Who is Responsible For My Medical Care After a Work Injury?
If you were injured on the job in North Carolina, you may wonder who is responsible for paying your medical bills. In most cases, your employer’s workers’ compensation insurance must cover necessary medical treatment related to a workplace injury. Learn how medical care is handled under the North Carolina Workers’ Compensation Act, when you may request a different doctor or second opinion, and what to do if treatment is denied.
If you’ve been hurt on the job, one of the first questions you may have is: Who is responsible for my medical bills? The good news is that under North Carolina law, injured workers are not expected to shoulder the cost of necessary treatment for work-related injuries and may be entitled to workers’ compensation benefits.
At Daggett Shuler, we regularly help injured workers understand their rights under the North Carolina Workers’ Compensation Act. Here’s what you need to know about who pays for medical care after a workplace injury.
Your Employer (or Its Insurance Carrier) Pays for Medical Treatment
Under North Carolina General Statute § 97-25, medical compensation “shall be provided by the employer.” In practical terms, this means your employer’s workers’ compensation insurance carrier is responsible for paying for:
- Doctor visits
- Hospital care
- Surgery
- Prescription medications
- Physical therapy
- Medical equipment and supplies
Other treatment reasonably required to “effect a cure, give relief, or lessen the period of disability”
If your injury is accepted as compensable under workers’ compensation, you should not receive bills for authorized, necessary medical treatment related to your work injury.
In most North Carolina workers’ compensation cases, the employer or its insurance company has the right to direct medical care, meaning they choose the authorized treating physician.
However, you do have options in certain situations.
Can I See My Own Doctor After a Work Injury?
You may seek treatment from a provider of your own choosing, but the Industrial Commission must approve this. To change doctors, you must show evidence that the change is reasonably necessary to:
- Effect a cure
- Provide relief
- Lessen the period of disability
If there is a dispute about treatment, the Industrial Commission can also order necessary medical care. It’s important to understand that the treatment you seek on your own without authorization may not be covered unless approved. This is why speaking with an experienced workers’ compensation attorney at Daggett Shuler can be critical before changing providers.
Requesting a Second Opinion
If you want a second opinion, you may submit a written request to your employer. If your request is denied within 14 days, or if you cannot agree on a provider, you may ask the North Carolina Industrial Commission to order a second opinion examination. If approved, the employer is responsible for paying for that second opinion under the same rules as other medical compensation.
What If There’s an Emergency?
In true emergencies, your health comes first. Legal issues about payment can be addressed afterward. If your employer fails to provide medical care and an emergency arises, you may seek treatment from another physician. If the Industrial Commission determines the treatment was necessary, the employer can be ordered to pay the reasonable cost of that emergency care.
What If the Insurance Company Refuses Treatment?
Disputes over medical treatment are not uncommon in workers’ compensation claims. When disagreements arise about whether certain treatment is necessary, either party can file a motion with the Industrial Commission.
North Carolina law provides several avenues for resolving medical disputes, including:
- Administrative rulings
- Expedited hearings
- Emergency medical motions (which can be decided within days in urgent situations)
If a party acts unreasonably in requesting or objecting to medical treatment, the Commission may even assess costs and attorneys’ fees against that party.
Can Benefits Be Suspended?
Yes. If the Industrial Commission orders medical treatment and an employee refuses without justification, compensation benefits can be suspended until the refusal ends. However, the Commission has discretion to determine whether the refusal was justified under the circumstances.
What Should You Do After a Work Injury?
To protect your right to medical benefits:
- Report your injury to your employer immediately.
- Seek medical treatment through the authorized provider.
- Follow your doctor’s treatment plan.
- Keep records of all appointments and communications.
- Speak with a workers’ compensation attorney to support you through the complexities of a claim
Protecting Your Right to Medical Care After a Work Injury in North Carolina
While the law clearly states that employers must provide medical compensation for work-related injuries, disputes over authorization, second opinions, and necessary treatment can complicate matters.
If you were hurt at work and are struggling to get medical care approved or feel you are not receiving proper treatment, the team at Daggett Shuler can help you navigate the process and advocate for the benefits you may be entitled to under North Carolina law.
Contact us today by submitting an online form or calling our office at (336) 724-1234 for a free legal consultation.
