North Carolina Workers’ Compensation Board Upholds Decision Authorizing Insurer to Request Change in Medical Treatment Plan for Injured Worker

Legal News GavelThe North Carolina workers’ compensation system is intended to provide compensation to injured workers who suffered harm while on the job. This mandate is clear, but the claims process is often complex and can take quite a bit of time to navigate. At Maurer Law, our work injury lawyers are ready to assist you with determining whether you are entitled to workers’ compensation benefits.

In a recent decision, the North Carolina Industrial Commission considered whether an insurer can change an employee’s treating medical providers and treatment plan after the employee is awarded benefits. In the claim, the employee suffered an injury to her back when she was lifting and pushing an object of considerable weight at work. The employer had an insurance policy that provided liability insurance under a prior version of the North Carolina Workers’ Compensation Act. After the employee filed a claim for benefits, the parties agreed that the plaintiff’s injury was a compensable work injury.

Next, the plaintiff had a surgical fusion to address her back pain and then another series of procedures throughout the years, including a procedure to remove hardware and a cervical discectomy. The plaintiff was referred to a pain management doctor by her orthopedic surgeon, and she began seeing this doctor in 2002.

The pain management doctor prescribed two opioid narcotics to address her pain. The plaintiff remained in pain despite an increase in the dosage of one of these medications. The employee then received a morphine pain pump and fentanyl, as well as a few other medications, to address her extreme pain. The doctor reported at some point that he was concerned about the patient’s well-being and concerned that her intense and chronic pain had rendered her suicidal.

The parties executed a settlement of the workers’ compensation claim in 2007, but the claim did not resolve the plaintiff’s ongoing claim for medical reimbursement. The insurer asked that the plaintiff undergo an independent medical examination, and the doctor who performed this exam concluded that the plaintiff was receiving an extraordinary amount of medications. It was also determined through a series of hearings and motions that the plaintiff was not complying with her treatment program and that there was a question as to whether the plaintiff’s treating physician was prescribing the appropriate dosages of medications for her symptoms.

The insurers filed a motion to compel the plaintiff to undergo a pain rehabilitation program in Charlotte at the recommendation of the independent medical examiner. The judge initially denied the request, but the insurers appealed, and a reviewing panel overturned the judge’s decision but required the insurer to find a treatment program located closer to the plaintiff’s home. Another series of appeals ensued, and the reviewing judge concluded that the plaintiff must complete the Charlotte program and authorized the insurers to select a new treating physician for the plaintiff. The plaintiff appealed, and the reviewing court sided with the insurer, finding that there was sufficient evidence in the record indicating that the plaintiff’s course of treatment had led to a continual decline in her health.

If you believe that you are eligible for workers’ compensation benefits, or currently involved in a claims dispute, the seasoned workers’ compensation attorneys at Maurer Law are prepared to help you fight for your rights. We offer a free consultation and will be happy to answer your questions. Call us now at 1-844-817-8058 or contact us online.

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