Winston-salem, NC asked in Workers' Compensation for North Carolina

Q: Do I have the right to deny a recommended procedure by a doctor and still be covered by W/C for possible future surgery?

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1 Lawyer Answer
David Gantt
David Gantt
  • Workers' Compensation Lawyer
  • Asheville, NC
  • Licensed in North Carolina

A: NC law requires injured workers be given reasonable and necessary medical care. Our law also gives WC insurance companies the right to control medical treatment as long as they recognize the WC claim. Future medical treatment can be claimed for two (2) years after the last payment of weekly wage replacement or medical bill. When you refuse recommended treatment by a qualified physician, your refusal can trigger a WC insurance attempt to cut off your weekly benefit for the duration of your refusal. The IC could issue an ORDER permitting the interruption in weekly benefits to you for the time of your unjustified refusal. The key here is whether you are refusing "necessary" medical care. The WC Court or Industrial Commission (IC) can decide the question of fact as to whether the recommended procedure is "necessary". The injured worker can also ask the IC nurse to review the dispute and try to mediate a resolution without IC formal action. I usually advise clients in this situation to ask the IC nurse to review and see if dispute can be handled in this more timely fashion. I find that WC insurance companies rarely wish to go against the opinion of the IC nurse.

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