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Can You Go to Your Own Doctor for Workers’ Compensation?

If the employer accepts a workers’ compensation claim in North Carolina, the law requires the employer to provide “medical, surgical, hospital, nursing, and rehabilitative services, including, but not limited to, attendant care services prescribed by a health care provider authorized by the employer or subsequently by the Commission, vocational rehabilitation, and medicines, sick travel, and other treatment, including medical and surgical supplies, as may reasonably be required to effect a cure or give relief and for such additional time as, in the judgment of the Commission, will tend to lessen the period of disability; and any original artificial members as may reasonably be necessary at the end of the healing period and the replacement of such artificial members when reasonably necessitated by ordinary use or medical circumstances.” N.C. Gen. Stat. § 97-2(19), 25.

“[A]s a general rule, an employer has the right to select a physician to care for an injured employee and an employee may not procure his own medical treatment at the employer’s expense without the employer’s knowledge and consent.”  Ruggery v. N.C. Department of Corrections., 135 N.C. App. 270, 520 S.E.2d 77 (1999). In some situations, the employer or insurance company may require the employee to attend an “Independent Medical Evaluation (IME) and can even cut off the employee’s compensation if he/she does not comply.  N.C. Gen. Stat. 97-27. An injured worker should always consult with an experienced workers’ compensation lawyer before refusing to see a doctor.

Although employers have the general right to direct medical care in accepted cases, this right is not unlimited.  “There are a few recognized exceptions to the employer’s general right to direct medical treatment.” One example, is “[A]n employee may procure his own physician when the employer has failed to direct medical treatment in a prompt and adequate manner.” Another exception: “[A]n employee may procure treatment on his or her own in the case of an emergency.”   Kanipe v. Lane Upholstery, 141 N.C. App. 620, 540 S.E.2d 785 (2000); Schofield v. Great Atlantic and Pacific Tea Co., 299 N.C. 582, 264 S.E.2d 56 (1980).

If you wish to change doctors, a workers’ compensation lawyer can petition the N.C. Industrial Commission on your behalf to change physicians or approve the doctor you have chosen. However, it’s best to get approval from your employer, the employer’s insurance company, or the North Carolina Industrial Commission first to ensure insurance coverage of the medical expenses.  Even in the absence of an emergency or the employer’s failure to direct timely and adequate treatment, an employee still may select his or her own physician if such selection is approved by the Industrial Commission. The employee’s request for approval may even be filed after the treatment has been procured, just as long as the request is filed within a reasonable time thereafter. Doing so, however, involves some element of risk for the employee, as the Commission may deny the request.

In some cases, an experienced workers’ compensation attorney can help an injured worker seek an independent medical examination or petition to have their medical care transferred to a doctor they choose. The choice of healthcare providers is just one of the complications of an N.C. workers’ compensation claim.

If you are having difficulty obtaining benefits after suffering workplace injuries in North Carolina, you may benefit from legal representation. The workers’ compensation lawyers at Younce, Vtipil, Baznik & Banks, P.A. in Raleigh can help you understand your rights and guide you through the claims process after workplace accidents. Our workers’ compensation attorneys can deal with the insurance carrier and demand the medical care and lost wage benefits you need.

North Carolina Lets Employers Choose Their Employees’ Workers’ Comp Doctors

Most businesses in North Carolina are required to carry workers’ compensation insurance to provide paid medical care, temporary total disability benefits, and other benefits to employees who have on-the-job injuries or occupational illnesses. Under the North Carolina Workers’ Compensation Act, the employer and its workers’ compensation insurance carrier direct the medical treatment of injured workers who sustain workplace injuries.

Some large companies may have an onsite approved physician or nurse to provide medical treatment to an injured employee after an on-the-job injury. In most cases, employers will send you to a specific medical provider.

If you have a work-related injury, it is important to determine your employer’s requirements and follow them. If you have serious concerns about the doctor providing the treatment, you should contact a board-certified North Carolina workers’ compensation lawyer to understand your options.

When Can Employees Choose Their Own Doctor Under Workers’ Comp?

An employee may choose their own healthcare provider if:

  • Their work-related injuries require prompt emergency medical care at the nearest hospital or trauma center.
  • The employer does not designate an on-site or off-site healthcare provider for the treatment of work-related injuries.
  • The designated healthcare provider is not appropriate for the employee’s injury, such as the need for specialist treatment or emergency room care. If a workers’ comp recipient needs a specialist’s care, the treating physician should provide a referral.
  • The designated provider is not providing appropriate care. This is a serious allegation that may be made in a petition to the NCIC if appropriate. It requires a knowledgeable workers’ compensation lawyer and outside medical professionals who have examined the injured employee and are willing to testify.
  • The authorized treating physician gives up and says there is nothing else he/she can do. Your attorney can then show the Commission that there is another physician who has a reasonable treatment plan.
  • The employee formally requests a second medical opinion. In North Carolina, the employee has the right to a second opinion regarding the amount of a permanent partial disability rating. For example, if the authorized doctor assesses your shoulder as 10% permanently partially disabled, you can require the employer to pay for a second opinion regarding the amount of that rating. Occasionally, the second opinion doctor will look at the injury and decide that you have not yet reached maximum medical improvement, so a rating is not yet appropriate. The doctor can then propose a treatment plan to improve your function.

Let Our Board-Certified North Carolina Workers’ Comp Lawyers Help

If you have suffered a work-related injury or developed an occupational disease, it is important that you receive appropriate medical benefits. In many cases, your employer’s authorized treating physician can assist you properly. But if you are unhappy about the medical care you are receiving, you can ask your employer’s insurance carrier to allow you to change physicians. If the insurer denies your request, you can work with a knowledgeable workers’ compensation lawyer to petition for a change.

The board-certified North Carolina workers’ compensation attorneys at Younce, Vtipil, Baznik & Banks, P.A. are committed to helping injured employees seek the medical benefits and other workers’ compensation benefits provided by the North Carolina Workers’ Compensation Act after a serious workplace injury. Chip Younce and David E. Vtipil are board-certified specialists in North Carolina workers’ compensation law. They have helped thousands of injured workers.

Contact our workers’ compensation attorneys today at 919-661-9000 or online to discuss your workplace accident and workers’ comp benefits.

About the Author

Younce, Vtipil, Baznik & Banks, P.A.
At Younce, Vtipil, Baznik & Banks, P.A., our clients work closely with a legal team that is dedicated to providing outstanding client service and unflinching legal representation. The majority of our attorneys and support staff have worked with our firm for many years.

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