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 Most doctors know that if you have an accepted workers' compensation claim they aren't going to get paid unless the adjuster has authorized the visit first. Even if you have health insurance the doctor may not be willing to see you out of fear that United Healthcare/Blue Cross/etc., will retroactively deny the coverage.  There is no single answer to this problem. We've found that it doesn't really help to advertise that it's a workers' comp claim when you set the appointment.  Likewise, if you have health insurance we recommend listing that as the primary payment option when you check in at the doctor's office. After the visit the health insurance company may well send you a letter asking you if it was workers' comp or a personal injury matter and, if so, you'll promise to repay them out of a settlement. At that point it's fine particularly because you've gotten the treatment you need.  If your claim is denied it is helpful to show the doctor's office and/or the health insurance company the Form 61 showing that workers comp is NOT paying the visit. This can work even if you have an accepted claim but the adjuster is denying you access to a specific physician or course of treatment. If the adjuster will put that in writing you can use the letter to show that the visit in question isn't actually part of your workers' comp claim.  Finally, we must point out that some doctors just don't like to deal with lawyers and workers' compensation.  They say it is too much paperwork, too much hassle, and they don't want to get bothered with having to give depositions and other court matters.

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Information for injured workers in North Carolina

 


Q: No doctor will see me because I have a workers' compensation claim? What do I do?

A:

Most doctors know that if you have an accepted workers' compensation claim they aren't going to get paid unless the adjuster has authorized the visit first. Even if you have health insurance the doctor may not be willing to see you out of fear that United Healthcare/Blue Cross/etc., will retroactively deny the coverage.

There is no single answer to this problem. We've found that it doesn't really help to advertise that it's a workers' comp claim when you set the appointment.  Likewise, if you have health insurance we recommend listing that as the primary payment option when you check in at the doctor's office. After the visit the health insurance company may well send you a letter asking you if it was workers' comp or a personal injury matter and, if so, you'll promise to repay them out of a settlement. At that point it's fine particularly because you've gotten the treatment you need.

If your claim is denied it is helpful to show the doctor's office and/or the health insurance company the Form 61 showing that workers comp is NOT paying the visit. This can work even if you have an accepted claim but the adjuster is denying you access to a specific physician or course of treatment. If the adjuster will put that in writing you can use the letter to show that the visit in question isn't actually part of your workers' comp claim.

Finally, we must point out that some doctors just don't like to deal with lawyers and workers' compensation.  They say it is too much paperwork, too much hassle, and they don't want to get bothered with having to give depositions and other court matters.


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OTP - Greensboro
1155 Revolution Mill Drive,
Studio 4
Greensboro, NC 27405
Phone: 336-274-4494
Fax: 336-271-6769
Toll Free: 1-866-OTP-Law1

OTP - Winston-Salem
110 Oakwood Drive, Suite 420
Winston-Salem, NC 27103
Phone: 336-274-4494
Fax: 336-631-5225
Toll Free: 1-866-OTP-Law1

OTP - Burlington
409 Alamance Road, Suite C
Burlington, NC 27215
Phone: 336-226-5925
Fax: 336-226-4492
Toll Free: 1-866-OTP-Law1

OTP - Asheboro
904 South Cox Street
Asheboro, NC 27203
Phone: 336-633-4496
Fax: 336-633-3394
Toll Free: 1-866-OTP-Law1

OTP - Raleigh
3700 Glenwood Avenue, Suite 350
Raleigh, NC 27612
Phone: 919-573-5241
Fax: 919-785-2239
Toll Free: 1-866-OTP-Law1

OTP - Fayetteville
4200 Morganton Road, Suite 200-11
Fayetteville, NC 28314
Phone: 910-764-3363
Fax: 910-764-3364
Toll Free: 1-866-OTP-Law1

OTP - Charlotte
550 S. Caldwell Street, Suite 1800,
Charlotte, NC 28202
Phone: 704-547-1617
Fax: 704-919-3439
Toll Free: 1-866-OTP-Law1

OTP - Hickory
101 Government Avenue SW
Hickory, NC 28601
Phone: 828-322-1271
Fax: 828-322-1643
Toll Free: 1-866-OTP-Law1

OTP - Wilmington
1213 Culbreth Drive,
Wilmington, NC 28405
Phone: 910-509-7274
Toll Free: 1-866-OTP-Law1

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