Reminders for NC Adjusters When Requesting Medical Information from Treating Physicians
In the course of handling a workers’ compensation case, an adjuster will have to communicate with the employee’s treating physician to collect valuable medical information relevant to the diagnosis and ability to return to work. As noted in N.C.G.S § 97-25.6(c)(2), Written Communications with Healthcare Providers:
Defendants may communicate with the Plaintiff’s authorized health care provider in writing, without the express authorization of Plaintiff, to obtain certain relevant medical information not available in Plaintiff’s medical records, provided Defendants provide Plaintiff with contemporaneous written notice.
Without express authorization by the employee, but with contemporaneous written notice – Defendants may request the following additional information not available in the employee’s medical records:
- The diagnosis of Plaintiff’s condition;
- The appropriate course of treatment;
- The anticipated time that Plaintiff will be out of work;
- The relationship, if any, of Plaintiff’s condition to the employment;
- Work restrictions from the condition, including whether Plaintiff may return to work with the employer as provided in attached job description (New provision enacted 7/1/12 provides clarity that Defendants may forward job description to physician);
- The kind of work for which Plaintiff may be eligible; and
- Any permanent impairment as a result of the condition.
Defendants must provide Plaintiff a copy of the healthcare provider’s response within ten business days of receipt.
When communicating with healthcare providers, NC adjusters and Defendants can use the following examples as a guide:
- Communications on Diagnosis: In situations where you are trying to differentiate between a shoulder injury or back injury; or if you are trying to determine if Plaintiff has an enumerated occupational disease; or if the doctor is just not being clear about the diagnosis in his note – you can ask the question bluntly in correspondence.
- Communications about Return to Work: Useful when you require information for when Plaintiff may be able to return to some form of light duty work. You no longer have to serve the form MSQ on which too much information may be placed.
- Communications regarding causation: You may now reference facts listed in Plaintiff’s records that might indicate lack of causal relationship and then inquire about opinion.
- Communications regarding appropriate care:
- Why are you recommending X treatment?
It is critical to keep in mind that all correspondence with the treating physician must be shared with the employee. All correspondence must occur with an authorized healthcare provider.