How Can I Make Sure I’m Getting the Best Possible Care for My Injuries?
The answer to this question often boils down to whether or not your injury is a workplace injury (in which case it may be covered by workers’ compensation) or is not a workplace injury.
If the injury is not a workplace injury, then the injured victim has the ability to select his or her own medical providers and direct his or her own medical care. The victim should first look to their relevant health insurance plan to determine whether or not a referral from a primary care physician is necessary in order to see a specialist, such as an orthopedist, neurologist or neurosurgeon. Most individuals covered by Medicaid do require such a referral from a primary care physician. Oftentimes even if a primary care physician’s referral is not required the primary care physician can offer sound medical guidance in recommendations for further or more specialized care.
Some clients find that their medical questions are not sufficiently answered by their original treating physician, while other clients may wish to seek a consultation with a different physician in order to assess available treatment options. These both involve circumstances in which an injured victim seeks a second opinion. Second opinions can often be valuable to victims of injury by having a fresh set of eyes look at problems that have not been resolved through initial medical care.
If a person’s injury is covered by workers’ compensation insurance, the workers’ compensation insurer has the initial right to direct medical care. This includes selection of the physician with whom the injured worker will treat. The injured worker typically has fewer rights at first simply because the worker’s own health insurance will specifically exclude from coverage those injuries which are covered by workers’ compensation. Thus, if an injured worker wishes to initially treat with his or her own choice of physician, the worker will typically have to pay 100% of the cost of such treatment out-of-pocket.
As treatment of an injured worker continues, however, the worker can have the right to request a second opinion concerning treatment options. The worker (or his or her attorney) and the workers’ compensation insurer are required to attempt to agree on a second opinion physician; however, if agreement cannot be reached, the worker’s attorney may petition the North Carolina Industrial Commission (this is the state agency tasked with overseeing the workers’ compensation system in North Carolina) for a legally-binding order authorizing a second opinion with one of a few physicians of the worker’s choice. If a second opinion is sought only on the impairment rating provided by the original treating physician, however, the injured worker has an unfettered right to select his or her own physician for this purpose.