A medical dispute may involve a diagnostic test, referral, surgery, prescription, equipment, attendant care, provider change, transportation, or another treatment recommendation. The response depends on the claim status, accepted conditions, medical record, urgency, and procedural posture.

A medical-treatment dispute should identify the exact care requested, the provider’s medical basis, the claim’s acceptance status, the written request and response, the urgency, and the specific Industrial Commission relief sought.

Define the disputed treatment precisely

  • Claim number, employer, carrier or administrator, injury date, accepted conditions, disputed body part, and current benefit status
  • Provider, order date, diagnosis, requested test or treatment, clinical purpose, expected timing, and any stated alternative
  • Preauthorization form, prescription, referral, supporting note, prior care, response to care, restrictions, and consequences of delay
  • Date and method of the written request, person who received it, follow-up, authorization, partial response, denial reason, or no response
  • The immediate relief requested and whether the issue is routine, time-sensitive, or alleged to be an emergency

Confirm whether G.S. 97-25(f) applies

G.S. 97-25(f) provides motion procedures for medical compensation or medical disputes in claims subject to specified acceptance or payment-without-prejudice provisions of G.S. 97-18. A denied claim, fee dispute, provider billing issue, or broader compensability dispute may require a different process.

Under subsection (f), a party may seek an administrative ruling from the Executive Secretary. The statute also describes reconsideration and an expedited formal-hearing path. The filing route should match the existing claim status and the exact relief requested rather than treating every delayed authorization as the same dispute.

Build a decision-ready medical record

  • Include the provider’s actual order and explanation, not only a patient summary of the request
  • Organize the relevant office notes, imaging, testing, prior treatment, response, medication, restrictions, and prognosis in date order
  • Address the carrier’s stated medical, causation, scope, network, utilization, or documentation objection with source evidence
  • State which facts are agreed, which are disputed, what evidence supports each position, and what order would resolve the issue
  • Preserve proof that informal efforts were attempted and give the opposing party the required filing and materials

Emergency medical motions require specific facts

G.S. 97-25(f)(3) identifies information for an emergency medical motion, including diagnosis, treatment recommendation, time-sensitive need, potential adverse consequences, known expert or examiner opinions, supporting records, and an explanation of informal resolution efforts. Calling a request urgent is not a substitute for those facts.

The statute also directs the Commission to consider factors when a stay is requested, including immediate harm, nature and cost of relief, risk from treatment or delay, authorized-physician support, and reasonable alternatives. A filing should distinguish the emergency itself from the later merits of the disputed care.

Use the current forms and filing instructions

The Industrial Commission’s forms directory includes Form 25PR for medical-treatment preauthorization and forms used for hearings and other claim events. The correct filing may also require a motion or supporting documents not supplied by a single form. Verify the current filing method, service, document type, and any order or hearing instructions.

Track what happens after the ruling

Record the order date, required treatment, provider, authorization, appointment, payment, appeal or reconsideration status, stay request, and compliance. A favorable authorization still needs to become scheduled and delivered care; an adverse ruling may leave a different procedural or evidentiary question.

The related adjuster-communication guide provides a traceable protocol for treatment requests, medical documents, response dates, work status, and evidence-based escalation before a dispute record is filed.

Rosensteel Fleishman Car Accident & Injury Lawyers provides information about discussing a North Carolina workers’ compensation medical-treatment dispute with a Charlotte lawyer. The review should begin with claim status, the provider’s order, the request and response, urgency evidence, and the next filing date.

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