In Part I and II of this series we discussed the legislative power shift in 2010 and identified four significant changes. Here are some more legislative changes, all imposed after 2010:
5. Even If The Claim is Denied the Employer Can Still Get An IME.
Before 2010, although an employer might be able to get the employee’s medical records once the claim was filed, if the claim was denied the employee took the position that the employer had no right to force the employee to go to an insurance-selected physician for an IME. That has now changed.
6. In Second Opinion Rating Evaluations Certain Medical Evidence Can Be Ignored.
An employee has an absolute right to get a second opinion about the extent of a permanent injury, if dissatisfied with the impairment rating given by the insurance-selected treating physician. Occasionally, this new physician, who was selected by the employee, would make a medical finding that the employee needed further medical treatment or would diagnose another medical condition that had not been evaluated by the treating physician. This new information would be the basis of a motion to the Industrial Commission for additional medical care. New legislation states that as to any opinions unrelated to the rating the Commission “must either disregard or give less weight” to these medical opinions.
7. Restrictions on the Ability to Change Physicians.
Before 2010, the employee had the right to petition the N.C. Industrial Commission to change physicians. Occasionally there were personality conflicts between the employee and the insurance-selected physician, or the physician would be ignoring certain complaints, or not reporting the complaints in the medical records. When these matters were brought to the attention of the Executive Secretary’s Office, the Commission had the discretion to authorize a change of physician. New legislation now requires that the Plaintiff prove by a “preponderous of the evidence” that a change is necessary.
8. Greater Difficulty Getting Second Opinion for Employee.
Before 2010, the employee could select a physician for a second opinion examination and request the Industrial Commission to approve this physician. Now the employee must first request approval “in writing” from the employer and attempt to jointly agree on a new physician. If this effort fails, then the employee can seek approval from the Industrial Commission. This new procedure is a roadblock to allowing the employee quicker access to a different medical provider.
Part IV of the series will discuss other changes, including administrative changes, to the Act. Stay tuned.