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If I File a Workers’ Compensation Claim in NC, How Do I Receive Medical Treatment and Who Controls It?

Male medical doctor or nurse wearing surgical gloves and stethoscope

As a worker’s compensation attorney in NC, I receive lots of questions about medical treatment after job-related injuries.

If I get hurt at work, should I go straight to the hospital? What should I tell them when I get there? Can I choose my own doctors? More importantly, who pays for my treatment?

You simply must be prepared. After all, if you ever find yourself struggling to recover from a serious work injury, the last thing you’ll want to worry about is a growing stack of medical bills.

The goal of this article is to provide you with some basic information about what to do and where to go after a workplace injury in North Carolina.

What is covered?

If you have an accepted workers’ compensation claim in North Carolina, you are entitled to medical benefits. This usually includes things like doctor’s appointments, physical therapy, prescriptions, and even surgery. To put it simply, medical benefits are any treatments that help you recover from your injury.

In many cases, the term “medical benefits” even applies to:

  • Travel costs to and from your medical appointments (if more than 20 miles round-trip)
  • Attendant care
  • Medical equipment
  • Home or vehicle modifications

Unlike a typical health insurance plan, there are no co-pays or deductibles in workers’ compensation cases. The insurance company is responsible for 100% of your approved medical expenses. It sounds pretty good, right? But there’s a catch.

 

Who chooses the doctors?

In North Carolina, the workers’ compensation insurance company has the right to direct your medical care. This means they choose which doctors you see, when you see them, and which treatments you receive.

What if I refuse the treatment?

The insurance company might try to cut off your benefits altogether.

What if I request a second opinion?

The insurance company might deny the request or try to weigh in on which doctor you see before agreeing to pay for it.

What if I go to my own doctor?

The insurance company will probably refuse to pay for it. If your doctor makes any new treatment recommendations, they will probably refuse to pay for those as well. If you choose to pay for the treatment on your own, you might not be reimbursed.

As you’ve probably guessed, these issues can (and usually do) lead to lots of problems. Many injured workers in North Carolina eventually find themselves wrestling with an insurance company over the issue of medical care.

 

So what should I do after an injury?

Report! Report! Report!

If you’ve been injured on the job, immediately (or as soon as possible) tell your coworkers and supervisors what happened. Written notice is even better. Fill out an incident report. Make sure the details of your accident are consistent. When you get to a doctor, make sure he or she is aware that you had an accident on the job. Your medical records are going to become very important so make sure the doctor knows exactly what happened to you.

Get to a Doctor

If your injury is serious enough, you may be taken to the hospital by ambulance. For all other non-emergencies, ask your employer whether they have an onsite or designated offsite healthcare provider for workers’ compensation patients. If so, tell them you need an appointment. Alternatively, work with your employer to locate a nearby healthcare facility that accepts walk-in patients. It could be an urgent care clinic or a hospital, depending on the severity of your injury. When you arrive, make sure you tell the doctor(s) that you were injured on the job and give them the name of your employer.

Establish Treatment

As you recover from your injury, follow your workers’ compensation doctor’s instructions with regard to medical treatment. If your injury is severe enough, you may be referred to a specialist for further testing, pain management, or surgery. At any point, if you feel uncomfortable or dissatisfied with the quality of your healthcare, it might be a good time to consult with an attorney and explore your legal options within the workers’ compensation system.

 

Golden justice scale in front of lawyer reading book on tableCall Experienced North Carolina Workers’ Compensation Attorneys

You are now armed with some basic knowledge about your right to medical treatment after a work-related injury. However, in our experience, some insurance companies are always finding creative new ways to save money, which could mean denying you benefits.

Even if you are receiving some benefits now, it doesn’t mean that it’s everything you may be entitled. So, pick up the phone and contact an experienced workers’ compensation attorney at the Law Offices of James Scott Farrin at 1-866-900-7078. Your initial case evaluation is free. Remember, nothing is more important than your health.