How to find a Workers' Comp Doctor

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.  Contact me for expert guidance.