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Rating Guide Criteria for Doctors in NC Workers’ Compensation Cases

The North Carolina Industrial Commissions provides guides to physicians for determining how to rate the impairments for specific types of injuries. The guidelines are just a starting point and not a precise definition. Doctors who are making an evaluation of the impairment rating of a worker can use the guides but they should also factor in the intangible factors such as the amount of pain the worker can endure, how weak the employee is, the dexterity of the worker and other factors.

The guides are for injuries to the upper extremities, lower extremities and the spine. In North Carolina work injury cases, the doctor examines the affected body part and then assigns an impairment rating based on how well or how poorly the worker can use that part. Oftentimes, the doctor defers to a functional capacity examination (FCE) to help determine the level of loss of function. For example, the doctor may say the worker has 20% permanent impairment in his or her right upper extremity (arm). The impairment rating is just one factor in the amount of wage loss benefit the employee will get and the length of those benefits.

The final impairment rating should be based on the physicians’ knowledge, the clinical examination of the patient, and the doctor’s experience.

Some Recent Concerns by Doctors about the North Carolina Impairment Requirements

Some of the more recent issues that doctors and lawyers have raised about when and how to do their impairment ratings are:

Rating and Release

Due to some changes in the law, impairment ratings are becoming more and more important in North Carolina work injury cases.

Recent changes, for example, allow a worker to be forced to engage in ‘fake’ jobs if some residual disability prevents him from actually getting and keeping a job, and the doctor agrees it would help the injured worker, regardless of whether or not he has reached “maximum medical improvement”. This change has meant more litigation, between the employer and claimant, about the ability of the worker to perform the tasks in a given available job. The ratings, along with the analysis of the worker’s physical limitations can help or hurt the employee’s argument that he/she is not able to do the specific available job.

The rating can be given when the patient has reached maximum medical improvement even though the doctor may have already concluded that additional surgeries or additional medical treatments will not help the worker.

The North Carolina Industrial Commission guidelines for impairment ratings are not the same as the American Medical Association ratings. There is not a direct correlation between the two. Doctors, in North Carolina work injury cases, should begin with the Commission guidelines because those guidelines were designed to match the North Carolina Workers’ Compensation Statute.

The Right of the Worker to Get a Second Opinion as to a Rating

The employer is obligated to pay for the first medical opinion and treatment as to any permanent partial impairment. The employee can get a second medical opinion with a doctor of his choosing only as to the rating – at the employer’s expense, after the employer obtains a rating and where the worker is dissatisfied with the impairment rating offered by the worker’s original treating doctor. The employer and insurance carrier can also request that a second medical opinion be obtained. In some cases, such as where the worker does not have legal counsel, the Commission may recommend that there be an independent medical opinion. Litigation often centers around the situation where the two medical opinions contradict each other. Workers should review the right to a second opinion with an experienced North Carolina Workers’ Compensation attorney.

For a more in-depth discussion of your rights to a second opinion under NC Workers Comp Law, Click Here.

Medical Records

The medical provider should understand that the following people are entitled to medical rehabilitation records, the testimony of the doctor, and the opinions of the doctor – as a matter of course:

  • The patient if not represented by an attorney
  • The patient’s counsel
  • The employer or the insurance carrier, usually through their attorneys and/or nurse case managers or insurance adjusters.

If one side (employer or employee) has the records, then the other side should be able to get those records, without charge. In most respects, therefore, at least as to the employer and its representatives, the rules and laws on privacy and privilege as to your medical privacy do not apply.

The medical records, along with the history and patient notes, can often help determine if the work injury is compensable. For this reasons, workers should consult with their work injury lawyer before seeing their doctors. The lawyer can help explain what questions may be asked. Submission of the medical records and opinions can often mean that there is less of a need to depose the treating doctor – depending on how clear and concise the records are.

Rehabilitation Personnel

Insurance carriers often use nurse case managers to monitor the care the patient is getting, to help the employee keep scheduled appointments and take the prescribed treatments. These nurses may also help the employee return to a job they can manage. The Workers’ Compensation law does allow for these nurse case managers.

Many employees, employee counsel, and even the doctors have complained that the nurse case managers are not acting as facilitators. They are acting as advocates for the employer or insurance company. Doctors should understand that the nurses are to act only as facilitators. Nurse case managers cannot direct the worker’s treatment. Decisions with regard to the patient’s treatment always remain with the worker’s treating doctor. If the employer attempts to direct treatment in opposition to the worker’s doctor, the worker can and mostly likely should request that the Commission put a stop to such behavior.

Doctors should also understand that the nurse case manager does not have the right to be present in the examination room at all times. The patient is entitled to a private conversation with his or her doctor.

Call North Carolina Work Injury Attorney Joe Miller for Help Now

If you were hurt while working on the job, you need a lawyer who will fight for you. A strong advocate understands the legal and medical complexities of workers’ compensation Cases. Often the difference between a good result and a bad result can be the attention to detail and a full understanding of the law. To speak with a strong advocate today, please phone lawyer Joe Miller today at 888-694-1671 . You can also complete his contact form.

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If you are looking at this site, you or a loved one has probably been hurt. If that's true, you've come to the right place. Helping people who have been hurt is what we do. In fact, it is all we do. Joe Miller Law is a law firm concentrating exclusively on representing people who are injured by the carelessness of others or those hurt on the job. We provide the highest quality legal services to people who have been seriously injured. We practice Personal Injury law and Workmens' Compensation law in both Virginia and North Carolina.