NC Workers’ Compensation Second Opinions

CLIENT: “Am I entitled to a second opinion under workers’ comp law?”

ME: “Yes, but it’s complicated.”

I have this conversation at least once a month.  And it is way more complicated than it should be.  When the insurance company-loving-Republicans took over the NC legislature a few years back, they changed injured workers’ rights to second opinions.  It used to be that you just asked for a second opinion – on whatever – with whomever you wanted and then you got it.  It ain’t so easy anymore.

Now there are two types of second opinions.  97-25 allows for a second opinion on all issues, whereas 97-27 allows for a second opinion ONLY on the rating.  Well, how are they different?

97-25 FULL SECOND OPINION

With this option, you can ask a doctor about any medical issue related to your claim – diagnosis, treatment, causation, work restrictions, MMI, rating – whatever.  The trick is that the plaintiff and the insurance company have to either a) agree on a doc, or b) have the NCIC appoint a doc.  The crappy bits are somewhat obvious, and somewhat not.  When you are agreeing to a doc, you generally aren’t going to get someone who is famous for being plaintiff-friendly.  And there’s always the concern that any doc an insurance company will agree to has a “good” history with them, which should concern you.  And if the NCIC appoints one, who knows who or what you’ll get.  It’s very much a roll of the dice.

97-27 SECOND OPINION ON RATING

With this option, you can choose ANY doc you want, essentially, but you can ONLY ask his/her opinion as to your disability rating.  Of course, you should only use this one when that’s the only real dispute you have.  It’s nice to be able to choose your doc, as you can feel more comfortable about their innate prejudice/bias.  Sadly, as insurance companies are wont to do, they have found a way to stymie these.  Their current ploy is to say that they’ll only pay what the NCIC fee schedule allows for an appointment – which is like $150 or so – and they refuse to pre-pay.  Virtually no doc will agree to that.  The great irony is that the insurance companies will happily pay their own prostitutes, I mean doctors, $1600 or more for a second opinion.  Completely ridiculous.  As a consequence, docs are getting the idea that they should be getting $1500 or so for these appointments, so then even the good docs aren’t willing to play ball for anything less.

 

It’s no fun.  Once again, the law wasn’t always like this, and it’s simply another example of the legislature destroying peoples’ rights in favor of big business.  Sadly, we have to play by the rules set out by the State, though, so we’re stuck with them for now.

This is all the more reason why you need the best guidance you can get in your worker’s compensation claim.  Call me for info anytime.  919-929-2992.

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Jeffrey Allen Howard, Attorney at Law, PLLC
1829 E. Franklin St. - Bldg 600
Chapel Hill, NC 27514

(P) 919-929-2992
(F) 919-636-4779

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