If a state employee is hurt on the job and wants to see a chiropractor, but the state agency's approved-provider list does not include chiropractors, does the general chiropractic free-choice statute (§ 90-157.1) let the employee go to a chiropractor anyway, or does the Workers' Compensation Act's provider rules (§ 97-25) require Industrial Commission approval?

Plain-English summary

Senator Fountain Odom asked which statute controlled when a state employee with a compensable work injury wanted chiropractic treatment but the employing agency's provider list did not include chiropractors. N.C.G.S. § 90-157.1 generally protects a beneficiary's choice of a licensed chiropractor for services within the profession's scope. N.C.G.S. § 97-25 governs medical treatment under the Workers' Compensation Act.

The AG concluded the employee could consult a chiropractor only if the Industrial Commission approved under § 97-25. The opinion says the Commission has exclusive jurisdiction over rights and remedies under the Act and decides what treatment is appropriate for a particular employee. N.C.G.S. § 97-25 lets an employee seek a change of treatment and suggest other treatment, subject to Commission approval. The opinion expressly says chiropractic treatment may be provided or approved.

The decision concerns the Commission's authority. It does not decide whether the state agency's provider list is lawful or tell the agency how to respond to a particular request. If the employee seeks chiropractic care for a compensable injury, the opinion directs the question of appropriate treatment to the Commission.

Currency note

This opinion was issued in 1994. Check the current Workers' Compensation Act and Industrial Commission procedures before relying on it for a current treatment request.

Common questions

Q: Can a state employee choose a chiropractor for a work injury without Commission approval?
A: No. The opinion says § 97-25 controls in the described situation and makes chiropractic treatment subject to Industrial Commission approval.

Q: Does the agency's list decide whether chiropractic treatment is appropriate?
A: The opinion does not rule on the list itself. It says the Industrial Commission has exclusive jurisdiction to decide appropriate treatment for a particular employee.

Q: May the employee request a change in treatment?
A: Yes. The opinion quotes § 97-25 as allowing the employee to request a change and suggest other treatment, subject to the Commission's approval.

Q: Did the AG say chiropractic care is barred from workers' compensation?
A: No. It says there is no question that chiropractic treatment may be provided or approved; the employee's freedom to consult a chiropractor is subject to Commission approval.

Q: What if an employee refuses Commission-ordered treatment?
A: The quoted statute says refusal bars further compensation until it ceases, with the stated exception for a period of suspension if the Commission finds the circumstances justified the change in medical or hospital service.

Background and statutory framework

N.C.G.S. § 90-157.1 addresses the choice of chiropractic providers by recipients of services from the state and other listed entities. N.C.G.S. § 97-25 sets the medical treatment process for compensable work injuries, including Commission decisions about changes of treatment. The AG concluded that if the two statutes conflict in the described case, § 97-25 controls.

Citations

• N.C.G.S. § 90-157.1 (chiropractic free-choice rule; no state or local agency may deny beneficiaries the freedom to choose a duly licensed chiropractor for services within chiropractic scope of practice)
• N.C.G.S. § 97-1 et seq. (North Carolina Workers' Compensation Act)
• N.C.G.S. § 97-7 (neither employer nor employee may reject the Workers' Compensation Act's payment and acceptance provisions)
• N.C.G.S. § 97-25 (medical compensation provisions of Workers' Compensation Act; Industrial Commission approval required for changes of treatment; employee may select own physician subject to Commission approval)
• Hedgepeth v. Lumbermen's Mut. Cas. Co., 209 N.C. 45, 182 S.E.2d 704 (1935) (NC Supreme Court; Industrial Commission has exclusive jurisdiction over Workers' Compensation rights and remedies)
• Hogan v. Cone Mills Corp., 315 N.C. 127, 337 S.E.2d 477 (1985) (NC Supreme Court; legislative intent for Commission's continuing jurisdiction)
• N.C. Chiropractic Ass'n v. Aetna Cas. & Sur. Co., 89 N.C. App. 1, 365 S.E.2d 312 (1988) (NC Court of Appeals; appropriate treatment is matter within exclusive jurisdiction of Industrial Commission)

Source

• Landing page: https://ncdoj.gov/opinions/employee-selection-of-chiropractic-treatment-in-workers-compensation-claim/

