Getting a Second Opinion on Your Workers’ Comp Doctor in North Carolina

The physician who releases you to full duty is often the one the carrier selected, which places great weight on one opinion formed in fifteen-minute appointments.

North Carolina’s Workers’ Compensation Act does not require you to accept it without question. It offers more than one way to bring in another physician, depending on whether the dispute is about your treatment, your rating, or who directs your care.

Key Takeaways About Workers’ Comp Second Opinions

• A second opinion on treatment begins with a written request under N.C.G.S. § 97-25. If the employer denies it, or no provider is agreed on inside the window the statute allows, the Industrial Commission can order the exam at the employer’s cost.
• A second opinion on a permanent impairment rating is paid for by the employer, in the same manner as employer-designated providers, under N.C.G.S. § 97-27.
• Changing treating physicians requires a petition to the Commission and proof, by a preponderance of the evidence, that the change is reasonably necessary.
• An employer-requested independent medical examination is not the same thing as a second opinion you sought. Under § 97-27, an employee must submit to examinations at reasonable times and places.
• Carriers often treat a rating or a full-duty release as the end of a claim, and our role is to test that opinion with medical evidence.

Numbers That Decide What a Rating Is Worth

• Private employers in the state recorded 64,200 nonfatal workplace injuries and illnesses in 2024, a rate of 1.9 cases per 100 full-time workers. In an accepted claim the employer directs the medical care, so the treating physician in most of those files was not the worker’s choice.
• A rating is paid as a percentage of scheduled weeks at your compensation rate, and that rate cannot exceed the year-of-injury maximum the Industrial Commission publishes, $1,446.00 in 2026. A few percentage points against a 200-week schedule can be worth thousands.

Can you get a second opinion on workers’ comp in North Carolina?

Yes, and the route depends on what you are disputing: the treatment you are receiving or a permanent impairment rating. A third path is not a second opinion at all, but an examination the employer requests.

How a second doctor gets involved in a claim

	Second opinion on treatment (§ 97-25)	Second opinion on your rating (§ 97-27)	Employer-requested IME (§ 97-27)
Who asks for it	The employee, in writing	The employee, after a rating has been assigned	The employer or carrier, or the Commission orders it
What it is about	Whether the treatment being provided is the right treatment	Whether the impairment percentage is accurate	Gathering a medical opinion for the defense of the claim
Who pays	The employer, when the exam is obtained through the routes the Act provides	The employer, in the same manner as employer-designated providers	The employer or carrier
What happens if there is disagreement	The employee may ask the Commission to order the exam if the employer denies the request or no provider is agreed on inside the statutory window	The competing opinions become evidence, and the Commission weighs them	The report becomes evidence in the claim like any other medical opinion
Can you decline	It is your request, so you decide whether to pursue it	It is your request, so you decide whether to pursue it	An employee must submit to examinations at reasonable times and places under § 97-27

How do you ask for a second opinion?

In writing. A written request starts the process under § 97-25, and a verbal mention to an adjuster does not carry the same weight.

The parties then have 14 calendar days to agree on a provider. If the employer denies the request, or that window closes without agreement, the employee may ask the Commission to order the exam at the employer’s cost. The Commission’s page for injured workers explains how disputes reach it.

Who pays for a workers’ comp second opinion?

The employer, when the second opinion comes through the routes the Act provides. Under § 97-25, an exam the Commission orders after a denied or unanswered request is at the employer’s cost.

Under § 97-27 of the Workers’ Compensation Act, a second opinion on a rating is paid by the employer in the same manner as employer-designated providers.

What if you disagree with your impairment rating?

A rating is one physician’s opinion at a point in time, and § 97-27 lets you obtain a second opinion at the employer’s expense. Two physicians examining the same shoulder can reach different percentages, and both go in the record.

Why does the rating matter so much?

Because the percentage gets multiplied. Under N.C.G.S. § 97-31, total loss of the back or spine is 300 weeks, an arm 240, a hand 200, a leg 200, and a foot 144.

The rating is applied against those weeks and paid at 66 2/3% of the average weekly wage (AWW), what you earned over the 52 weeks before the injury, divided by 52. A few points changes what a claim is worth.

What is maximum medical improvement, and why does the rating come then?

Maximum medical improvement (MMI) is when a physician concludes your condition will not improve further with treatment. It does not mean you are healed, only that the picture has stabilized enough to measure.

The rating is usually assigned then, because one given while you are still improving measures a moving target.

What happens after a rating is accepted?

The payout tied to that rating gets locked in. Form 26A, the Employer’s Admission of Employee’s Right to Permanent Partial Disability, records the rating and the compensation owed.

Signing settles that piece of the claim, so a second opinion belongs before that signature.

Can you change your treating doctor altogether?

Sometimes, by petitioning the Industrial Commission. Under N.C.G.S. § 97-25, a change of physician requires showing, by a preponderance of the evidence, that it “is reasonably necessary to effect a cure, provide relief, or lessen the period of disability.”

Preponderance of the evidence means more likely than not, but it still requires something concrete: records, a documented lack of progress, a treatment plan unchanged for months. Many workers also ask about choosing your own doctor.

What is an independent medical examination, and is it on your side?

An independent medical examination (IME) requested by the employer or carrier is an evaluation you can be required to attend under § 97-27. The examining physician is not treating you and is not providing care, but producing an opinion for the file.

That does not make the report wrong, and it may reach conclusions that help you. Most claimants answer honestly and describe their limitations plainly.

What to bring to a second opinion appointment

The full treatment record rather than a summary. Many request their own records in advance, because the file the second physician receives is not always complete.

A written list helps: what still hurts, what you can no longer do, and how long you can stand, sit, or lift.

Current written work restrictions are worth bringing, along with notes from family about changes at home. Travel costs to appointments may also be reimbursable.

Workers’ Comp Second Opinion Questions Answered by Attorneys

Will asking for a second opinion hurt my workers’ comp claim?

Requesting a second opinion is a step the Act provides for, and § 97-25 sets out a written-request process. North Carolina law also treats acting on workers’ compensation rights as protected activity.

How long does it take to get a second opinion approved?

There is no set timeline. The Act gives the parties 14 calendar days to agree on a provider after a written request, and many second opinions are arranged inside that window. Where the employer refuses or the window closes without agreement, the next step is asking the Commission to order the examination, which takes longer.

What if the second doctor agrees with the first one?

The second opinion becomes part of the medical record either way. Agreement between two physicians narrows the dispute rather than ending the claim, and does not affect your other benefits.

Can I record my independent medical examination?

That depends on the circumstances, and it is not a decision to make in the waiting room. Recording raises questions about consent and about how it would be used later, so ask your attorney first.

When the Doctor Says You Are Fine and Your Body Says Otherwise

You leave a fifteen-minute appointment holding paperwork that describes a person who can do the job, while the body walking out the door disagrees with it.

Consultations are free, and the firm is paid only out of a recovery, never up front. Under N.C.G.S. § 97-90, the Industrial Commission reviews and approves that fee in a workers’ compensation case. Matthew Bissette, a partner, heads the Workers’ Compensation Department.

A rating that came back low is worth a second look. Call +1 (800) 785-5000, or talk it through with our Greensboro workers’ comp attorneys.