Medical Treatment in NC Workers’ Compensation

When an injury is covered by workers’ compensation it is the responsibility of the employer or its workers’ compensation insurance company to provide medical treatment.  This is usually done by choosing a private medical provider to provide the treatment.  Some employers, mainly large manufacturers and hospitals, may have in-house medical services.

Treatment must be provided to cure the injury, help the employee return to work, or relieve pain.  Medical treatment includes traditional medical services such as doctor’s visits, rehabilitation, diagnostic testing, surgery, prosthetics and medications.  In some cases medical treatment can also include an adjustable bed and even housing modifications that are necessary because of physical limitations related to the injury.  Chiropractic treatment is covered under workers’ compensation in North Carolina however if more than twenty chiropractic visits are needed the chiropractor must obtain additional authorization from the employer.

medical treatment in nc workers comp

Workers’ compensation is not health insurance.  Medical treatment is provided only for the compensable injury or disease, as well as any condition that is a direct and natural consequence of the compensable condition.  So for example if an employee sustains a covered knee injury which leads to a change in the way he or she walks, which in turn results in a lower back condition, then the back condition may also be covered.

Medical treatment will last so long as it is needed, with some exceptions.  The right to medical treatment will expire two years after the last payment of any medical and wage replacement compensation.  So an injured worker who accepts the payment of a permanent partial disability rating, then does not receive medical treatment for two years, will lose medical benefits.  Medical treatment may also be denied if the employee lets a long period of time lapse without treatment.  Employees can prevent the unexpected expiration of medical benefits by completing and filing a Form 18M with the North Carolina Industrial Commission.  An approved 18M will keep medical benefits alive even after the expiration of the two year time limit.

The choice of doctors is the most frequently and strongly contested issue in the North Carolina workers’ compensation system.  In addition to prescribing medical treatment the authorized treating physician will assign temporary and permanent work restrictions that will determine when the injured employee can return to work as well as the kinds of work that are suitable. The authorized treating physician will also assign disability ratings which will form the basis for payment of permanent partial disability benefits.  Clearly a lot is at stake in determining which physician will direct medical treatment.

In general, the employer has the first opportunity to select the authorized treating physician who will direct the injured employee’s medical treatment.  The authorized treating physician will examine the employee, order diagnostic tests, prescribe medications and set work restrictions.  The authorized treating physician will often refer the employee to a specialist if necessary.

Employees may ask the Industrial Commission to approve a change in the authorized treating physician if the employee can show that a change is necessary to cure the injury, reduce pain or help the employee return to work.  The employee can also ask for a second opinion with a non-treating physician.  Employees have the right to a second opinion by a physician of their choice on any Permanent Partial Disability rating.  If an employer refuses to authorize medical treatment that has been recommended for the employee by an authorized medical provider then the employee may ask the Industrial Commission to approve the treatment.

The employer can require an injured worker to attend an independent medical examination (IME) with a physician of its choice at any time. There is no requirement that the employer have accepted the claim in order to get an Independent Medical Examination.  The IME must be with a physician licensed and practicing in North Carolina and be at a reasonable time and place.  An employee who refuses to attend an Independent Medical Examination runs the risk that his or her workers’ compensation benefits will be cut off until he or she complies.

Employers may hire nurse case managers to assist in coordinating the medical treatment for injured North Carolina workers.  Nurse case managers must abide by the North Carolina Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims.  Although the nurse case manager is paid by the employer he or she must exercise independent judgment in their efforts.  Nurse case managers may attend doctor’s appointments and may discuss the employee’s treatment with the doctor.  Injured workers have the right to a private visit with their physician without the nurse case manager being present.

An injured worker who drives more than 20 miles round-trip for medical treatment should be reimbursed for mileage.  The amount of the reimbursement is set annually by the NC Industrial Commission based on the Standard Mileage Rate set yearly by the IRS.  Mileage should be reported by the injured worker to the employer or the insurance adjuster on an Industrial Commission Form 25T.

For more information about Medical Treatment in NC Workers’ Compensation please contact Board Certified NC Workers’ Compensation Attorney Kevin Bunn for your free consultation.

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