This post discusses if you can choose your own doctor in a NC Workers' Compensation case. We represent injured workers in Raleigh, NC and surrounding areas and do not get paid unless you win. Call us today for a free case review, (919) 615-3095.
In North Carolina, the Workers' Compensation Act provides medical compensation and wage loss (indemnity) benefits for non-fatal injuries and death benefits for fatal injuries. Medical compensation includes medical treatment and mileage reimbursement for treatment of your workplace injury. Lost Wage benefits provide monetary compensation due to your inability to earn wages because of your work injury. This benefit provides compensation based on the physical impairment of the injured body part as well.
After your injury, your employer may have directed you to an urgent care facility (like FastMed) or the hospital for a medical examination. At that appointment, the health care provider informed you that you need continued care, so where do you go for treatment?
Can you choose your own doctor for Workmans Comp in NC?
The first step in determining if you can go to your own doctor is filing a Form 18 with the North Carolina Industrial Commission (N.C.I.C). After filing, your claim will either be accepted (approved) or denied.
Accepted Claims:
If your claim is accepted by the workers' compensation insurance company:
The insurance company will usually assign you a nurse case manager and a authorized treating physician to handle your medical treatment. These health care providers are paid by the insurance company and may not look at your work injury in the same light as your own doctor might. The insurance company can also send you for an Independent Medical Examination (which is rarely favorable to you) but you must attend under NC Law. While this treatment may not be ideal, it is being paid for by your employer's insurance carrier.
Unfortunately, you can only go to your own treating doctor in a accepted NC Worker’s Compensation case under some circumstances. As discussed above, the insurance carrier for your employer can send you to the doctor of their choice in the beginning; however, under North Carolina law ( NC Gen Statute 97-25 ) and under a certain set of facts, you can go to your own doctor with permission from the North Carolina Industrial Commission:
"the employee must show by a preponderance of the evidence that the change is reasonably necessary to effect a cure, provide relief, or lessen the period of disability. When deciding whether to grant an employee's request to change treatment or health care provider, the Commission may disregard or give less weight to the opinion of a health care provider from whom the employee sought evaluation, diagnosis, or treatment before the employee first requested authorization in writing from the employer, insurer, or Commission."
At the N.C.I.C, cases are heard before a commissioner, who acts like a judge. If you are unhappy with the commissioner’s decision, you or your NC workers' compensation lawyer can appeal the decision.
It should be noted that the insurance company can tell you where to go for medical treatment even if they have not yet accepted your claim. We have seen cases where insurers pay for medical treatment up front but later deny the claim. If this has happened to you read below about denied claims.
Denied Claims:
If your claim is denied by the workers' compensation insurance company:
If your workers' comp claim was denied, the insurance company is denying that you have a work related injury. At this point, you can go anywhere you want for medical treatment, but, if you do not eventually win your Workers' Compensation case, you will not be reimbursed for your medical expenses or indemnified for your lost wages.
Do you need a NC Workers' Compensation Lawyer?
If you need help asking the N.C. Industrial Commission for permission to see your own physician, you should consider hiring an attorney who handles NC worker’s compensation claims . You may also be able to get a second opinion on your disability rating or on surgery. Knowing the law or hiring an attorney who does is critical to the outcome of your worker’s compensation case in fighting the insurance carriers who are trained in denying claims. Doctors who work for insurance carriers are motivated by the insurance carriers who hire them. These doctors do not know your medical history the way your own doctor does. When your injury requires surgery, it is always a good idea to get a second opinion from another doctor in the same field of specialty, because of the risks involved with surgery.
The Bishop Law Firm can help you request permission to go to your own doctor in a NC Worker’s Compensation case as well as get a second opinion. We represent Worker’s Compensation clients in Raleigh, Cary, Durham, Fayetteville, Rocky Mount, Roanoke Rapids, Chapel Hill, Louisburg, Smithfield, Wilson and surrounding areas in North Carolina. If you have questions about your medical care or your WC claim, contact us today at (919) 615-3095.
