Who Pays If I’ve Been Injured At Work And Need A Doctor?

In NC, workers compensation has the right to select and is required to pay for your treating physician once they accept your claim as compensable. Whether or not they have accepted your claim as compensable is the question. If workers compensation refers you to a particular physician to treat your injury, that does not obligate them to pay for anything more than that particular visit. In other words, they can pay for as little or as much treatment as they wish until they decide to accept or deny the compensability of your claim. You can’t assume that workers compensation will start paying weekly benefits if you can’t work or continue to pay for medical treatment unless your claim is accepted as compensable.

How Do You Know If  My Claim Is Compensable? 

There’s a poster in every business that has workers compensation that tells an injured worker to notify the employer in writing of an injury within 30 days and to File a Form 18 with the NC Industrial Commission if they wish to claim workers compensation benefits. Workers compensation then has 30 days to 1) Accept your claim and pay weekly benefits as appropriate and file a Form 60  2) Pay weekly benefits where appropriate “without prejudice” and send you a Form 63 (with box #1 checked) with your first comp check. This gives them 90-120 days to investigate your claim and decide whether to accept or deny compensability. 3)  pay medical benefits without prejudice and send you a Form 63 (with box #2 checked) which again means that they can continue to pay for as little or as much treatment as they wish until they decide to accept or deny compensability of your claim. Or 4) Deny your claim and send you a Form 61. So, usually, you know if they have accepted your claim as compensable if they have started paying weekly compensation and not sent you a Form 63.

Can I Choose My Own Doctor?

The law is that you can pick your own physician until workers compensation accepts your claim as compensable. However in the early stage of an injury, it is recommended that you go to Urgent Care or the Emergency Room if recommended by workers compensation. They will pay the bill and workers comp will usually abide by the Urgent Care or Emergency Room recommendations if you are placed on light duty or are taken out of work, and will probably refer you to a specialist if that is recommended by them.  If you are happy with the choice of physician that workers compensation selected and you don’t need to miss much work, that would be a good result.

On the other hand, you may not be happy with workers compensation’s choice of physician, but you hope or expect that workers compensation will accept the claim if you need to start missing work. A bad result would usually be if workers compensation denies the claim just when the doctor they have selected says you need surgery or has a medical opinion that hurts your case. At that point, you need to look at your other resources such as Short Term Disability and health insurance,  if available. An appeal of a workers compensation case can take months or sometimes years.

Workers compensation does not have the right to insist that you treat with their doctor unless or until they have accepted your case as compensable. Nor do they have to abide by work restriction from their choice of doctor or yours unless or until they have accepted your case as compensable.

This can get complicated. If workers compensation is paying for medical treatment and you are concerned that you are not improving or getting worse, you should check with an experienced workers compensation attorney to review your situation with you.

Henry Teich has been a North Carolina Board Certified Specialist in Workers’ Compensation since 2000.

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