11 NCAC 23C .0108         INTERACTION WITH PHYSICIANS

(a)  At the initial visit with a physician the rehabilitation professional shall provide identification in the form of a company identification or business card and explain the rehabilitation professional's role in the case.

(b)  In all cases, the rehabilitation professional shall advise the worker that the worker has the right to a private examination by the health care provider outside of the presence of the rehabilitation professional.  If the worker prefers, he or she may request that the rehabilitation professional accompany him or her during the examination.  However, if the worker or the worker's attorney notifies the rehabilitation professional in writing that the worker desires a private examination, no subsequent waiver of that right shall be effective unless the waiver is made in writing by the worker or, if represented, by the worker's attorney.

(c)  If the rehabilitation professional needs to have an in-person conference with the physician following an examination, the rehabilitation professional shall reserve with the physician sufficient appointment time for the conference.  The worker shall be offered the opportunity to attend the conference with the physician.  If the worker or the physician does not consent to a joint conference, or if in the physician's opinion it is medically contraindicated for the worker to participate in the conference, the rehabilitation professional shall note this in his or her report, may communicate directly with the physician, and shall report the substance of the communication.

(d)  When the rehabilitation professional determines that it is necessary to communicate with a physician other than at a joint meeting, the rehabilitation professional shall first notify the injured worker, or his or her attorney if represented, of the rehabilitation professional's intent to communicate and the reasons therefore.  The rehabilitation professional is not required to obtain the injured worker's or his or her attorney's prior consent if:

(1)           The communication is limited to scheduling issues or requests for time-sensitive medical records;

(2)           A medical emergency is involved;

(3)           The injured worker's health or medical treatment would either be adversely affected by a delay or benefited by immediate action;

(4)           The communication is limited to advising the physician of the employer or carrier approval for recommended testing or treatment;

(5)           The injured worker or attorney has consented to the communications;

(6)           The communication is initiated by the physician; or

(7)           The injured worker failed to show up for a scheduled appointment or arrived at a time other than the scheduled appointment time.

When a rehabilitation professional communicates with a physician without the prior consent or presence of the injured worker, the rehabilitation professional must document the reasons for and the substance of the communication and report the reasons and substance to the injured worker or his or her attorney, if represented, pursuant to Rule .0106 of this Subchapter.

(e)  The following requirements apply to interactions regarding impairment ratings, independent medical examinations, second opinions or consults:

(1)           When a party or health care provider requests a consult, second opinion, or independent medical examination that is authorized or ordered, the rehabilitation professional may, if requested, assemble and forward medical records and information, schedule and coordinate an appointment, and, if the worker consents, have a joint meeting with the health care provider and the worker after a private exam.

(2)           When any such exam is requested by the carrier, the worker shall receive at least 10 calendar days' notice of the appointment unless the parties agree otherwise or unless otherwise required by statute.

(f)  The rehabilitation professional shall simultaneously send to the parties copies of all written communications with health care providers and shall accurately and completely record and report all oral communications.

History Note:        Authority G.S. 97-25.4; 97-25.5; 97-32.2; 97-80;

Eff. January 1, 1996;

Amended Eff. November 1, 2014; June 1, 2000;

Recodified from 04 NCAC 10C .0108 Eff. June 1, 2018.