Many questions and answers about Worker’s Compensation can be found at the North Carolina Industrial Commission Website. Still, the best recommendation is that a worker review his/her case with an experienced North Carolina Workers’ compensation attorney. The attorney will be current on the relevant laws and legal issues. Mostly, the lawyer will understand many of the practical issues that can help make the difference between a substantial recovery and a minimal recovery – or no recovery at all.
Attorney Joe Miller knows the legal and practical issues. He is also a strong advocate for his clients, most of whom are in pain and worry daily about how they can manage their medical costs and daily living expenses. He has been helping injured workers in North Carolina and also in Virginia get justice for over 25 years. Along the way, he has obtained substantial settlements and awards for thousands of injured workers.
Some of the medical questions his firm advises clients about are:
Who controls the medical treatment?
The employer or the employer’s insurance carrier generally provides the employee with a list of doctors to see and pays the bills for the medical treatment. Employees, with some exceptions such as a medical emergency, treat with the company doctors. If there are good grounds, the employee (with the help of the lawyer) can petition the Industrial Commission for the right to change doctors. Before switching doctors, the employee should get the approval of the employer or, better still, approval from the North Carolina Industrial Commission.
Chiropractic Rules
Generally, an employee can see a chiropractor up to 20 times in North Carolina – if the employer agrees. Employers often agree because the cost for chiropractic services is less than that for pain management and orthopedic doctors. After 20 visits, the chiropractor needs additional approval from the employer.
Can employees be reimbursed for travel expenses for medical treatment?
Employees can be reimbursed in the following instances:
If the travel is more than 20 miles, employees can be reimbursed at the rate of:
- 25 cents a mile for travel prior to June 1, 2000;
- 31 cents a mile for travel between June 1, 2000 and January 17, 2006;
- 5 cents a mile for travel between January 18 and December 31, 2006;
- 5 cents a mile for travel between January 1 and December 31, 2007;
- 5 cents a mile for travel between January 1 and June 30, 2008;
- 5 cents a mile for travel between July 1 and December 31, 2008;
- 55 cents a mile for travel during 2009;
- 50 cents a mile for travel during 2010;
- 51 cents a mile for travel between January 1 and June 30, 2011;
- 5 cents a mile for travel between July 1, 2011 and December 31, 2012;
- 5 cents a mile for travel between January 1 and December 31, 2013; 56 cents a mile for travel between January 1 and December 31, 2014;
- 5 cents a mile for travel between January 1 and December 31, 2015;
- 54 cents a mile for travel on or after January 1, 2016.
In addition, the North Carolina Industrial Commission permits self-insurers to pay the employee directly for travel expenses – without approval from the Commission.
You need to keep track of and submit your mileage for any and all doctor or therapy visits over 20 miles.
Can an employee see a non-company doctor in case of an emergency?
Yes. The employee can get emergency treatment from a doctor or hospital. The employee must though immediately request approval from the NC Industrial Commission after the fact.
Where should a medical provider send the bill for payment?
The bill, along with the medical records, should be sent certified mail, return receipt requested, to the employer, self-insured employer, or the workers’ compensation insurance carrier. The receipt should be kept as proof of mailing.
Can doctors send medical bills electronically?
Yes. Medical bills, first reports of work injury and subsequent injury reports can be sent through the North Carolina Industrial Commission Electronic Data Interchange (EDI).
When should the medical provider submit the request for payment?
Generally, doctors should submit their medical bills to the NCIC within 75 days of treatment or service. Some extensions can apply such as when an initial work injury claim is first denied and then later approved.
How are IME bills handled?
Bills for Independent Medical Exams (IMEs) are submitted with a special code. The IME includes more than just the exam. It also includes a full review of medical records and a detailed medical report.
How are supplies paid?
“The North Carolina Industrial Commission has adopted nearly 1100 HCPCS billing codes to describe supplies and equipment used in workers’ compensation treatment. However, the Commission has not yet incorporated into its fee schedule all of the HCPCS level codes for supplies and equipment. For example, none of the “J” codes have been adopted.” “If a custom-made orthotic or prosthetic is not contained in the Commission schedule, these items should be paid per agreement between provider and payer.”
Do insurers and self-insurers have to send medical bills to the Industrial Commission?
No, they do not. Insurers and self-insurers may pay all medical bills, including hospital bills, without submitting them to the Industrial Commission for approval.
Can a medical provider bill for administering an intramuscular injection?
Only if an office visit is not charged.
What is a “medical only” claim?
This type claim means that there is no more than one day of lost time, no disfigurement or impairment, and no more than $2000.00 in medical expenses. Basically, it means that the employee will not be paid any lost wages. The employee is entitled to get medical treatment. The employee or the employer’s insurance carrier must still pay all medical bills that are reasonably supported by medical evidence.
Do you have concerns about your work injury medical bills?
Get help now by making an appointment with an experienced North Carolina Workers’ Compensation lawyer. It’s frustrating just trying to get healthy so you can get back to work or so you can, at least maximize your health situation. The last thing you want to do is worry about who is going to pay your bills. An experienced attorney understands how doctors and hospitals get paid when you are hurt on the job. For help now, call lawyer Joe Miller at 888-694-1671. You can also contact him through his online site.