Original opinion text

November 3, 1994

Senator Fountain Odom
Co-Chair, Chiropractic Care LRC
ATTN: Stephen J. Schanz
545 Legislative Office Building
Raleigh, North Carolina 27603

RE: Advisory Opinion; Employee Selection of Chiropractic Treatment in Workers' Compensation Claim; N.C.G.S. § 90-157.1 and § 97-25

Dear Senator Odom:

You have requested our opinion on the following question:

"An employee of a state agency suffers a work-related injury. Employee wishes to consult a chiropractor regarding his injuries but is told by the employing agency that treating providers must be selected from a list provided by the agency. Such a list does not include chiropractors among the providers. Does N.C.G.S. § 90-157.1 or § 97-25 control in this situation?"

For reasons which follow, the employee may consult a chiropractor only if approved by the Industrial Commission, as provided in N.C.G.S. § 97-25.

N.C.G.S. § 90-157.1 provides:

"No agency of the State, county or municipality, nor any commission or clinic, nor any board administering relief, social security, health insurance or health service under the laws of the State of North Carolina shall deny to the recipients or beneficiaries of their aid or services the freedom to choose a duly licensed chiropractor as the provider of care or services which are within the scope of practice of the profession of chiropractic as defined in this Chapter."

N.C.G.S. § 97-25 provides:

"Medical compensation shall be provided by the employer. In case of a controversy arising between the employer and employee relative to the continuance of medical, surgical, hospital, or other treatment, the Industrial Commission may order such further treatments as may in the discretion of the Commission be necessary.

The Commission may at any time upon the request of an employee order a change of treatment and designate other treatment suggested by the injured employee subject to the approval of the Commission, and in such a case the expense thereof shall be borne by the employer upon the same terms and conditions as hereinbefore provided in this section for medical and surgical treatment and attendance.

The refusal of the employee to accept any medical, hospital, surgical or other treatment or rehabilitative procedure when ordered by the Industrial Commission shall bar said employee from further compensation until such refusal ceases, and no compensation shall at any time be paid for the period of suspension unless in the opinion of the Industrial Commission the circumstances justified the change in the medical or hospital service.

If in an emergency on account of the employer's failure to provide the medical or other care as herein specified a physician other than provided by the employer is called to treat the injured employee, the reasonable cost of such service shall be paid by the employer if so ordered by the Industrial Commission.

Provided, however, if he so desires, an injured employee may select a physician of his own choosing to attend, prescribe and assume the care and charge of his case, subject to the approval of the Industrial Commission."

In the situation set forth, the State employee has suffered a compensable injury pursuant to the North Carolina Workers' Compensation Act. N.C.G.S. § 97-1, et. seq. The North Carolina Industrial Commission has exclusive jurisdiction of the rights and remedies afforded in such cases. Hedgepeth v. Lumbermen's Mut. Cas. Co., 209 N.C. 45, 182 S.E.2d 704 (1935). It was the purpose of the General Assembly that the Industrial Commission should have a continuing jurisdiction of all proceedings begun before the Commission for compensation in accordance with its terms. Hogan v. Cone Mills Corp., 315 N.C. 127, 337 S.E.2d 477 (1985). Neither the State nor the employee may reject the provisions of that Article relative to payment and acceptance of compensation. N.C.G.S. § 97-7.

If there is a conflict between the two statutes set out above, it is our opinion that the provisions of the Workers' Compensation Act in N.C.G.S. § 97-25 must control.

Although N.C.G.S. § 97-25 provides that the employer provide medical compensation, it also provides for the employee to select a physician of his own choosing subject to the approval of the Industrial Commission and to request a change of medical treatment and to suggest other treatment subject to the approval of the Industrial Commission. What treatment is appropriate for a particular employee is a matter within the exclusive jurisdiction of the Industrial Commission. N.C. Chiropractic Ass'n v. Aetna Cas. & Sur. Co., 89 N.C. App. 1, 365 S.E.2d 312 (1988). There is no question as to whether chiropractic treatment is or may be provided or approved. This statute specifically allows an employee freedom to consult a chiropractor regarding his injuries subject to approval.

Elisha H. Bunting, Jr.
Special Deputy Attorney General

Ann Reed
Senior Deputy Attorney General