In case of injuries covered by workers’ compensation in Charlotte, NC, any medical treatment the employee requires is the responsibility of their employer or their workers’ compensation insurer. That is why some employers choose private medical services providers, while others even offer in-house medical services.
NC workers’ compensation covers treatments meant to cure the injuries, relieve the pain, and expedite the employee’s recovery and return to work. These treatments may include anything from traditional medical services (doctor’s visits, rehabilitation therapy, diagnostic testing, prosthetics, surgery, and medication) to adjustable beds, wheelchairs, and even housing modifications (in case the injury leads to physical limitations).
Even chiropractic treatments qualify for payment under workers’ compensation in North Carolina. In case the employee needs more than twenty chiropractic visits/sessions, their chiropractor will need to obtain the employer’s approval to continue treatment. Of course, not all medical treatments qualify for payment under workers’ compensation. The ones that do are subject to strict terms and conditions.
When Does Workers’ Compensation in North Carolina Cover Medical Treatment?
There is a huge difference between health insurance and workers’ compensation. The latter only covers treatment for compensable injuries and diseases, for conditions directly related to and a direct consequence of one’s work responsibilities and environment. Thus, workers’ compensation may cover treatment for a lower back condition only if the employee can prove that the condition is the direct result of a work injury they sustained, or of the activities they perform at work on a daily basis.
In general, the medical treatment can last as long as it is necessary. However, there are a few exceptions. The employee loses their right to treatment within two years from the last medical and/or wage replacement compensation paid.
Thus, workers who accept payment for permanent partial disability and do not receive further medical treatment within the following two years lose their right to further treatment benefits. Employees who wait too long before seeking medical treatment may have their claim denied as well.
In order to prevent the expiration of their medical benefits, employees can fill in Form 18M, and file it with the NC Industrial Commission. If approved, this form will allow them to benefit from medical treatment compensation even after the two years period elapses.
Who Decides What Medical Treatments Qualify for Payment under NC Workers’ Compensation?
One of the most controversial aspects related to worker’s compensation in North Carolina is the choice of medical professionals. Authorized treating physicians are the ones who:
- Prescribe the treatment an injured employee follows
- Assign temporary or permanent work restrictions
- Decide when the employee can resume activity and under what conditions
- Determine one’s disability rating, a percentage with major impact on the amount the employee will receive as permanent partial disability benefits.
In NC, workers’ compensation law lets the employer choose the authorized treating physician. This professional will examine the injured employee, recommend further diagnostic tests, prescribe any medication necessary, and propose work restrictions. In case of serious injuries, or cases outside their area of expertise, the authorized treating physician may refer the employee to a specialist.
If the employee feels the authorized treating physician is not able to cure their injury, alleviate their pain, or help their recovery, they can request the approval of the Industrial Commission to change their authorized treating physician. They also have the right to ask for a second opinion from a non-treating physician if they feel the treatment recommendations or the Permanent Partial Disability rating they received does not reflect their needs and state of health.
Any medical treatments the employee needs will require the approval of the employer. The latter has the right to request an independent medical examination of the employee, no matter if they approve the employee’s claim or not. A licensed, practicing NC physician should conduct the examination, and the time and place should be reasonable, to allow the employee to attend.
The employer has the right to cut off any workers’ compensation benefits they pay to the employee until the latter complies and attends the examination. Employers have the right to hire their own nurses or case managers (complying with the rules of the NC Industrial Commission) to help them coordinate medical treatment under workers’ compensation.
The employer is the one covering the cost of the services the nurse case manager provides. However, these professionals should remain objective and independent in their activity. Although nurse case managers have the right to attend doctors’ appointments and discuss treatment protocols with the physician, the employee has the right to a private consultation with the physician, without the nurse case manager’s presence.
If the treatment an injured employee needs to follow is only available at distances of over 20 miles, they should also receive a reimbursement for mileage. The NC Industrial commission establishes the reimbursement amount every year, using the IRS’ Standard Mileage Rate. The employee should use Form 25T to report mileage to their employer, insurance adjuster, or the NC Industrial Commission.
How to Claim Payment for Medical Treatment under Workers’ Compensation in Charlotte, NC
Claims for medical treatment payments under workers’ compensation in North Carolina are often a source of conflict between employers and employees. The former’s interest is to keep costs at a minimum, while the latter would like to receive the best medical treatment available, no matter the costs.
A great method to avoid conflicts between the parties and simplify the medical treatment approval and payment procedures is to hire a Charlotte, NC workers’ compensation attorney. They know exactly which forms are necessary and when, and what legal steps the employee needs to take in order to protect and pursue their interests. Their experience will help them assess which treatments qualify for payment under workers’ compensation and prove their necessity.
Most attorneys already know some authorized treating physicians and medical institutions performing diagnostic tests and independent medical examinations in Charlotte, NC, and can reach an agreement with the employer, to make sure the employee receives the best medical care, at the lowest costs.
Meet with a Charlotte Workers’ Compensation Attorney for a Consultation
At Ted A. Greve & Associates, we provide free preliminary consultations and legal assistance on a contingency fee basis. By entrusting your case to us, you benefit from the experience of a dedicated team formed of trial lawyers with over two decades of experience, chiropractic and podiatric physicians, licensed insurance adjusters, and other experienced paralegals. We have the know-how and resources to support even the most challenging claims for workers’ compensation in Charlotte, NC, and win the highest compensations. Contact us now, and let us help you receive the medical treatment you need and deserve!