires the employer to make available an additional examination with a specialist only if the PLHCP’s written medical opinion for the employer indicates that the employee should be examined by a specialist. See 29 C.F.R. § 1926.1153(h)(7)(i). And the employee must provide written authorization before the PLHCP’s written medical opinion for the employer may include a recommendation for a specialist examination. See 29 C.F.R. § 1926.1153(h)(6)(ii)(B). Thus, if the PLHCP’s opinion for the employer does not contain the PLHCP’s recommendation for a specialist examination because the employee did not authorize the employer to receive it, then the employer is not responsible for offering additional examinations. See 81 Fed. Reg. at 16837.