North Carolina Appellate Court Upholds Award of Compensation for Medical Treatment Despite Insurer’s Initial Denial of Coverage for the Consultations

Work-related injuries can be very complex and it can be difficult to determine the full extent of the harm at the moment the injury happens. Ensuring that you receive the medical treatment and diagnoses that you deserve is a key part of any workers’ compensation claim. At Maurer Law, our North Carolina workers’ compensation lawyers have handled countless claims involving a broad variety of injuries. We are standing by and ready to help you seek the compensation that you deserve.

In a recent workers’ compensation claim, a worker was injured while working as a lead installer for a security systems company. The worker reported feeling a sudden pop and the onset of pain in his lower back while lifting some hardware. A few days later, he went to an urgent care facility to receive treatment. The doctor recommended that he switch to light-duty work and receive physical therapy. He filed a claim for workers’ compensation benefits, which the employer accepted.

Soon thereafter, he returned to the same doctor, reporting ongoing pain in his lower back and buttocks but indicated that the physical therapy was helpful. Over the following months, however, he indicated that his pain worsened. His treating physician recommended work conditioning but the man could not complete it due to bladder incontinence. He eventually saw a doctor about the incontinence, who concluded that it might be related to his back injury and that he should seek a second opinion. The insurance carrier denied the worker’s request for consultations with a neurosurgeon and orthopedist, but the worker went and saw them anyway. The exam revealed that he suffered a lumbar disc desiccation that required surgery. The man returned to the physician a while later and reported symptoms that suggested he was suffering from deep vein thrombosis (DVT).

The insurance company denied the worker’s claims relating to the urological issues and DVT conditions, stating that they were not related to his back injury. The parties went through a series of hearings. The Commission ultimately made a number of findings, including a determination that the insurer was required to reimburse the worker for the appointments and exams he underwent to diagnose his urinary issues, as well as a determination that his back condition is compensable along with the recommended surgery to address it. The Commission concluded, however, that the urinary issue and the DVT were not causally related to the back injury and that the worker was not entitled to compensation for these conditions.

The insurer appealed, arguing that the Commission made a number of reversible errors. The insurer argued that it should not be required to compensate the worker for the treatment and testing he underwent regarding the urinary and DVT conditions. The court rejected this argument, concluding that the nature of the incontinence was a medically urgent situation that could have severe consequences if not treated in a timely fashion and that the worker appropriately sought consultations and second opinions even though the insurer initially denied his requests. The appellate court also affirmed the conclusion that the lumbar surgery was necessary and reasonable to treat the back injury.

If you were hurt at work, you may be entitled to benefits and compensation for your medical expenses. The North Carolina workers’ compensation system can be difficult to navigate, especially if you are dealing with other stress and disruptions in your life associated with the injury. Our seasoned team of legal professionals will guide you through the process while ensuring that you receive the fair treatment and just compensation that you deserve. To schedule a free consultation call us at 1-888-258-1087 or contact us online.

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