Can You Choose Your Own Doctor After a North Carolina Workplace Injury?

Who Normally Chooses the Doctor in a North Carolina Workers’ Comp Claim?

In an accepted workers’ compensation claim, the employer or its insurance carrier generally provides and directs the medical treatment.

North Carolina General Statute § 97-25 states that medical compensation is to be provided by the employer.

In practice, that often means the employer or workers’ compensation carrier selects the initial physician or clinic and authorizes referrals to specialists.

The North Carolina Industrial Commission likewise explains that employers or their insurance carriers may select treating physicians and other medical providers, subject to orders of the Commission.

That arrangement is significantly different from ordinary health insurance, where you may be accustomed to selecting a doctor from an approved network.

Why Does the Workers’ Comp Carrier Control Treatment?

Workers’ compensation is responsible for paying reasonable medical treatment required because of the compensable workplace injury.

Because the employer or carrier is responsible for those medical expenses, North Carolina law gives it substantial control over the physicians providing authorized treatment.

That control can affect more than who sends the bill.

The authorized treating physician may make important decisions concerning:

• Your diagnosis
• Medical restrictions
• Whether you can return to work
• Physical therapy or other rehabilitation
• Referrals to specialists
• Whether surgery is recommended
• Maximum medical improvement
• Permanent work restrictions
• Permanent impairment ratings

Those medical opinions can have a significant effect on both treatment and the workers’ compensation benefits available to you.

 

Can You Ask to Change Doctors?

Yes.

An injured employee can request treatment from another healthcare provider, but simply making an appointment with a different doctor does not necessarily make that physician an authorized workers’ compensation provider.

Under G.S. § 97-25, an employee may seek approval for a healthcare provider of the employee’s choosing to take over treatment.

If the employer or carrier does not agree, the injured employee can ask the North Carolina Industrial Commission to approve a change.

What Must You Show to Get a Different Doctor?

The statute provides an important standard.

To obtain Commission approval for a change of treatment or healthcare provider, the employee must show that the proposed change is reasonably necessary to:

• Effect a cure
• Provide relief, or
• Lessen the period of disability

The employee must establish that by a preponderance of the evidence.

In practical terms, simply saying “I do not like this doctor” may not be enough.

A stronger request may involve circumstances such as:

• Persistent symptoms that are not being adequately addressed
• A specialist being needed for the particular injury
• Recommended treatment being unavailable through the existing provider
• A significant disagreement concerning diagnosis or treatment
• Medical evidence supporting a different course of care

Every situation is fact-specific, and approval is not automatic.

 

Do Not Simply Start Treatment With Another Doctor Without Authorization

This is one of the most important practical points for an injured worker.

If you are unhappy with the authorized physician, making an appointment with your own doctor before asking the employer, insurer or Industrial Commission for approval can create problems.

The North Carolina Industrial Commission warns that payment for treatment obtained from a different physician is not guaranteed unless written permission to change doctors is obtained from the employer, carrier or Commission before the treatment occurs.

G.S. § 97-25 also permits the Commission to give less weight to the opinion of a physician whom the employee consulted before first requesting authorization for the change.

That does not mean unauthorized medical evidence is always worthless.

It does mean there can be a substantial difference between:

requesting approval for another physician first

and

obtaining treatment independently and asking workers’ compensation to pay for it afterward.

If your claim has already been accepted and you want a different treating physician, dealing with authorization before changing doctors can avoid unnecessary disputes.

 

Can You Get a Second Medical Opinion?

Yes. North Carolina law provides a procedure for requesting a second opinion.

Under G.S. § 97-25, an injured employee can make a written request to the employer for a second-opinion examination by a qualified physician.

The employer may agree to authorize and pay for the examination.

If the request is denied, or the employee and employer cannot agree in good faith on the physician within 14 calendar days after the employer receives the written request, the employee can ask the Industrial Commission to order the second opinion.

If ordered or authorized under the statute, the employer bears the expense of the examination.

A Second Opinion Is Different From Changing Treating Doctors

These two concepts are easy to confuse.

A second opinion usually means another physician evaluates the medical issue and gives an opinion.

Changing physicians means the new healthcare provider actually assumes responsibility for ongoing treatment.

You might want a second opinion because you disagree with a diagnosis or want another physician to evaluate whether surgery is necessary.

You might seek a change of treating physician because you believe different ongoing medical care is reasonably necessary.

The appropriate procedure depends on what you are trying to accomplish.

 

What If You Disagree With Your Permanent Impairment Rating?

North Carolina law provides another specific second-opinion right when an authorized physician assigns a permanent impairment rating.

Under G.S. § 97-27, if an employee is dissatisfied with the percentage of permanent disability assigned by the authorized healthcare provider, the employee is entitled to another examination specifically addressing the permanent impairment rating.

For this particular examination, the worker can select the qualified physician.

The employer pays for the physician’s examination, although the statute provides that travel expenses for obtaining that examination are paid by the employee.

This is narrower than a general second opinion.

The physician selected under this provision is evaluating the percentage of permanent impairment. The statute specifically limits the weight that may be given to opinions from that examination on unrelated medical issues.

 

What Is an Independent Medical Examination?

