A workers compensation claim can become more difficult when the injury report does not clearly explain when, where, and how the accident occurred. This is particularly important with hand, wrist, and finger injuries because pain, weakness, or loss of coordination may develop gradually after the initial event. An insurer may question whether the condition came […]
The doctor who treats a work injury can affect diagnosis, referrals, restrictions, return-to-work planning, and the medical record used in a workers’ compensation claim. North Carolina does not give either side an unlimited choice of provider.
The employer ordinarily provides medical compensation, but an injured worker can request a different provider or choose one subject to Industrial Commission approval; paying for care independently does not by itself make the provider authorized.
Start with the current treatment authorization
G.S. 97-25(a) states that the employer shall provide medical compensation. In an accepted claim, the employer or carrier commonly identifies an authorized provider, approves referrals, and pays covered treatment. The practical first step is to confirm in writing which provider, body part, diagnosis, referral, test, medication, and appointment are authorized.
- Keep the authorization letter, claim number, adjuster contact, provider name, appointment date, and each referral or preauthorization request
- Ask the provider to record an accurate work-injury history, current symptoms, diagnosis, treatment plan, restrictions, and follow-up date
- Compare the written job description with the real lifting, standing, driving, schedule, pace, and environmental demands
- Document canceled appointments, unavailable providers, denied referrals, travel barriers, and delays rather than relying on telephone recollection
An employee can request a different provider
Under G.S. 97-25(c), an injured employee may select a provider to attend and assume care subject to Commission approval. When the employee asks to change treatment or providers, the statute requires proof that the change is reasonably necessary to effect a cure, provide relief, or lessen the period of disability.
Make the request in writing before assuming a privately selected provider will be paid. Identify the requested provider, reason for the change, current treatment problem, medical support, availability, and relief requested. The Commission may give less weight to an opinion obtained before authorization was first requested in writing.
Emergency care and ordinary provider changes are different
G.S. 97-25(e) addresses emergency treatment obtained because the employer failed to provide medical compensation. Whether care qualifies and will be ordered paid depends on the facts. Urgent health needs should be addressed promptly, while the worker preserves the symptoms, timing, attempts to obtain authorized care, emergency records, bills, and notice to the employer or carrier.
Track who may receive and send medical information
G.S. 97-25.6 allows access to relevant medical information while setting procedures for records and communications with authorized providers. It distinguishes record requests, written questions, oral communications, additional information submitted by the employer, and administrative contact.
- Keep each medical-record request and the records actually produced
- Retain contemporaneous notice of written provider communications and the provider’s response
- Record notice and participation details for any permitted oral communication
- Review a proposed submission of additional information for accuracy and preserve any timely response or protective-order request
Build a provider-choice record
A useful file identifies the authorized provider, treatment requested, response date, medical basis, appointment availability, interruption in care, work consequences, and exact Commission relief sought. It also separates a request to change treating providers from a second opinion or an employer-requested independent examination.
The related workers’ compensation adjuster-communication guide explains how to create a traceable record for treatment requests, authorization, medical privacy, work status, and escalation.
Rosensteel Fleishman Car Accident & Injury Lawyers provides information about consulting a Charlotte workers’ compensation lawyer about an authorized-treatment or provider dispute. The review should begin with the written authorization, medical recommendation, request, response, and current care status.
Sources
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