SIX RULES FOR DEALING WITH MEDICAL REHABILITATION PROFESSIONALS
What steps should an employee take to protect their rights when involved with medical rehabilitation professionals, particularly nurses? Our workers' comp lawyers in Raleigh suggest a few tips below. When you're done reviewing the details below, learn about how to deal with doctors during the North Carolina workers' comp process.
- Never allow a medical rehabilitation professional to have a private conference with a doctor. The rules specifically provide that the worker be offered the opportunity to attend any conferences between the rehabilitation professional and the physician. The worker has an absolute right to be present for all conferences between the doctor and the rehabilitation professional. The only exception to this rule is if the physician holds the opinion that it is “medically contraindicated for the worker to participate in the conference.” If this unlikely even should happen, the rehabilitation professional must note that fact in his or her report, and they must include in that report the substance of the communication. There are other very limited exceptions relating to scheduling meetings, requests for medical records, and other very limited situations. However, when such communications are made outside the presence of the injured worker, and without his or her consent, the rehabilitation professional must document the reasons for and the substance of the private communications.
- Always insist upon a private examination by the doctor outside the presence of the rehabilitation professional. The rules give the injured worker the absolute right to this private examination, and the rehabilitation professional cannot be present unless the worker consents.
- Never let the rehabilitation professional switch the treating physician without your consent. One of the areas of greatest abuse of the system by workers’ compensation insurance companies is their habit of “doctor shopping” when the authorized treating physician renders opinions which the insurance company does not like. These opinions usually fall into the category of work restrictions and the capacity of the employee to return to work.
Unfortunately, there are a few doctors who are little more than medical prostitutes. These are the doctors to whom insurance companies always send claimants for examination or treatment when they want an opinion that the worker is able to return to work without restrictions or with very little restrictions.
The lawyers who handle workers’ compensation cases on a regular basis know who these doctors are and know what they are going to say even before the worker is seen by the doctor. The insurance industry knows that these doctors will, “sing their song” for the money they are paid and will make every effort, legal or illegal, to be sure that the injured worker is seen by that doctor. These very few doctors are paid hundreds of thousands of dollars each year by insurance companies to do their “dirty deeds.” These doctors are a disgrace to their profession, as well as to the administration of workers’ compensation claims.
As long as the employer accepts the responsibility for paying a workers’ compensation claim, the employer is entitled to direct the medical care of the employee. The employer is entitled to initially choose the physicians who will treat the claimant. These physicians thereby become the worker’s “approved” treating physicians. Once treating physicians for the employer are established, the employer is not allowed to switch the treating physicians without the approval of the NC Industrial Commission.
Even though the employer is not allowed to “switch” treating physicians, it is the widespread practice for insurance companies to “doctor shop” when they don’t like the opinions of the initial approved treating physician. The employers and their insurance companies can only get away with this if they are allowed to by the employee. Unless an employee is represented by an experienced workers’ compensation lawyer, the insurance company will direct the employee to go from doctor to doctor until one of these doctors renders an opinion which the insurance company likes.
It is usually the rehabilitation nurse who directs this doctor shopping practice. The choice of the physician is extremely important. In most cases, the doctor’s testimony literally means the difference between winning and losing. That is why you should be extremely careful not to let the insurance companies switch doctors. The insurance company does have a right to have you examined by a physician of their choice even though that physician may not be the authorized treating physician. There is not much you can do about the choice of that physician. However, you can fight the attempt by the insurance company to switch treating physicians. A treating physician, particularly if he or she has been a treating physician for an extended period of time, is in a much better position to form opinions concerning the nature and extent of the injured employee’s disability, and therefore the opinion of that doctor usually carries greater weight with the Industrial Commission than does the opinion of an examining physician who only has seen the patient one time.
- Be careful not to make careless statements to the medical rehabilitation counselor. The medical rehabilitation counselor may encourage the employee to make statements indicating that their condition is better than it really is. If you talk to the nurse on a good day and relate that you are feeling much better and feel that your condition is markedly improved and fail to report on the many days that you’re having bad days that one sided report may give a false impression to the treating doctor. Many times the treating doctor bases their opinion on what is reported to him or her by the rehabilitation nurse.
- Ask rehabilitation nurse for copies of all reports. It is important to check these reports for accuracy to be sure your symptoms are correctly reported to the doctor, and that the nurse is correctly reporting what the doctor has told you about your condition. North Carolina workers' comp insurance case managers rely heavily on reports from the medical rehabilitation nurses. It is unfair to the injured worker for a rehabilitation nurse to skew their reports to show that the injuries are not as severe as they truly are.
- Keep your lawyer informed. Keep your lawyer informed of any significant discussions with your nurse rehab counselor. The performance of the nurse rehabilitation counselor is important. It is therefore essential that you keep your lawyer informed if you feel that the nurse rehab counselor has taken a position contrary to your interest or is working against you in obvious ways. Any concerns that you have with your rehabilitation counselor should be discussed with your Raleigh workers' comp lawyer.