North Carolina Workers' Compensation and Medical Providers
Below you will find a Hardison & Cochran Podcast episode on the subject of seeing medical providers after you have been injured at work. The transcript of the episode is also below for those who would simply like to read and not listen. To listen or read transcripts from other podcasts from Hardison & Cochran, please visit our Podcast Page.
Episode # 6 Medical Providers and North Carolina Workers’ Compensation Transcript
Bill Campbell: [00:01:34] I’ve been talking about medical providers. Obviously the medical providers for worker’s comp are selected by the Workers Comp carrier. Can people who are hurt really trust the doctors if they’re selected by the people that are trying to diminish your claim, so to speak?
Ben Cochran: [00:01:51] In my practice you see various different medical providers. I cannot say that I have ever seen a medical provider that did not take into consideration my client’s interests. I think that doctors have an ultimate duty to treat their patients. They take that very seriously and I believe that we do have a situation where you can feel confident that you’re going to receive medical treatment that is in your best interests and is meant to help you with your difficult circumstances. That being said, there are certain medical providers that are utilized by workers compensation more than other medical providers.
In North Carolina, the insurance company gets to select and choose which medical provider you get to go see. You do see when the medical providers are approached about work restrictions, whether or not somebody can or cannot work. Different medical providers do approach that differently. In workers compensation, you are less likely to see an individual taking completely out of work than you would in an injury situation that did not revolve around worker’s compensation.
You’re going to more likely than not see some type of restriction placed on the individual so that they could go back to work as long as it is a light-duty position. Thereby it becomes the employer’s obligation or responsibility to make sure that this employee that’s injured can come back to work. And it’s no longer the medical provider that has placed the injured employee out of work. And so if the employer cannot accommodate the restrictions, then the reason that the employee is not back to work is not simply because the doctor has them out of work, but it’s because the employer cannot accommodate those restrictions.
You see that more often than in workers’ compensation because the medical providers obviously don’t want to be labeled with the stigma that they keep employees out of work due to their injuries completely and totally.
Bill Campbell: [00:04:16] When a person goes and sees these medical providers how do they need to be communicating with them? What are some things they need to tell them? What do they need to not tell them? and if there’s anything they don’t need to tell them?
Ben Cochran: [00:04:25] When you’re talking to your medical provider, whether it be the urgent care doctor, the specialist, surgeon or physical therapist, you need to be clear and concise in what your complaints are. Each and every body part that aches, the different daily life activities that you’re having trouble doing as much knowledge to the medical provider so that they can assess your symptoms and assess your injuries to determine what type of medical treatment that you require.
The key about being very detailed is because I see it oftentimes that three or four months later it’s first reported in the medical records that the left shoulder was injured in the accident as well as the right shoulder. Three months later the insurance company is going to have difficulties with relating to the original injury by accident.
So you have to be certain that you document to the medical provider. Each and every complaint that you have and how it’s effecting you.
Bill Campbell: [00:05:35] This is probably the biggest question people have with worker’s comp and having to go see a doctor that they didn’t choose. Can they see their own doctor? Can they have a second opinion if they don’t like the opinion of the doctor that they’ve been directed to?
Ben Cochran: [00:05:50] In North Carolina there are two statutes that deal with second opinions that can be requested by the injured employee. The first one 97 25 and the second one is 97 27. The two different statutes are distinguishable into the interpretation of what the second opinion doctor is allowed to cover or allowed to offer opinions as to the evaluation of the injured employee. So when we look at 97 25. That is a second opinion that has been requested by the injured employee to which the defendants, or the insurance company, they had the opportunity to participate in the selection of the second opinion. So what that means, is that the insurance company and the injured employee agree on who the second opinion is going to be.
Now that second opinion doctor has full authorization to offer opinions about any aspect of the injuries, there causes, future medical treatment, and the permanent partial disability rating. That means what type of overall injury has that person suffered. So it is a full independent medical examination. It is a true second opinion. Now that second opinion was not just chosen by the injured employee the injured employee did have some participation in the selection.
Now let’s say the insurance company says we we don’t want to agree on somebody. Well at that point, once the insurance company said we don’t want to agree on somebody, the injured employee can petition the Industrial Commission for an order selecting one of their IME requested physicians. Meaning one of the Physicians that the injured employee wanted to see. And at that point the Industrial Commission reviews the positions of the insurance company and their injured employees and they determine who the second opinion is going to be done by. All of that once again is under 97 25. Now when we look at the next statute 97 27.
That particular statute allows for a second opinion specifically chosen by the injured employee. However, that opinion is only valid, or afforded weight, as it relates to the permanent partial disability rating. So essentially the court is only going to look at what the second opinion doctor that was chosen by the employee feels or opines as to the permit a partial disability rating. So you have a situation where you’re treating with the insurance company’s Doctor, you have a shoulder surgery, you’re given a rating by the doctor that was selected by the insurance company.
Let’s say it’s a 5 percent. You’re back to work, your shoulder feels great. Your only issue is you think the 5 percent rating is too low. Well at that point, the injured employee using 97 27 can choose a physician of their own, go see that doctor and have that doctor to give them a new rating. If that rating is higher, they are averaged. That is pursuant to 97 27.
Bill Campbell: [00:09:35] What if I don’t want to have the recommended treatment by the doctor? Do I have to do it?
Ben Cochran: [00:09:39] Well it depends on what the treatment recommendation by the physician Is. What I mean by that is if you have a physician that recommends physical therapy and you don’t wait to do physical therapy. More likely than not the insurance company can file a motion to compel with the Industrial Commission.
And at that point, he Industrial Commission can order you to participate in physical therapy or no longer be allowed to have benefits from worker’s compensation until such time as you do comply with the treatment recommendation. But if you look at a different situation, let’s say that the treating physician recommends that you have a lumbar spinal fusion.
Do you have to do that? In North Carolina, we use a balancing risk test. So what happens is if the risk of potential harm is out balanced by the risk of benefit then you do not have to participate in that medical treatment.
Essentially what that means is if there is a potential that there is death or paralyzation such as we are dealing with a lumbar fusion and the doctor can say, “Well I think there’s a 50% chance it will make you better.” The Industrial Commission is not going to force you to do a high risk procedure that cannot in guaranteed benefit.