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Contact the Law Offices of James Scott Farrin
1-866-900-7078
Contact the Law Offices of James Scott Farrin 1-866-900-7078

Denied Treatment by Workers’ Comp? You Have More Rights Than You Know

Many people call in and tell me that the workers’ compensation insurance company is not paying for all their medical bills. Understandably, this is a very worrisome situation.

If a workers’ compensation claim has been accepted, the law requires that the employer and its workers’ compensation insurance company provide medical treatment and pay the bills for any treatment that is “medically necessary.” That same law, however, gives the employer and its insurance company the right to “direct” any employee’s medical care.

What I have seen happen is that the workers’ compensation carrier will not pay for visits to a doctor that they did not pre-approve. Certainly, the workers compensation carrier is typically liable for any medical bills incurred from EMS and emergency room visits. But outside of these general and necessary bills, my experience has been, you may have to fight for what you want.

Workers’ compensation is responsible for paying for medical visits, diagnostic tests, epidural steroid shots, physical therapy, surgery, and related rehabilitation services that are deemed medically necessary. If, for example, you want them to pay for home care by a relative, that is typically not compensated, unless the relative is a licensed medical provider.

What Is Covered Under NC Workers’ Compensation?

If you have an accepted workers' compensation claim in North Carolina, you are entitled to medical benefits. This usually includes things like doctor's appointments, physical therapy, prescriptions, and even surgery. To put it simply, medical benefits for any treatments that help you recover from your injury.

Compensation can include, in many instances:

  • Travel costs to and from medical appointments (if more than 20 miles round-trip)
  • Attendant care
  • Medical equipment
  • Home or vehicle modifications

The workers’ comp insurance company is responsible for 100% of your approved medical expenses, so you are not responsible for co-pays as with regular health insurance.

Who Controls Your Care Under Workers’ Comp?

In North Carolina, your workers’ comp insurance carrier has the right to choose which doctors you see, when you see them, and which treatments you receive. (They may even appoint one of their approved nurses to “watch over” you. Click here for more about who these nurses may really be watching out for.) If you refuse certain treatments, they can (and likely will) discontinue benefits.

If you want a second opinion, you have the right to request it. Be forewarned. The insurance company might deny your request or try to direct which doctor you see before they agree to pay for treatment.

You have the option of requesting to see your own doctor. Based on my experience, however, the insurance company is likely to refuse to pay for that. If your doctor makes any new treatment recommendations, they will probably refuse to pay for those too. If you choose to pay for the treatment on your own, they may not reimburse you.

Delay, Deny, Defend Schemes Do Not Deter Us

As you've probably guessed, these issues can (and usually do) lead to lots of problems for the injured worker who is only trying to heal so they can get back to work and get on with their life. Yet instead of moving on and healing, many of them find themselves wrestling with their insurance company over denied medical treatments.

We’ve seen so much of these denial tactics that we developed a book called Insurance Companies (and Others) Behaving Badly.

I have been a lawyer for more than 25 years and I’d like to be able to say I have seen it all when it comes to insurance company denials. Truth be known, they seem to never stop inventing new reasons to try to deny injured workers. But their denials don’t deter me or any of our other workers’ comp lawyers.

NC Workers’ Compensation Lawyers Offer FREE Case Evaluation

Based on our team’s 150 years of combined experience, it is almost always a good idea to speak with us about your workers’ comp questions and issues. Our confidential case evaluations are free, and you may learn that you’re entitled to more than the insurance company claims.

If workers’ compensation is refusing to pay for any medical treatment, or if they are denying approval of medical treatment, contact us or call 1-866-900-7078 to learn how a workers’ compensation lawyer from the Law Offices of James Scott Farrin could potentially benefit you.

Brian Clemmons joined the Law Offices of James Scott Farrin in 2010.

Mr. Clemmons received his J.D. from the University of North Carolina School of Law. He received his B.A. in History from the University of North Carolina at Chapel Hill. He’s spoken at numerous continuing legal education courses and has more than 23 years of experience in a variety of practice areas, including: personal injury, Workers' Compensation and Social Security Disability. He also has a great deal of experience as a defense attorney for insurance firms, so he has seen personal injury law from both sides of the table.

Mr. Clemmons believes that honest communication is key to a successful case.

Contact Information

Raleigh Law Office

4325 Lake Boone Trail, Suite 100
Raleigh, NC 27607
Phone: 919-834-1184
Toll Free: 1-866-900-7078

Durham Law Office

280 South Mangum Street, Suite 400
Durham, NC 27701
Phone: 919-688-4991
Fax: 800-716-7881

Fayetteville Law Office

517 Owen Drive
Fayetteville, NC 28304
Phone: 910-488-0611
Toll Free: 1-866-900-7078

Charlotte Law Office

1001 Morehead Square Drive, Suite 350
Charlotte, NC 28203
Phone: 704-599-1078
Toll Free: 1-866-900-7078

New Bern Law Office

1505 South Glenburnie Rd, Unit P
New Bern, NC 28562
Phone: 252-634-9010
Toll Free: 1-866-780-3422

Greenville Law Office

702 G Cromwell Dr.
Greenville, NC 27858
Phone: 252-355-5205
Toll Free: 1-866-780-3227

Greensboro Law Office

300 N. Greene Street, Suite 850
Greensboro, North Carolina 27401
Phone: 336-665-7072
Toll Free: 1-866-900-7078

Goldsboro Law Office

214 South William Street, Suite 3
Goldsboro, NC 27530
Phone: (919)-731-2581
Toll Free: 1-866-900-7078

Henderson Law Office

514 Dabney Drive, Suite 200
Henderson, NC 27536
Phone: 252-492-4600
Toll Free: 1-866-900-7078

Roanoke Rapids Law Office

709 Julian R. Allsbrook Highway
Roanoke Rapids, NC 27870
Phone: 252-537-9670
Toll Free: 1-866-900-7078

Rocky Mount Law Office

3202 Sunset Avenue, Suite B
Rocky Mount, NC 27804
Phone: 252-937-4730
Toll Free: 1-866-900-7078

Sanford Law Office

703-B South Horner Boulevard
Sanford, NC 27330
Phone: 919-775-1564
Toll Free: 1-866-900-7078

Wilson Law Office

2315 Airport Blvd Suite A
Wilson, North Carolina 27896
Phone: 252-246-9090
Toll Free: 1-866-900-7078

Winston-Salem Law Office

301 N. Main Street, Suite 2409-C
Winston-Salem, NC 27101
Toll Free: 1-866-900-7078