How much control do you have over the choice of doctors in a workers’ compensation case?
The good news about workers’ compensation is that any accidental injury that happens at work is eligible for coverage. The bad news is that it is ultimately your employer’s decision, instead of yours, as to which treatments and medical consultations will be covered. Workers’ compensation doctors are as concerned about providing the least expensive treatments as they are about providing the most effective ones. Therefore, if, for example, you continue to suffer from back pain months after a work injury and after completing physical therapy, your employer will likely not agree to pay for surgery on your back until you have tried other less expensive treatments and are sure that they are not helping. North Carolina law gives patients receiving treatment through workers’ compensation some say in changing the course of their treatment, but the patients often get plenty of pushback from their employers. A Charlotte workers’ compensation lawyer can help you advocate for yourself to get the treatment you need.
Your Employer Gets First Pick of Doctors. It is an exaggeration to say that your doctor controls every aspect of your treatment in a workers’ compensation case. When you file a workers’ compensation claim, your employer will present you with a list of participating doctors from which you can choose. If necessary, these doctors will refer you to specialists. If you feel that the treatment that your workers’ comp doctor has recommended is not working or will not work, you have the right to request a second opinion.
The same applies if you disagree with your workers’ compensation doctor about whether you have reached maximum medical improvement or about the work tasks that you can currently handle.
If you want a second opinion, you must request it in writing. You and your employer will then agree on which new doctor you will see; if you cannot agree, then the Industrial Commission will choose.
You Can Go To A Doctor Of Your Choice, But There Is No Guarantee That Workers’ Comp Will Pay For It. In emergency situations, you must go for treatment at the nearest hospital, without regard for which insurance the hospital and its doctors accept; therefore, workers’ comp pays for emergency treatment regardless of which doctor or hospital is providing the treatment.
Finding a doctor that you trust and with whom you feel comfortable is not easy; if you have already established a good relationship with a doctor who has treated you for previous health conditions, it is understandable to want to be able to see them about your work injury, too. Your employer’s workers’ compensation insurance will not agree to this unless you make a very strong case for why your own doctor can help you in ways that the doctors chosen by your employer cannot. You must show by preponderance of the evidence that your own doctor is better suited to manage your case than any of the previous doctors chosen by your workers’ comp case manager.
Workers compensation cases can become very complicated, it is important to have the right counsel through the entire process.
plumides, romano & Johnson, pc