Another doctor may enter the case for a very different reason: the employer or insurance company requests an independent medical examination, commonly called an IME.

An IME is not the same thing as the employee requesting a second opinion.

Under G.S. § 97-27, an employer can require an injured employee who is claiming compensation to attend an examination by a qualified physician designated and paid by the employer, subject to the statutory requirements.

This right can apply even where the employer has denied the workers’ compensation claim.

Can You Refuse an IME?

Refusing or obstructing a properly requested examination can have serious consequences.

The statute permits workers’ compensation benefits and proceedings to be suspended while an unjustified refusal or obstruction continues.

That is why an IME request should not simply be ignored.

If there is a legitimate concern about the physician, location, timing or scope of the requested examination, the better approach is generally to address the issue through the workers’ compensation process rather than simply refusing to attend.

 

What If You Need Emergency Medical Treatment?

Workplace injuries do not always occur in circumstances where an employer has time to select a physician first.

If you suffer a serious injury requiring emergency treatment, getting appropriate immediate medical care should take priority.

North Carolina law recognizes emergency situations.

Under G.S. § 97-25, when emergency treatment becomes necessary because the employer has failed to provide medical compensation, the Industrial Commission may order the employer to pay the reasonable cost of treatment provided by another physician.

After emergency treatment, however, ongoing care may still need to be coordinated with the employer or workers’ compensation insurance carrier.

 

What If the Workers’ Compensation Claim Has Been Denied?

A denied claim can create a particularly difficult medical situation.

If the employer or insurance carrier denies that your injury is compensable, it may also refuse to authorize or pay for the treatment you need.

You may then need to obtain treatment through other available means while the workers’ compensation dispute is being resolved.

Keep copies of:

• Medical records
• Medical bills
• Prescription expenses
• Work restrictions
• Referral recommendations
• Correspondence from the employer or insurer denying treatment

If the injury is later determined to be compensable, the question of responsibility for reasonable treatment related to the workplace injury can become part of the workers’ compensation case.

A denied claim is also one of the circumstances where getting advice early can be particularly important because medical evidence often becomes central to proving that the condition resulted from the workplace accident.

 

What If the Doctor Sends You Back to Work but You Do Not Feel Ready?

This is one of the most common reasons injured workers become concerned about who controls their medical care.

The authorized physician may release an employee to:

• Return to regular duty
• Return with restrictions
• Perform modified or light-duty work

The employee may still be experiencing significant symptoms or believe the restrictions do not accurately reflect what they can safely do.

Simply refusing to return to work can create problems with ongoing benefits.

At the same time, legitimate medical concerns should not be ignored.

A disagreement about return-to-work status may justify discussing a second opinion, additional medical evaluation or a request for different treatment depending upon the circumstances.

The important point is to address the disagreement through the workers’ compensation process rather than simply abandoning either treatment or employment.

 

Can Your Regular Doctor Still Be Helpful?

Potentially, yes.

Your regular physician may know your medical history and may have important information about your condition before and after the workplace accident.

Prior medical records can also help distinguish a new workplace injury from an existing medical problem or document how the accident aggravated a pre-existing condition.

But there is an important difference between a physician having useful medical information and that physician becoming the authorized treating doctor for the workers’ compensation claim.

If you want your existing physician to assume responsibility for treatment that workers’ compensation will pay for, authorization may need to be obtained.

 

Why the Authorized Treating Physician Matters So Much

The treating doctor’s role can extend well beyond providing medical care.

Medical opinions can influence questions about:

• Whether the workplace accident caused the injury
• Whether additional treatment is medically necessary
• Whether you remain unable to work
• What work restrictions are appropriate
• Whether surgery or other treatment is needed
• Whether you have reached maximum medical improvement
• Whether permanent restrictions are required
• Whether you have sustained permanent impairment

That can directly affect both medical treatment and disability benefits.

For this reason, concerns about an authorized doctor should be taken seriously — but handled through the procedures available under North Carolina law.

 

What Should You Do If You Want a Different Workers’ Comp Doctor?

If you believe your current treatment is inadequate, start by documenting the problem.

Practical steps can include:

• Continue attending authorized appointments unless advised otherwise.
• Explain your symptoms and treatment concerns clearly to the physician.
• Keep copies of work notes, restrictions and medical recommendations.
• Make requests for a second opinion or change of physician in writing.
• Do not assume an unauthorized doctor will automatically be paid by workers’ compensation.
• Preserve any medical evidence supporting the need for different treatment.
• Do not simply stop cooperating with authorized treatment.

If the employer or insurer refuses a reasonable request, the North Carolina Industrial Commission can resolve disputes over medical treatment.

 

Talk to Kellum Law Firm About Your Workers’ Compensation Medical Treatment

Medical treatment is often one of the most important parts of a North Carolina workers’ compensation case.

If you are not receiving the care you believe you need, have been denied a second opinion, disagree with your impairment rating or want to request a different physician, understanding the correct procedure can help protect both your health and your claim.

Kellum Law Firm represents injured workers throughout North Carolina. Our North Carolina workers’ compensation lawyers can review the claim, the medical treatment being provided and the options available when there is a dispute over your care.

Contact Kellum Law Firm for a free case evaluation. We’re With You All The Way.