Under the Workers’ Compensation Act, the term “medical compensation” includes a number of different benefits. Medical compensation refers to obvious benefits such as medical, surgical, hospital, nursing, and rehabilitative care. They also include prescription medications.
However, medical compensation also includes mileage reimbursement for travel greater than 20 miles round-trip to an appointment. Vocational rehabilitation services, to assist an injured worker in finding another job, are also included as medical compensation. Finally, in cases of severe injury, a worker may be entitled to benefits for attendant and nursing care.
The workers’ compensation insurance company is responsible for paying your medical bills for authorized treatment. These bills are forwarded to the insurance company by the doctor’s office. If the insurance company refuses to pay medical charges, the injured worker can file a request with the North Carolina Industrial Commission for a hearing to seek an order that the medical bills be paid.
The injured worker can receive medical treatment for as long as it is reasonably necessary to heal the injury, provide relief, or return the worker to gainful employment. Upon being released by his doctor, the worker has two years to petition the Industrial Commission to receive additional medical treatment. Workers injured before July 5, 1994 are entitled to receive lifetime medical treatment.
The worker must be able to show that the treatment sought is causally related to the on-the-job injury. Consequences and complications that reasonably and naturally flow from an on-the-job injury generally are covered by workers’ compensation.
In general, the employer has the right to direct medical care in a workers’ compensation claim. This right includes selecting the employee’s treating physician.
The right to direct medical care is not, however, absolute. In an emergency situation, an employee may be able to seek care from a non-authorized physician and have the employer pay for the medical bills. In addition, subject to the approval of the Industrial Commission, an employee may be able to select a physician of his own choosing. This is particularly the case where the employer fails or refuses to provide necessary medical care.
The proper procedure for changing doctors is to ask permission of the insurance company. This must be done within a reasonable period of time of changing doctors. If the insurance company refuses or does not respond to the request, the injured worker can ask the Industrial Commission to enter an order allowing a change of physician. Failure to comply with these steps can result in the employee bearing these medical expenses.