It’s a big deal when you can’t work because of a job-related injury. Your ability to recover quickly and fully may depend on quality medical treatment. Your first instinct might be to see your regular family doctor or to ask around for referrals to a good specialist.
Unfortunately, under North Carolina workers’ compensation law, employers can dictate who treats your work injury. You can pick from a list of approved providers, but it’s not truly a choice. However, under the statute you are entitled to a second opinion and you can request permission to switch doctors.
You must see your employer’s preferred physicians – with a few exceptions.
The workers’ comp system is stacked against employees in many ways. One of them is the requirement that you seek treatment with the employer’s preferred physicans and clinics. These doctors are licensed professionals, but they know who butters their bread. Physicians who have been pre-selected by the employer are more likely to downplay your disability rating, reducing your level of benefits. They are less likely to recommend surgery or physical rehab services in favor of more conservative (i.e., less expensive) treatment options such as “rest” or prescribed exercises. And those doctors are more likely to declare you fit to resume working, even if you are still hurting and healing.
- The automatic right to a second opinion – North Carolina statute allows you, as an injured employee, to request (in writing) a second opinion examination by a doctor of your choosing and at the employer’s expense. If the request is denied or you and the employer can’t agree on a provider, you can appeal to the Industrial Commission to authorize a second opinion. Note: the treating physician has the right to sit in on the second opinion exam and the results must be disclosed to the employer and the insurer.
- The (limited) right to change providers – A second opinion or other dispute with the employer’s preferred doctor may convince you that you need a change. You may transfer your care to a health care provider of your choice, subject to the approval of the Industrial Commission. You must show the commission “by a preponderance of the evidence” that switching providers is reasonably necessary to obtain a cure or relief, or to shorten the period of disability.
- Emergency situations – The employer must pay for reasonable emergency medical care, even if the provider is not on the employer’s list of designated hospitals or physicians. This is especially true when the employer has denied
Expect the employer, insurer or provider to fight you
Disputes about medical providers or coverage of specific medical treatments are heard by the Industrial Commission. Either party can contest medical issues and workers’ compensation decisions in a hearing before a Deputy Commissioner. While you are not required to hire legal representation, it is highly recommended. The average person is at a great disadvantage against insurance companies who know the letter of the law and how to interpret it in their favor. Your request could be delayed or dismissed due to the deadlines and technicalities of Commission proceedings. You should have a workers’ compensation lawyer who can assert your rights, make the case for your desired medical treatment, and counter the attorneys and medical experts on the other side.
Source: North Carolina Statute § 97-25