North Carolina’s Independent Medical Exam in Workers’ Compensation Claims

If you have been injured at work, you may be entitled to workers’ compensation benefits from your employer. When you file your claim, your employer will likely ask you to see an approved medical provider for an independent medical exam to discuss a treatment plan. If you are a worker covered by workers’ compensation insurance, you should know about North Carolina’s independent medical exam in workers’ compensation claims.

What Is Workers’ Compensation?

Workers’ compensation is insurance coverage that most employees in North Carolina are required to carry. When a worker is injured while at work or as a direct result of work activities, workers’ compensation benefits can help them by reimbursing medical costs, partially offsetting lost wages, and providing partial or total disability pay. If a worker is killed on the job, workers’ compensation coverage can provide death benefits to the worker’s family.

Workers’ compensation is an important safety net for both workers and employers all over the United States, as workplace injuries are extremely common. In 2024, employers in the private sector reported more than 2.5 million injuries and illnesses related to work. According to the Occupational Health and Safety Administration, there were 5,283 fatal workplace injuries in 2023.

What Incidents Can Be Covered by Workers’ Compensation?

Workers’ compensation may cover any injury or illness that is directly related to work activities. For an injury to be covered, it generally must occur while an employee is at work and because of the activities they are doing at work. For example, if a worker falls from a ladder or is struck by falling equipment on the job, the resulting injury is likely eligible for workers’ compensation coverage.

Most illnesses are not eligible for workers’ compensation coverage. For example, if you contract the flu while you are at work, and you have to miss a few days, that absence is not a workers’ compensation incident.

However, if you develop a chronic illness because of exposure to toxic materials at work, you may be eligible for workers’ compensation. For example, many workers have developed mesothelioma, which is a form of lung cancer, from long-term exposure to asbestos at work.

What Should You Do When You Are Injured on the Job?

If you sustain an injury while at work, you should seek immediate medical treatment. After your medical condition is stable, you should notify your employer of the injury within 30 days. The next step is to file a workers’ compensation claim detailing the injury, your expenses, and any lost wages.

In the time between your injury and the finalization of your workers’ compensation claim, it is important to keep track of any medical expenses associated with the injury. Workers’ compensation should reimburse you for these, but diligent record-keeping is essential to receiving the compensation you deserve.

In some cases, you may be required to undergo an independent medical exam in order to claim your benefits.

What Is the Independent Medical Exam in Workers’ Compensation Claims?

When you are injured on the job, the first thing you should do is seek medical treatment. When you file a workers’ compensation claim, you can use the documentation from that treatment as supporting evidence. In some cases, your employer or the North Carolina Industrial Commission, which is the organization that governs workers’ compensation in the state, may request that you undergo an independent medical exam.

Insurance companies are businesses. At the end of the day, the insurance company’s priority is its bottom line. The independent medical exam is a way for your employer or the North Carolina Industrial Commission to verify that your injury is eligible and that your doctor’s recommended treatment plan is reasonable. The examining physician should be a neutral third party, not affiliated with your employer or the insurance company.

According to North Carolina law, your employer or the North Carolina Industrial Commission is entitled to request an independent medical exam as a condition of your receipt of benefits. Such an exam is more likely to be requested if your workplace injury or illness has resulted in partial or total disability because a disability percentage must be determined in order to finalize your benefits.

FAQs

What Happens if I Refuse the Independent Medical Exam?

If your employer or the North Carolina Industrial Commission asks for an independent medical exam for your workers’ compensation case, you are required to comply with this request in order to receive benefits. If you refuse to undergo the exam, you may not be allowed to collect workers’ compensation benefits, including lost wages, medical reimbursement, or disability pay.

Can I Have My Doctor With Me at the Exam?

Yes, you can have any physician you want with you at the independent medical exam, including your regular physician or the physician you already saw regarding your workplace injury. It may be advisable to have your physician, your attorney, or both with you at the exam as a safeguard for your rights and to prevent disingenuous reporting.

Do All Workers’ Compensation Claims Require Independent Medical Exams?

No. Not all workers’ compensation claims require the injured employee to undergo an independent medical exam. In some cases, an examination from the employee’s usual physician is enough, and the recommended treatment is deemed acceptable. The independent medical exam is only required if the employer or the North Carolina Industrial Commission asks for it.

Who Is in Charge of Workers’ Compensation in North Carolina?

In North Carolina, the agency in charge of facilitating the workers’ compensation system is the North Carolina Industrial Commission. If you need to contact the Industrial Commission for any reason, you can reach them by phone or by fax. Should you need to stop by in person, their office is located at 430 North Salisbury Street in Raleigh.

Need Representation? Hire a Workers’ Compensation Lawyer

If you have been injured on the job, you need a competent lawyer to help you navigate the workers’ compensation process. At Christina Rivenbark & Associates, we have decades of combined experience advocating for our clients. Contact us today to talk about your case and what we can do for you.