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If you were injured on the job in North Carolina, understanding your medical rights is crucial—especially when it comes to second opinions. You may find yourself questioning a diagnosis, wondering if a surgery is really necessary, or unsure about your disability rating. In any of these cases, you may have the right to ask for another doctor’s opinion. Our Charlotte workers’ compensation lawyers break down what North Carolina workers’ compensation law allows, how to request a second medical opinion, and why it might be a key part of strengthening your claim.
Your Right to Medical Care Under North Carolina Workers’ Compensation Law
Under the North Carolina Workers’ Compensation Act, injured workers are entitled to medical treatment for work-related injuries. This includes doctor visits, surgeries, therapy, medications, and other care reasonably necessary to cure or give relief from an injury. You can find this right outlined in N.C. Gen. Stat. § 97-25.
However, there’s an important catch: the employer or their workers’ comp insurance company usually selects your treating physician. That means you don’t automatically get to pick your own doctor.
Authorized treatment refers to care provided by the physician chosen by your employer or insurer. Unauthorized treatment is care obtained without prior approval and might not be reimbursed unless later approved by the North Carolina Industrial Commission.
When You Might Need a Second Medical Opinion
Even though your treatment is covered, you might still disagree with the care you’re receiving. That’s where a second opinion can come into play.
You may want a second opinion if:
- You disagree with a diagnosis or treatment plan
- You’re advised to have surgery or another invasive procedure you’re unsure about
- Your doctor clears you to return to work, but you’re still in pain
- There’s a disagreement about your maximum medical improvement (MMI) or disability rating
These situations can be frustrating and confusing. Your own experience matters, and if something doesn’t feel right, it’s worth pursuing clarity.
Second Opinion vs. Independent Medical Examination (IME)
It’s important to understand the difference between a second opinion and an Independent Medical Examination (IME). Although they might sound similar, they serve different purposes and are controlled by different parties.
Here’s how they differ:
- A second opinion is requested by you (the injured worker). It’s done to obtain additional professional insight and confirmation regarding your diagnosis, treatment, care plan or disability. This allows another qualified expert to review your case and ensure all appropriate options have been considered.
- An IME, on the other hand, is often requested by your employer or their insurance company. Usually done when they disagree with your diagnosis or recommended treatment plan. It may be used as a tool to stop or limit your benefits. Employers may request an IME in accepted or denied claims.
The findings from an IME can carry legal weight and could be used in court to challenge your claim. That’s why knowing who initiated the exam, and why they did, matters.
Types of Second Opinions
North Carolina laws provides for second opinions under two different statutes:
- §97-25 – Second Opinion Examinations on Treatment -This applies when an employee requests an additional medical evaluation of their treatment. Upon a written request from the employee, the employer may agree to a second opinion examination. The parties must agree on the physician.
If, within 14 days, the request is denied, ignored, or the parties cannot agree on a doctor, the employee may file a motion with the North Carolina Industrial Commission (NCIC) to order a second opinion. The employer is responsible for the cost of the examination, whether it is agreed to voluntarily or ordered by the Commission.
A second opinion examination under §97-25 is one-time only, and the employer is not bound by the findings or any further treatment recommendations made by the second opinion doctor. If the employer does not approve the employee’s request—or does not approve the employee’s suggested physicians—they may: deny the request, suggest alternative doctors, or ignore the request. If an agreement cannot be reached, the employee will likely file a motion with the Commission.
- §97-27(b) – Second Opinion Examination on Disability Rating – This applies when an employee disagrees with the permanent partial disability (PPD) rating assigned by their authorized treating physician and requests an additional medical evaluation on their PPD rating. The employee may select any qualified physician, without requiring approval from the employer or insurance company.
The examination is one-time only and is limited to evaluating the PPD rating, not the ongoing need for medical treatment. Any opinions outside the scope of the PPD rating must be disregarded or given less weight by the Industrial Commission. If the employer does not approve the employee’s request—or does not approve the employee’s suggested physicians—the employee will likely file a motion with the Commission.
Who Pays for a Second Medical Opinion?
If your employer or insurer covers the full cost. This includes transportation or any necessary accommodations.
However, if they deny your request and you proceed without approval, you may have to pay up front. In some cases, the NCIC may later rule that the second opinion was necessary and order the insurer to reimburse you.
Talk with an attorney as soon as possible if you need a second opinion or receive a notice to submit to an independent medical examination.
How a Second Opinion Can Strengthen Your Workers’ Compensation Claim
Sometimes, a second opinion reveals a different approach to treatment or supports your concerns about returning to work too soon. This can be powerful for your case.
Here’s how a second opinion may help:
- Validates your symptoms or diagnosis
- Supports extending your treatment or benefits
- Offers a new disability rating that increases your compensation
- Becomes additional evidence if you have to attend a hearing or appeal a denied claim
- Support a request for a change in treating physician
The right medical evidence can make the difference between a denied and an approved claim. Think of your second opinion as part of building a more complete case.
Working with a Lawyer to Get the Opinion You Need
The legal process can get complicated fast, especially if your request is denied. This is where an experienced workers’ compensation lawyer like the team at Bradford Law can help.
Here’s what a lawyer can do:
- Guide you through your Workers Compensation process
- Help you present your case effectively to the NCIC
- Connect you with independent providers who are both qualified and credible
- Ensure you’re following timelines and procedures correctly
Bradford Law has worked with injured workers across North Carolina to secure fair treatment and full benefits. If you’re hitting roadblocks with your injury case or simply want a second look, you don’t have to face it alone.
Need help asserting your rights to medical choice after a work injury? Contact Bradford Law to discuss second opinions and protect your claim.
