RALEIGH -- I have practiced medicine in Wake County as a neurologist for over 20 years. Until several years ago, I treated injured workers in connection with the workers' compensation system. During this period, it was my experience that workers' compensation insurance carriers and some large employers tried to exercise excessive control over the medical care received by injured workers.
Insurance carriers have nurse case managers who physically attend the medical appointments of injured workers. These nurse case managers provided the insurance adjusters with the results of the appointments. However, they would also often question treatment plans, and I would wonder if they advocated courses of treatment that favored the insurance company rather than the patient.
On other occasions, the insurance companies would have "Peer Review" doctors from other states call me to "discuss" my treatment recommendations or other issues. I was constantly asked to respond to forms with dozens of questions.
Most times, we were poorly paid for our efforts in trying to help these patients. I eventually stopped treating injured workers altogether due in large part to the unwelcome meddling of insurance.
I am, thus, disturbed at some of the changes to the workers' compensation system being proposed in state House Hill 709, which is called "Protect and Put N.C. Back to Work." These changes will further erode the ability of a physician to care for an injured patient independently.
Under this bill, insurance adjusters would have the right to contact doctors directly to demand changes in treatment plans. HB 709 severely limits the ability of injured workers to request a change of treatment from the plan devised by a company doctor. Injured workers would be barred from getting second opinions on treatment plans. Independent doctors would be prohibited from commenting on the treatment plans of company doctors employed directly by large companies in many cases.
In short, HB 709 would effectively finish off any notion that injured workers in North Carolina will receive unbiased medical care.
The medical system in workers' compensation cases can be frustrating at times but currently works and allows for independent physician care. The proposed changes do not increase the protection of the doctor-patient relationship. Instead, HB 709 gives insurance companies free rein to coerce doctors into providing inferior medical care.
Real workers' compensation reform would strengthen what is left of the doctor-patient relationship by improving the trust shared between them. It would recognize that cost containment is secondary to the goal of affecting the quickest and most complete recovery for the injured worker. It would seek to balance the right of the insurance carrier to direct care and the right of injured worker to receive unbiased care. House Bill 709 does not do these things. North Carolina deserves better.
Gregory M. Bertics, M.D., is a neurologist who practices in Raleigh.
