Who Controls An Injured Workers' Medical Treatment in North Carolina?

If you are injured in the State of North Carolina as a result of an injury by accident while in the course and scope of your employment then you may be entitled to both medical and lost wage benefits pursuant to Chapter 97 of the North Carolina General Statutes. These Statutes are commonly referred to as the North Carolina Workers’ Compensation Act. Everyday I receive many questions from injured employees in regards to their medical treatment through workers’ compensation. As a result of these questions we felt it was imperative to try and address these concerns as one of our newsletter topics. We hope that the following discussion is helpful in answering questions that the public may have in regards to medical treatment through the Act.

When an employee is injured in the State of North Carolina and the insurance carrier deems it to be a “compensable claim” then they will instruct the injured employee where they are to seek medical treatment. Many injured employees do not wish to be treated by the recommended physician and would rather seek medical assistance at a physician that they already know. However, it is becoming more evident every day that the carrier does maintain the right to direct medical treatment of the injured employee.

What does this mean for the injured employee? Does the injured employee ever have the ability to see a doctor for an independent opinion? As long as the injured employee is in the healing period, it is very difficult for the injured employee to select a physician of his choosing. The carrier has physicians which are within their insurance network that they utilize on a regular basis. They are not likely to let the employee independently select another physician. In addition, employers often have contracts with other physicians to handle their workers’ compensation claims. This does not mean that the injured employee will receive inadequate medical treatment but the injured employee will undoubtedly feel as though they are being forced to see a particular physician.

There are essentially two stages of an injured employee’s medical treatment when you are speaking about a work related injury. The two stages are termed as “pre” and “post” maximum medical improvement. The term maximum medical improvement indicates that the treating physician has opined that the injured employee is as good as they are going to get medically under their care. The term pre-MMI is associated with the time period identified as the healing period. This is the period of time directly following the compensable injury by accident. The carrier or self-insured employer refers the injured employee to a doctor of their choosing during this period of time. My recommendation to those injured employees is to put forth a good faith effort to comply with the physician’s recommendations.

I recommend that the injured employee comply with the directives of the treating physician because the law requires the employee to comply with reasonable medical treatment recommendations. Unfortunately, not complying may jeopardize the injured employee’s right to receive further compensation both monetarily and medically. Does this mean that the employee is at the complete mercy of the carrier or self-insured and their treating physician? No.

Once the treating physician has decided that the injured employee is at maximum medical improvement, they have come to the conclusion that they can no longer offer any medical benefit to the employee and essentially the employee cannot get any better. It is at this time that we enter the post-MMI period. But what does this mean? This means that the employee obtains the ability to receive what has been called a second opinion on the rating. The law allows when there is a question of permanency that the injured employee can obtain an opinion from a physician duly licensed in North Carolina for their opinion as to their rating. Once the physician offers a second opinion in regards to the rating if the physician also indicates there is further medical treatment that can be offered then the injured employee can apply to the Industrial Commission to have these recommendations authorized by the carrier.

The injured employee does have options. If the treating physician assigned by the carrier releases the injured from their medical care and the injured are not satisfied then they can get a second opinion on the rating. Moreover, it is possible that the carrier may allow you to see another physician for a second opinion. They generally will not allow you to choose the physician but maybe you can agree on a physician. Remember, it is in the insurance company’s best interest to get you well as quickly as possible also. I also want to stress one other option. The law allows the injured employee the ability to apply to the Industrial Commission at any time for treatment from another physician. The Industrial Commission has the power to order the insurance company to send you to another physician. You will need to contact the Executive Secretary’s office with the Industrial Commission in order to do this.

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