NORTH CAROLINA
Employer or Carrier Selects
The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. (N.C. Gen. Stat. § 97-25,NC Industrial Commission Website: A HREF="http://www.ic.nc.gov/faqs.html">http://www.ic.nc.gov/faqs.html )

Change of Provider
The employee may petition the Commission to change physicians or approve a physician of employee's selection when good grounds are shown. Payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered. (N.C. Gen. Stat § 97-25, NC Industrial Commission Website: http://www.ic.nc.gov/faqs.html )

In order for the Commission to grant an employee's request to change treatment or health care provider, the employee must show by a preponderance of the evidence that the change is reasonably necessary to effect a cure, provide relief of lessen the period of disability. (N.C. Gen. Stat § 97-25)

Panels
Not addressed

Panel Provisions
See Direction of Care law.

NORTH CAROLINA MCO
Employee Selects from Network
If an employee's medical services are provided through a managed care organization pursuant to this section, subject to the rules of the managed care organization the employee shall select the attending physician from those physicians who are members of the managed care organization's panel, and may subsequently change attending physicians once within the group of physicians who are members of the managed care organization's panel without approval from the employer or insurer. (N.C. Gen. Stat. § 97-25.2)

Change of Provider
If an employee's medical services are provided through a managed care organization pursuant to this section, subject to the rules of the MCO, the employee shall select the attending physician from those physicians who are members of the managed care organization's panel, and may subsequently change attending physicians once within the group of physicians who are members of the managed care organization's panel without approval from the employer or insurer. Additional changes in the attending physician or any change to a physician or examination by a physician not a member of the insurer's ' managed care organization's panel shall only be made pursuant to the organization's contract or upon reasonable grounds by order of the Commission. ((N.C. Gen. Stat. § 97-25.2)

Panels
Required*

Panel Provisions
Following the onset of an injury, and upon an employee's first request to change attending physician, the MCO shall provide the employee with a list of reasonably accessible and available panel physicians qualified to treat or manage the primary condition for which the employer has accepted liability or authorized treatment from which the employee may select the attending physician. The employer and MCO shall provide for access to all medical compensation services, and include in its panels, or otherwise make available for the employee's choice, one or more licensed physicians representing all specialties available in the community to provide necessary treatment for the employee's primary compensable condition. (4 N.C.A.C. 10D.0108)

The information on this website constitutes summary information only and does not constitute legal advice. Review of the full text of the referenced statutes and regulations may be necessary. Coventry Health Care Workers' Compensation, Inc. makes no representations or warranties about the accuracy of the information contained on this website.