- Medical Control
The employer/insurer directs selection of a treating provider. The employer/insurer may grant
permission to seek medical treatment from a chiropractor, but the injured employee is limited to
20 visits. If additional visits are medically necessary, the chiropractor should request
authorization from the employer/insurer. The employee may select his/her own pharmacy or
select a pharmacy from the Express Scripts pharmacy network. Emergency medical care does not
require preapproval and should be secured at the nearest location.
- Out-of-state medical providers are allowed to bill charges in full or based on a prior
agreement if one has been established. If one has not been established, expect
reimbursement pursuant to your state’s fee schedule.
- Medical Compensation
Employers must provide, and injured employees must accept, all reasonable medical, surgical,
hospital, nursing, and rehabilitative services, and medicines, sick travel, and other treatment,
including medical and surgical supplies, as may reasonably be required to effect a cure or give
relief, and tend to lessen the period of disability, and any artificial members as may reasonably be
necessary at the end of the healing period, which are needed due to the compensable injury. The
costs of medical compensation are in addition to the disability benefits discussed in the preceding
section, and do not offset or reduce them. If the employer denies liability or fails to provide
treatment, or in the case of an emergency, the employee may select the physician or hospital but
must promptly request Industrial Commission approval.* The employer or its insurance carrier
may select the treating physician and other providers of medical compensation, subject to
contrary orders of the Commission. If the employee is dissatisfied with the services rendered by
providers selected by the employer, the employee may request the Commission order a change of
treatment, or approve treatment by providers of employee’s selection.* Such request should
state reasonable cause and be submitted with any medical opinions or records that support the
request, and a copy of the request should be simultaneously sent to the employer or its insurance
company. If an employee fails to cooperate with a provider selected by the employer after being
ordered to do so by the Commission, compensation may be suspended while such refusal
continues..
The right to medical compensation ends two years after the last payment of medical or indemnity
compensation unless, prior to the expiration of this period, a Form 18M application is filed by
the employee showing the substantial risk of the necessity of future medical treatment, and is
thereafter approved by the Commission.
| North Carolina WORKERS COMPENSATION COLLECTION PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS |
Copyright © 2011 Workcompliens.com All rights reserved
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February 21, 2012: North Carolina News:
NCIC Adopts a New Medical Provider Fee
Dispute Resolution Procedure
January 02, 2012: North Carolina News:
Electronic Document and Fee Portal [EDFP]
To Become MANDATORY
October 31, 2011 North Carolina: News:
Effective October 31, 2011, Compromise
Settlement Agreements (Clinchers), and
Forms 21, 24, 26, and 26A may be uploaded
and electronically paid through a new
Industrial Commission Electronic Document
and Fee Portal (web portal).
NCIC Adopts a New Medical Provider Fee
Dispute Resolution Procedure
January 02, 2012: North Carolina News:
Electronic Document and Fee Portal [EDFP]
To Become MANDATORY
October 31, 2011 North Carolina: News:
Effective October 31, 2011, Compromise
Settlement Agreements (Clinchers), and
Forms 21, 24, 26, and 26A may be uploaded
and electronically paid through a new
Industrial Commission Electronic Document
and Fee Portal (web portal).
| General Information |
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