Can I Choose My Own Doctor To Treat My Workers’ Compensation Injury In NC?

July 15 , 2022

The short answer- YES! But it may not be easy or simple to do so.

You have to be able to trust your physician and know that they have your best interests at heart. Being in a partnership with your doctor is the key to recovery from any injury or illness. When the Affordable Care Act, often called Obamacare, was being discussed, many folks were concerned that they would not have coverage to continue to see the doctor of their choice. Protection of the patient’s right to chose to their doctor was and continues to be an important provision of the Affordable Care Act.  https://www.healthcare.gov/health-care-law-protections/doctor-choice-emergency-room-access/

Federal law protects the right of choice of medical provider, so many expect that North Carolina law would be similar. However, business interests in North Carolina took the opposite position for North Carolina injured workers. Insurer and companies contended that workers should NOT be allowed to select their own physicians. And they convinced the North Carolina politicians to change the law in 2011 to limit the worker’s right to chose their doctor.Choose My Own Doctor To Treat My Workers’ Compensation Injury

The Struggle for Personalized Medical Treatment and the Role of Doctors in the Process

Our current law states that the employer shall provide medical treatment (N.C.G.S. §97-25), which means that your employer or the workers compensation carrier gets to pick the doctor to treat you for your injuries. I talk everyday to workers who are frustrated by dealing with the urgent care doctors, orthopedic doctors or pain doctors selected by the insurance company. Those company doctors say that they cannot write anyone out of work or order an MRI because the insurance company “won’t let them”. That is not true! The doctors should be using their own medical experience to make decisions about what is best for each individual patient.  If they change their treatment plan because they want to keep the insurance company happy, they lose their focus on helping their patients. (In another article, I will discuss when your doctor orders something and the insurance company denies it.  That’s a different fight. )

I have even heard doctors state that it is “illegal” to write an injured worker completely out of work. Nothing could be further from the truth. If your doctor says that to you- it’s time to look for a doctor who is on your side. Of course, there are some doctors who do care, but don’t think that you should be out of work or need an MRI and use the insurance company as a scapegoat rather than telling you their honest opinion.  Is the doctor an insurance company pawn or are they too afraid to be honest with you? Either way, it does not help you get treatment and get better.

Navigating Exceptions in Workers’ Compensation Laws for Personalized Medical Care

Many workers read the above paragraph and give up hope- but don’t let that be you! There are specific exceptions in the law which give workers the right to chose and to get treatment from their own doctors. Let’s discuss those options. If you want to read the specific section of the law on this topic- it is here: https://www.ic.nc.gov/ncic/pages/statute/97-25.htm.

The law provides three options for workers to get authorization for treatment by the doctor of their choice. First, you have the right to request a second opinion on your treatment options. The request must be in writing and the workers’ compensation carrier has 14 days to respond to the request. They can agree, refuse or propose an alternative physician. If there is no agreement on the physician or an outright refusal of the second opinion, the worker can file a motion with the Industrial Commission asking them to order the insurance company to authorize and pay for the visit.   However, this is a one time visit and is not a guarantee that the doctor will become your approved physician. A good attorney can guide you on when and how to obtain a second opinion as well as how to follow up on that evaluation to get the care you need.

Another option is to make a motion for a change in a treating physician.  The law puts the burden on the worker to show why the company or insurance doctor should be replaced. Further, the law requires that the worker given written notice/ request for authorization BEFORE they go to see the doctor of their choice. The insurance companies were concerned that workers’ would shop around for a doctor to say things helpful for the worker. (Of course, we all know that the insurance companies shop for and buy doctors to say what they want). Before my client’s attend appointments with fair and unbiased doctors, we send a written request to the insurance company.

Securing Your Medical Choices

What happens if you don’t send written notice before seeing the doctor of your choice? (Here’s the kicker)  Your doctor’s opinion is stripped of it’s value as a matter of law! The statute says it this way: “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.” Knowing these laws and how they interact with selection of physicians is crucial to getting good medical care.

Finally, there is an option to select your own physician if there is an emergency situation and the carrier fails to provide care. This means that if you fell and think you may have broken your arm, you can select where to go if you don’t get immediate guidance from your employer. Don’t sit in pain and wait for authorization if you have a legitimate emergency situation. One of my clients fell into a hole on a construction site and obviously damaged his knee, but spent two hours in the back of a pick up truck (he couldn’t bend his leg), waiting on a return call from someone to tell him where to go.  I would have told him to go on to the emergency room and we would sort out the billing later.

There are other topics that touch on the right to chose your doctor- such as second opinions on impairment ratings, billing and reimbursement rates, expedited motions for approval of medical care- but I hope having knowledge of the information above will let you see that you have choices and options.  And having a good attorney working with you is the best way to get the treatment you to need to get better.

Empowering Injured Workers

In 2011, the North Carolina Legislature stripped workers of their right to choose their own doctors after suffering a work-related injury. Now, the workers’ compensation insurance providers choose which primary doctors injured workers can see, as well as who their specialty care or follow-up medical providers will be.

At the Ramsay Law Firm, P.A., our Charlotte workers’ compensation attorneys know that while this is still true, workers do have the right to pursue a second opinion for their treatment.

If you have been injured at work and are not satisfied with the insurance company’s choice of physicians, you have rights.

Our Mecklenburg County workers’ compensation attorneys work directly for our injured North Carolina clients, and will ensure your rights are protected throughout your case.

What Rights Do I Have To Seek A Second Medical Opinion For A North Carolina Workers’ Compensation Injury?

Under the new laws, injured workers do have some right to petition the North Carolina Industrial Commission to ask that they require the insurance company to pay for a second opinion.

Our Charlotte workers’ compensation law firm founder and managing attorney, Martha Ramsay, has been giving a voice to the injured for more than 25 years and can help you determine the benefits you are entitled to after suffering a workplace injury in North Carolina.

That includes petitioning the Commission to force the insurance company to honor a second medical opinion.

Do I Have The Right To Pursue A Second Opinion For My Doctor’s Impairment Rating?

The North Carolina Industrial Commission has developed a guide for physicians to rate industrial accidents and to provide a reference point for making impairment evaluations. Under the North Carolina Workers’ Compensation Law, the physician rates injuries according to the percentage of impairment of the affected part of the body.

The rating examines the extent of the injury, which could include the limited ability to use a body part or an inability to use the body system. These ratings are calculated using the North Carolina Industrial Rating Guidelines.

Once the impairment rating is assigned, the injured worker still has the option to get a second opinion on the impairment rating only.

The physician who reviews the rating cannot provide an opinion on whether the worker needs additional medical care, or when or if the worker can go back to work.

We can help you clearly understand each of your rights under our North Carolina Workers’ Compensation laws.

Contact Our skilled North Carolina Workers’ Compensation Specialists today

Our dedicated workers’ compensation law firm provides free consultations to all injured North Carolina employees by calling 704-376-1616 or contacting us online

Our Board-Certified Workers’ Compensation attorneys and a skilled team of lawyers and support staff in Charlotte are here to manage each detail of your case, so you can focus on your recovery.

All Workers Welcome. Ask Martha for Help Today.

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