Injury Treatment Denied By Insurer

I injured my knee at work, but now the North Carolina workers’ comp insurer refuses to pay for the surgery my doctor recommends. Questions like this come up all the time in North Carolina. After a workplace injury, often employers or the insurance companies want you to get better fast and return to work, and sometimes the right treatment is denied by the insurer just because it is expensive.

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The employer and their insurer often want to limit the cost of your medical care and avoid expensive tests, interventions and therapies. A number of extreme cases have shown us time and again where their priorities stand:

• In one example a woman was following a rehabilitation therapy and the insurer sent a “nurse consultant” who was systematically present at the rehab appointments. A nurse consultant’s official job is to coordinate an injured patient’s treatment in order to get the victim back to work as soon as possible. In this situation, the nurse consultant had repeated conversations with the doctor pressuring him to declare the woman fit to return to work.
• In another case that we managed to resolve, the insurance company had hired an outside doctor to decide whether lumbar surgery was required. The doctor’s opinion was negative after having analyzed the patient’s file, even though the doctor did not see the injured worker once during the review process.
• In several cases we have seen that the insurer’s tactic is to deny necessary scans and tests; this allows them to conclude that “there is no objective sign of injury” and close the file. Other doctors concentrate all their energy on proving that there was a pre-existing condition or that there is no relation between the injury and the accident.

Is there anything you can do to protect yourself from bad faith and shameful tactics?

The North Carolina Industrial Commission administers workers’ compensation claims in the state, and has put in place expedited hearing procedures for these types of medical issues.

The key to successfully handling these hearings is to be prepared and to have a complete and detailed account of your accident, your medical history, the defense’s assertion and your doctor’s detailed arguments in favor of the proposed treatment.

In North East North Carolina, workers’ comp attorney Joseph Miller, Esq is the right person to support your case and get you the medical benefits to which you are entitled. You need someone who:

• Is really experienced and entirely focused on North Carolina workers’ compensation;
• Has a very good knowledge of medical issues and knows how to ask doctors the right questions;
• Has an excellent track record of winning and resolving cases.

Contact Joe Miller Law in Elizabeth City, where attorney Joseph Miller, Esq has been representing injured North Carolina workers for over 20 years. Call us locally 757-455-8889 or toll-free 888-694-1671 today, or send us an e-mail for a FREE, no commitment discussion of your case.