NC Workers' Compensation Second Opinion

Employer/Injured worker’s right to a 2nd Medical Opinion
By Kimberly BishopNovember 19, 2017

This post discusses an injured worker’s right to a second medical opinion. If you are receiving medical treatment for a workplace injury continue reading to find out how to receive all the medical treatment you are entitled to under NC Workers' Compensation.

NC Workers' Comp Benefits

In North Carolina, the North Carolina Industrial Commission (N.C.I.C.) governs workers' compensation cases. State law 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 work injury. Lost Wage benefits provide monetary compensation due to your inability to earn wages because of your on the job injury. This benefit provides compensation based on the physical impairment of the injured body part as well.

Who gets to control your medical treatment as the injured worker?

If your workers' compensation claim is accepted by the insurance company, they have agreed that you have a valid workers' comp claim. The employer's workers' compensation insurance carrier pays for and controls where the injured worker is seen for treatment. If the injured worker wants to change to a new doctor:

“in order for the Commission to grant an employee’s request to change treatment or health care provider, the employee must show by a preponderance of the evidence that the change is necessary to effect a cure, provide relief, or lessen the period of disability” N.C. Gen. Stat. §97-25 .

An injured worker must provide proof for the reason he/she wants to change their treating physician in a workers’ compensation case rather than simply making a request to change treating physicians.

The North Carolina Court of Appeals has determined that "treatment provided to injured workers that provides “relief from pain constitutes ‘relief’ as the term is used in N.C. Gen. Stat. §97-25 (See Simon v. Triangle Materials, Inc., 106 N.C. App. 39)."

An example would be the need for spinal injections for back pain. An authorized treating physician (company doctor) who is being paid by the insurer may not suggest, mention or agree with injections because they do not offer them at their office while the employee's own doctor may offer injections in his/her office to relieve pain. 

If the treatment that the employee's own doctor can offer will "effect a cure, provide relief, or lessen the period of disability," the N.C.I.C. may approve the injured worker's request to see the medical provider even if the employer's workers' compensation insurance company will not. However, you may not be able to choose the medical provider to provide the second opinion.  

If your workers' compensation claim is denied, you can go to any physician for treatment but be advised that if you do not win your claim in front of the North Carolina Industrial Commission, you will not be reimbursed for your expenses.

Can you get a second opinion with Workers' Comp in NC?

NC Workers' Compensation law permits an injured worker to obtain a 2nd opinion regarding appropriate medical care, such as recommended surgery or course of treatment.

If an injured worker desires a second opinion with a physician of his/her own choice, the injured worker may make the request in writing to the employer. The employer has 14 days to agree to the injured worker’s written request. If the employer does not agree to the injured workers’ written request for a second opinion, then the injured worker may request the N.C.I.C. to order a second opinion. If the N.C.I.C. grants the request, the employer must pay for the expense of the requested second opinion doctor. N.C. Gen. §Stat. 97-25. If the employer refuses to grant the second opinion, you may be able to pay for your own second opinion, but you will not be compensated for the expense. 

You should also be aware that the employer has a right to 2nd opinion as well. The workers' compensation carrier can request that the injured employee report to a independent medical exam by a doctor which they have chosen and paid for. If the employee refuses to see the IME doctor their benefits can be suspended. Even if the employer's workers' compensation insurance company has denied the claim, the employee still has to attend the IME.  

However, the injured employee can (and should) seek another medical exam to determine their percentage of permanent disability if they dispute the percentage arrived at by the IME doctor. N.C. Gen. §Stat. 97-27.

Medical benefits and payment issues often arise in NC Workers’ Compensation cases . If you find yourself wondering what to do about appropriate medical treatment for your on the job injury or if you need to obtain a second opinion, you should speak with a NC Workers’ Compensation Lawyer.

The Bishop Law Firm represents Workers’ Compensation clients in Raleigh, Cary, Durham, Rocky Mount, Wilson, Smithfield, Louisburg, Chapel Hill, Roanoke Rapids and surrounding areas in North Carolina. We do not get paid unless you win and we offer free case reviews by phone, (919) 615-3095.

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