North Carolina has specific rules for doctor selection if you suffer a workplace injury or illness. Employees are usually directed to a doctor by the employer, unless they underwent emergency surgery in the hospital. In such cases, the surgeon will usually continue on as the treating physician.
Employees may be able to switch to a different doctor if the employer is not cooperative, or the treating doctor is not appropriately trying to help the worker get healthy; however, it should be realized that it is not an easy thing to switch a treating physician in North Carolina. Specific procedures must be followed, or the worker could be stuck with the bill, or even worse, receive treatment from a physician whose opinions will count for nothing before the Industrial Commission. This will be discussed in this article.
Workers may also be required by the employer to submit to an independent medical exam by a physician chosen by the insurance company. This will be discussed further below.
You are also entitled to have an independent medical examination with a doctor typically agreed upon by your attorney and the defense attorney. If the sides cannot agree, the Commission will choose a doctor for the Independent Examination. This will also be discussed below.
Joe Miller has helped thousands of North Carolina workers get strong recoveries. He fights aggressively to help the worker get the medical relief he or she needs to return to maximum health. This fight includes arguing that the worker should have more control over the doctors that treat him or her. Joe Miller Esq. has worked with workers, doctors, and insurance companies for over 25 years. He is ready to help guide you through the medical stage of your worker’s compensation case so you can maximize your chances for a healthy recovery or for a proper diagnosis of all your medical problems.
The initial doctor visit
When an employee is hurt on an accident, he or she should, if possible, inform the employer or a supervisor of his/her injuries. The employer or supervisor often will then direct the worker to see the company doctor or another doctor of the employer or worker’s compensation insurance company’s choosing. If the employer does not have the time or ability to contact the employer/supervisor, the worker can get help from a local hospital or physician of the worker’s choosing – but must promptly request approval from the employer or the North Carolina Industrial Commission.
The employee must always make every effort to be careful to give an appropriate history of the work injury to the doctor and hospital. Many cases have hit snags because the employee didn’t tell the doctor and the hospital about how he or she was injured at work. If the medical records are missing that information, it could have a serious negative impact on your case.
The authorized treating doctor
Generally, if there was not initial surgical treatment, the work will be directed to a doctor by the worker’s compensation insurance company or employer. Workers cannot initially choose their own doctor or pick their own doctor in North Carolina and unless there are circumstances which justify it, the Commission will not pay attention to the opinions of any such physician chosen by the worker without Commission approval.
If we are involved in the initial stages of the case, and we have the opportunity to do so, we will protest if there is a referral by the insurance company to a doctor who is an infamous and proven advocate for the insurance companies. There are simply some doctors you must stay away from.
We make every effort to provide a list of alternate physicians and steer the worker away from the clutches of such doctors.
The right to ask for a change of doctors
Employees should review with an experienced North Carolina work injury attorney their right to ask to see another doctor. Workers have rights to select other doctors but only if the he or she gets approval from the North Carolina Industrial Commission. This is crucial in North Carolina because generally the Commission is going to ignore the opinions of any unauthorized physicians.
Workers have the right to ask for a change in treating physician if it is clear the initial treating doctor is not curing the injury or illness, or otherwise refuses to treat the worker. As noted above, switching doctors is not necessarily an easy thing to do in North Carolina. If the employee elects to attempt to seek treatment elsewhere and has the means to pay for it, he or she should always first request, in writing, authorization from the employer and workers compensation insurance company for the requested treatment, and await a reasonable time for response. We recommend this be done through certified mail.
The reason for the written request is because if you fail to ask for authorization before treatment, then the law says that the Industrial Commission may “disregard or give less weight” to the opinions of such a health care provider that you simply went out and chose on your own. This is why it is critically important that you not just seek treatment on your own, but always request authorization first, in writing. If a dispute arises, you must be able to prove to the Commission that you made the request and it was denied or never responded to appropriately.
Your Right to an IME 2nd Opinion Exam. As a separate right, exercised more frequently, employees can also ask for a second opinion examination with an agreed-upon physician on all medical issues, which is to be paid for by the workers compensation insurance company. Note that this is not medical treatment, this is simply an independent, one-time examination.
Your Right to a Ratings Exam. In addition, as an additional right, if the worker is dissatisfied with a partial disability rating by the treating doctor, he or she may choose a doctor to perform a partial disability rating. This is again a one-time exam, also paid for by the worker’s compensation insurance company; however, the “employee’s choice” rating examination must only relate to the percentage rating. The Commission will generally not pay attention to any opinions the ratings doctor may have, other than in relation to the rating itself.
Requesting a new doctor may prove to be important for several core reasons.
- The first is that you want to get the best medical care you can get. If the treating doctor is rushing you back to work, or not ordering the proper tests, you are not getting the best care. Your ability to work is your livelihood. You have the right to be treated by competent doctors who have your health interests at heart.
- The second is that the medical diagnosis and treatment directly affects your wage loss benefits.
- The treating doctor is the doctor who normally classifies the type of disability the worker has – temporary total, permanent total, or permanent partial impairment to a specific body part.
- The initial treating doctor will normally indicate if the worker can return to work;
- The treating doctor reports what work restrictions may apply—you cannot obtain benefits without knowing about these restrictions and having a current work note signed by the treating doctor.
- The treating doctor also assigns disability ratings which are used in the case of workers with partial disabilities.
- The third is that the medical diagnosis dictates what medical bills are paid. This includes more than just the doctor visits. It includes payment for medical devices, physical therapy, diagnostic tests such as MRI’s and CT scans, prescription expenses, and pain management.
Very specific procedures have been developed in the last couple of years in an attempt to “streamline” and speed up the hearing of medical treatment disputes before the Industrial Commission. It is crucial that you work with an experienced North Carolina workers’ compensation attorney such as Joe Miller Esq. who will help you explain to the Commission why a change of doctors is required and how to request approval for a change.
The Defense Independent medical examination (IME)
The employer and insurance company can, at any time, require that the worker submit to an independent medical exam with a doctor of their choosing. Generally, the employer seeks an independent medical exam, IME, if the employer or insurance company thinks the employee is ready to return to work or if the insurance company does not want to pay for an expensive surgery or other procedure recommended by your treating physician.
Your workers’ compensation lawyer should explain that the IME is not an objective opinion. It is usually an effort by the employer to get the worker to return to work so benefits can be terminated, or to wiggle out of paying for additional medical expenses.
That being said, employees must attend an IME, or run the danger of losing all benefits. We have very specific recommendations that we provide to all of our clients as to how to behave in a defense Independent Examination.
Some additional medical concerns in North Carolina Worker’s Compensation Cases
Nurse Case Managers. In North Carolina, employers can also require that employees work with nurse case managers. Nurse case managers are supposed to help the employee get proper medical guidance. Generally, though, the nurse case manager works for the employer and insurance company and not the employee. Workers should know their rights if they are assigned a nurse case manager. Our experience in North Carolina is that some can be actual patient advocates, and look out for the worker, while others are simply in cahoots with the insurance carrier and have no interest in helping the worker.
Chiropractic treatment. Employees are allowed up to 20 chiropractic visits if the employer grants permission to work with a chiropractor. Additional visits may be authorized if the employer agrees.
Get Strong Medical Advice for Your Work Injury Case
To get the best medical and wage loss results, it is important that you get treatment from the best doctors. For strong counsel and for a lawyer who understands the medical requirements in North Carolina work injury cases, contact attorney Joe Miller at 888-694-1671 and ask for Joe Miller, or complete his online contact form for an appointment.