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MEDICAL BENEFITS IN NC WORKERS' COMP CASES
What Medical Treatment is Covered?
North Carolina Workers' Compensation law provides that medical treatment Òshall be provided by the employer.Ó N.C. Gen. Stat. ¤ 97 25. The courts in North Carolina have interpreted medical treatment in the workers' compensation context to include any treatment or expense that would cure the injury, lessen the disability, or relieve pain. This includes traditional medical services such as doctor appointments, surgery and medication but may also include items such as an adjustable bed, prosthetics and, in certain circumstances wheelchair accessible housing. Employers have the right to require an employee to submit at a reasonable time and place to a medical examination by a physician. An employee that refuses reasonable medical treatment may have his workers' compensation benefits suspended.
Medical Restrictions and Ratings in North Carolina Workers' Compensation Cases.
In addition to providing treatment, medical doctors assign temporary and permanent work restrictions and rate the injured employee's level of temporary and permanent disability. (Injured employees have a right to a second opinion on permanent disability at the employer's expense). These medical decisions in turn dictate when or whether the injured employee can return to work, and what kinds of work are suitable. Not surprisingly control of medical treatment is one of the most important aspects of a North Carolina workers' comp case. Employers and insurers frequently deny necessary care or insist on certain medical providers known to be Òemployer friendly.Ó Injured employees are entitled to choose their own physician, subject to approval of the North Carolina Industrial Commission. Disputes between the injured employee and the employer relating to medical care are resolved by the Industrial Commission.
Nurse Case Managers.
Employers frequently employ nurse case managers in N.C. workers' compensation cases to assist them in regulating the provision of medical services. These nurse managers must be licensed in North Carolina, and must follow the rules set out by the North Carolina Industrial Commission. Employees have the right to a private visit with their physician.
Travel Reimbursement.
Injured employees in North Carolina are entitled to reimbursement for travel expenses associated with necessary medical care. This includes mileage reimbursement when the visit is more than 20 miles round trip. Lodging and meals may also be reimbursed at a set rate in certain circumstances.
How Long do I Receive Treatment?
Medical treatment in N.C. workers' compensation cases (sometimes called N.C. workmans comp) continues for as long as required, so long as there is not a two year lapse in the payment of benefits. Injured employees may avoid this two year limitation by obtaining approval from the Industrial Commission of anticipated future medical needs.
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