When you have suffered a work-related injury, you may not necessarily see your own physician for a diagnosis and treatment. You may need to select a physician from a list that your employer provides.
It is this doctor who will give you the diagnosis that is used as the basis for your workers’ compensation claim. They will also be the ones who are in control of your care so long as your work-related injury is being treated. The doctor may decide what care you will need to treat your injury. You may have rightful reasons to have questions about any doctor on the insurance company’s payroll.
Employees and Doctors Do Not Always Agree on Treatment
In some cases, there is a disagreement between the employee and the doctor about the medical care necessary to treat the injury. The doctor has cost concerns on their mind, while the employee wants to get the care they need to recover.
Although the treating physician has medical obligations, they may also be under pressure to contain costs. Who treats you can determine the speed and extent of your recovery. If you are involved in disputes over medical care, you should consider hiring an attorney to help advance your position.
You may not be satisfied with the doctor’s decisions about what treatment is necessary. From your standpoint, you may want to improve to the point where you can return to work as soon as possible. You may think the doctor is too conservative with your treatment or is hesitant to order a specific treatment that you think can help you recover.
Here, you will want to know that you have a doctor’s opinion from someone who is actually concerned about your health. Workers’ compensation doctors do not keep their business from the insurance company if they have a history of incurring costs. Even though they have an obligation to treat, these doctors may be loyal to their bottom line.
You Have Rights to a Second Opinion About Medical Care
Even though your employer and the insurance company exercise control over your treatment, you still have some rights under North Carolina law. While the insurance company is the one that is footing the bill, you still have some say in your medical care.
Under North Carolina law, you are legally entitled to a second opinion from a treating physician of your choice. You will need to make a request in writing to your employer, and they will have 14 days to respond.
Denying your request or not responding are not valid options for your employer under North Carolina law. If your employer does not allow you a second opinion, the North Carolina Industrial Commission will order one. If the NCIC must order a second opinion, your employer will need to foot the bill. At the same time, your employer also has the right to request a second opinion if they are unsatisfied with the diagnosis.
As an injured employee, you also have the right to request in writing that the NCIC allow you to switch treatment providers entirely to one of your choosing. You must show by a preponderance of the evidence that “the change is reasonably necessary to effect a cure, provide relief, or lessen the period of disability.”
If your provider gave their opinion before you made the request to the NCIC, the Commission can disregard it entirely or give it less weight. It may help you to speak to another doctor about your treatment if you want to ensure that you are getting the medical care you need.
You may still be entitled to workers’ compensation benefits, even after reaching the point of maximum medical improvement, if you can still do your job. You will receive a rating that will quantify exactly how disabled you are. This rating will be multiplied by your total potential monthly benefits to reach the amount of money that you will receive.
Seeking a Second Opinion About Your Disability Rating
If you seek a second opinion about a rating, you can use any doctor you want, including your physician. Even though the insurance company must pay for this appointment, they will try to find ways to make it difficult, such as paying a low set fee and forcing you to pay the rest. Your doctor’s opinion will be considered if you contest your disability rating.
The doctor that the insurance company will have you see can be biased towards the insurance company since that is who pays them. The doctor may not want to jeopardize continued and steady business from the insurance company. You should be suspicious of whatever rating they give you. Do not hesitate to ask for a second opinion on your rating, especially because you can use your own doctor.
Contact a Wilmington Workers’ Compensation Attorney Today
The attorneys at Horton Mendez can help you with any issue related to your workers’ compensation benefits, whether it is an initial claim or a problem you have when you are already receiving benefits. To speak with an attorney, you can send us a message online or call us today at (910) 668-8067.
Workers’ Compensation Medical Care FAQs
Can I appeal if I am unhappy about my treatment decisions?
Yes. If you cannot resolve the problems with the insurance company, you can file an appeal with the NCIC.
Do I need a lawyer for an appeal about my medical care?
Since the hearings will involve complex medical evidence, you should hire an experienced attorney to argue your case to the NCIC.