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What Doctors Can I See in a Comp Claim?

Before I get to the main topic of this post, I’d like to talk about a word that I will be using both here and in other posts.  That word is “carrier.”  Any employer that has three or more employees is required to “carry” workers compensation insurance (or prove that they have enough money to be their own insurance company, which is called being self-insured).  The workers compensation insurance company is called the “carrier.”  And since in the vast majority of cases the employer is not self-insured and has workers’ comp insurance, and since the insurance company is paying the bills for the employer, we usually just use the word “carrier” to describe the employer and its insurance company, or both.  Now, to the topic of choice of doctors.

One of the main benefits in workers’ compensation is medical care.  In some ways, it’s better than “regular” health insurance because the carrier is required to pay 100% of the medical bills, including prescription drugs.  There are no medical or prescription co-pays in worker’s compensation cases.  That’s the good part.  Here’s the not-quite-so-good part:  An injured worker generally has to go to the doctor that the carrier chooses.  You may live in Durham and want to see an orthopedist at Duke or Triangle Orthopedics.  You can always ask the carrier if you can see the doctor you have in mind, but if the carrier wants you to go instead to a doctor in Raleigh or Chapel Hill, then that’s where you have to go if you want worker’s comp to pay for it. The doctor the carrier assigns to your case is called the “authorized treating physician.”  There are a few exceptions to this general rule.  One is if there is an emergency and you cannot contact the carrier to arrange to see the authorized doctor.  Another exception would be if you ask the carrier to let you go to the doctor of your choice, and the carrier agrees to that.  A third exception would be if you feel that the doctor assigned to your case is not helping you, then you may request the Industrial Commission to order the carrier to allow you to switch doctors.  The Industrial Commission may or may not grant that request, but you do have the right to ask.

Another exception arises when you get to the end of your healing period (which is called maximum medical improvement, or “MMI”).  If you have received an impairment rating, such as 15% to the back, or 20% to the foot, you are automatically entitled to a second opinion of the rating, at the carrier’s expense, by another doctor of your choice.  Which doctor to choose for the second opinion is a critical decision.  Please let me help you with that — just give me a call at 919-683-2175.  

Step 1 for Workers’ Comp.

Just abut every legal remedy has time limits called “statutes of limitation.”  Normally, lawyers say that the “statute begins to run” (that is, the clock begins to tick on the time to bring a claim ) when the person who wants to bring a claim is injured, or in some cases when they discover they are injured.  Workers comp is an interesting animal in that it has what I will call one-and-a-half statutes of limitation.   What do I mean by this?

First, in North Carolina, the absolute statute of limitations for a comp claim is two (2) years.  This means that the claimant must file their claim with the North Carolina Industrial Commission or be barred from ever pursuing the claim.  However, there is another time limit (the “half” part of my description) called the “notice” requirement.  The  notice requirement says that a claimant must give written notice of their injury as soon as possible, but no later than thirty days after the injury.  The Industrial Commission likes to use forms, and there is a notice and claim form (called Form 18) that the injured person may download and fill out.  Once the injured person gives a copy of the Form 18 to their employer within thirty days, and at the same time sends the original to the the Industrial Commission, they have met both the notice and statute of limitations requirements.

For occupational diseases, the 30-day notice period and two-year statute of limitations begin to run when a claimant discovers they have an occupational disease.  That normally is the date the claimant’s doctor tells them that they have an occupational disease.   So, if your doctor informs you that the elbow pain you’ve had for the past six months is actually a case of “tennis elbow” caused by the constant motion you have to do for your job, you have thirty days from the time the doctor tells you that to do the Form 18.

If you would like to read what the Industrial Commission has to say about filing a claim, click here.


Why Choose Kenneth Duke?

First, clients benefit from the expertise that I have developed through 26 years of law practice in the Research Triangle area of North Carolina.   I have tried cases in the district and superior courts, and I have tried many workers compensation claims before the North Carolina Industrial Commission.  I  know my way around workers’ comp, personal injury and traffic law. 
Further, you usually will be dealing directly with me.  I do have an assistant, but when you call, as likely as not I will answer the phone.  I usually answer client emails myself.  I am willing to discuss directly with you the pros and cons of the various courses of action to be taken in your case, whether it’s a traffic, personal injury, or workers’ compensation claim. 
Call or email me right now and put my skills to work for you.