How Long-Term Medical Treatment Is Handled in NC Workers’ Comp Cases

Getting injured at work is always an overwhelming experience. Many employees wonder how they’ll pay for ongoing medical care, especially when recovery takes longer than expected. If your injury happened on the job in North Carolina, you have rights you need to be aware of that could help you cover your expenses.

Insurance payments for medical treatment that’s reasonably necessary

In North Carolina, if you get hurt at work, your employer’s workers’ compensation insurance must cover the medical care you need to heal from your injury. This means any treatment that can help fix your injury, ease your pain, or improve how well you function should be paid for by the insurance company. This can include care that lasts for many years and, in some cases, for life, as long as the treatment remains related to the work injury and medical benefits have not been formally closed.

What counts as “medical compensation” in North Carolina?

If you’ve been hurt on the job, it’s essential to understand what is considered medical compensation. This might sound simple, but it could cover some things you aren’t considering. Here’s what it should usually pay for:

Hospital visits, surgeries, imaging, and therapy

Workers’ compensation usually pays for trips to approved doctors and clinics related to your injury. This means you should not have to pay coinsurance or copays out of your pocket for things like X-rays, MRIs, CT scans, surgeries, physical and occupational therapy. An insurance company will likely request medical updates to continue approving ongoing treatments.

Prescription medication and medical equipment

Often, you can get your prescription filled with little to no cost as long as your treating provider prescribes it. Assistive products like crutches, braces, walkers, or wheelchairs are also often covered. Workers’ comp should supply or reimburse you for these when related and medically necessary.

Home care and changes to living spaces

Severe injuries can make it tough to take care of daily tasks while you heal. Workers’ compensation sometimes includes in-home nursing or personal attendant care based on what a doctor finds necessary.

Mental health counseling after an injury

In some cases, injuries at work lead to significant mental health struggles. If you’re feeling depressed, anxious, or having signs of post-traumatic stress disorder (PTSD) because of your injury, therapy with a mental health professional may be covered.

Workers’ comp and long-term medical care in North Carolina

If you are hurt on the job in North Carolina, state law lets you apply for workers’ compensation. This is a type of insurance your employer carries to help cover injuries or illnesses that happen because of work.

When your injury keeps you from working for a while, you may be approved for Temporary Total Disability (TTD) benefits. TTD pays a part of your wage for as long as your doctor says you cannot work, in most circumstances, up to 500 weeks, or just about 9.5 years.

Some injuries are so severe that returning to work isn’t safe or possible. In these cases, you may be eligible for Permanent Total Disability (PTD) benefits. These could provide you with medical coverage and wage payments for the rest of your life.

Getting medical care after a work injury: who chooses your doctor?

Usually, the employer or their insurance company sends you to a specific doctor, hospital, or clinic. This is often called the “authorized provider.” You don’t get to choose at first.

How to get a second opinion

You might not agree with what the employer’s doctor says. In these cases, the law lets you ask for another doctor’s opinion. This has to be in writing. Once you request this, your employer must respond within a reasonable time, often 14 days, and then must select a doctor (with your input). They also cover the bill for the exam. If there’s no agreement or your employer doesn’t act on time, the Industrial Commission can step in and pick the doctor. The employer covers these costs as well.

Switching or picking a doctor

Sometimes care with the employer’s doctor just isn’t working out. If you want to see another doctor or change your treatment, you must ask the Industrial Commission. You’ll need to show a good reason, like the new doctor knows more about your condition and would help you recover faster.

Emergencies

Sometimes getting permission for a provider just isn’t possible – like after a sudden, severe accident at work. If your employer or their insurer fails to arrange fast care, you can go to another doctor or hospital. If it turns out you truly needed emergency care, the employer might have to reimburse your medical costs.

Medical mileage and out-of-pocket reimbursement

If you need regular medical care for your workers’ compensation claim, you may need to travel for your appointments. Sometimes, this means driving significant distances to see approved doctors or specialists. In North Carolina, you can get reimbursed for these visits in some cases. If you drive 20 miles or more round-trip, you can get reimbursed $0.70 per mile. The trip must be for a medical appointment related to your workers’ comp claim. If you are entirely disabled, there might be special rules or more flexibility about what expenses are reimbursed.

What can an injured worker do when there is a dispute over long-term medical treatment?

When the insurance company denies medical coverage, it can feel overwhelming. Insurance carriers often try to limit or terminate care, even when the worker continues to experience pain, functional limitations, or worsening symptoms. When this happens, injured workers do have options.

1. Follow your authorized doctor’s recommendations

The most important step is continuing to treat with your authorized physician and strictly following their medical advice. If your doctor documents that ongoing treatment is reasonably necessary to provide relief, prevent deterioration, or manage chronic symptoms related to the work injury, that medical opinion carries significant weight under North Carolina law.

2. Request medical authorization in writing

If treatment is denied, your attorney can formally request authorization from the insurance carrier. This creates a paper trail and forces the carrier to explain why treatment is being refused. Many disputes are resolved at this stage once the carrier reviews updated medical records or clarifying opinions from the doctor.

3. File a motion with the Industrial Commission

When informal efforts fail, an injured worker can file a Form 33 Request for Hearing with the North Carolina Industrial Commission. This places the dispute before a Deputy Commissioner, who can order the insurance company to authorize and pay for treatment if it is found to be reasonably necessary and related to the work injury.

In urgent situations, such as denial of pain medication, diagnostic testing, or time-sensitive care, a motion to compel medical treatment may be appropriate. These motions can result in faster rulings, although there is no guarantee as they depend on Commission discretion.

4. Consider a second opinion or IME carefully

In some cases, a second medical opinion or Independent Medical Examination (IME) can support the need for continued care. However, insurance-requested IMEs often focus on minimizing treatment. Having legal guidance before attending an IME is critical to protecting your claim.

5. Do not assume a denial is the end

It is possible to dispute treatment denials. Many workers challenge a denial through proper legal procedures and are able to successfully reinstate medical care.

Long-term medical treatment disputes can have lasting consequences for an injured worker’s health and financial security. Taking prompt action and getting experienced guidance can make the difference between losing care and preserving your rights under North Carolina workers’ compensation law.

Our team has decades of experience guiding injured workers through each part of this process. If your claim was denied or you need help with any other aspect of your case, we’re here for you. Call Price Petho & Associates, Attorneys at Law, to schedule a free consultation with a North Carolina workers’ compensation attorney.