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, co-chairing the Chiropractic Care Legislative Research Commission, asked the AG how two NC statutes interact when a state employee is hurt on the job and wants chiropractic care. Special Deputy AG Elisha H. Bunting, Jr. and Senior Deputy AG Ann Reed delivered a clear answer: the Workers' Compensation Act controls.

The two statutes in tension.

• N.C.G.S. § 90-157.1 prohibits "any agency of the State, county or municipality, nor any commission or clinic, nor any board administering relief, social security, health insurance or health service" from denying recipients or beneficiaries the freedom to choose a duly licensed chiropractor for services within the chiropractic scope of practice. On its face, this looks like a chiropractic free-choice mandate that binds state agencies.

• N.C.G.S. § 97-25 is the medical-care provision of the Workers' Compensation Act. It says the employer provides medical compensation. The Industrial Commission resolves treatment disputes. The injured employee can request a change of treatment, and can select a physician of their own choosing, but "subject to the approval of the Industrial Commission." Refusal to accept Commission-ordered treatment forfeits compensation until the refusal ceases.

The Industrial Commission's exclusive jurisdiction. The Workers' Compensation Act is the exclusive remedy for work-related injuries in NC, and the Industrial Commission has exclusive jurisdiction over those claims. Hedgepeth v. Lumbermen's Mut. Cas. Co., 209 N.C. 45, 182 S.E.2d 704 (1935). The General Assembly intended the Commission to have continuing jurisdiction over all compensation proceedings. Hogan v. Cone Mills Corp., 315 N.C. 127 (1985). Neither the employer nor the employee can opt out of the Act's payment-and-acceptance provisions (N.C.G.S. § 97-7).

Resolving the conflict. The AG concluded that if there is a conflict between § 90-157.1 (chiropractic free-choice) and § 97-25 (Workers' Comp treatment approval), § 97-25 controls. The reasoning is implicit but clear: the Workers' Compensation Act is the specific scheme for handling work injuries, with its own machinery for treatment disputes; the chiropractic free-choice statute is a general health-care access rule. The specific statute controls over the general, and the Workers' Compensation Act's exclusive jurisdiction forecloses end-runs through other health-care choice mandates.

The employee's actual rights. The opinion is careful to clarify that the employee is not without recourse. Section 97-25 expressly allows the employee to: (a) select a physician of their own choosing, subject to Commission approval; (b) request a change of medical treatment; and (c) suggest other treatment, again subject to Commission approval. N.C. Chiropractic Ass'n v. Aetna Cas. & Sur. Co., 89 N.C. App. 1, 365 S.E.2d 312 (1988), confirms that what treatment is appropriate is "a matter within the exclusive jurisdiction of the Industrial Commission." Chiropractic treatment specifically can be provided or approved; there is no categorical bar. The only thing the employee cannot do is bypass the Commission.

Practical implications. A state employee in this situation should not simply go to a chiropractor and assume the agency will pay. The correct course is to ask the agency or the Commission to add chiropractic care as approved treatment, or to file a request with the Commission to change treatment. The Commission then decides whether the chiropractic care is appropriate. If the Commission approves, the agency pays. If the Commission denies, the employee can challenge the decision but cannot self-help by going outside the approved-provider list and expecting reimbursement.

The opinion is structurally important because it confirms that the Workers' Compensation Act's tradeoff (no-fault recovery in exchange for limited employer-and-Commission control over treatment) is not undermined by general healthcare-choice statutes. The bargain holds; the exclusive remedy is the exclusive remedy.

Currency note

This opinion was issued in 1994. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

The Workers' Compensation Act has been amended multiple times since 1994, including significant 2011 reforms that affected the treatment-selection provisions. Section 97-25 itself has been recodified and amended; the basic structure (Industrial Commission approval required for changes) survives, but specific procedures have changed. Anyone facing this situation today should pull the current Chapter 97 statutes and consult a workers' compensation attorney.

Common questions

Q: I'm a state employee hurt on the job. I want to see my own chiropractor. Can I?
A: Not without Industrial Commission approval. You should file a request with the Commission asking that chiropractic treatment be authorized. The Commission will consider the medical evidence, the agency's position, and your stated preferences. If approved, the agency or its insurer pays. If you simply go without approval, you may not be reimbursed.

Q: My agency's approved-provider list doesn't have any chiropractors. Is that legal?
A: The agency can maintain a list, but the Industrial Commission has the final say on what treatment is appropriate. If chiropractic care is medically warranted for your injury, the Commission can order chiropractic treatment even if the agency's standard list omits chiropractors. The 1994 opinion is clear that there is no bar to chiropractic care in workers' comp; it just requires the Commission's approval.

Q: What is § 90-157.1 actually for, then?
A: It is a general non-discrimination rule for chiropractic care, requiring most state and local agencies and health-administering boards to let beneficiaries choose chiropractic providers for services within the scope of chiropractic practice. It applies broadly to state health programs (Medicaid, state employee health benefits, public health services) but it does not override the Workers' Compensation Act's specific treatment-approval scheme. Think of it as a default rule that gives way when a more specific statute applies.

Q: Can the agency just deny chiropractic care entirely?
A: No, the agency cannot categorically refuse to consider chiropractic care. But the agency can require Commission approval before paying. The agency or its insurer may also have a litigation position arguing chiropractic care isn't medically appropriate for the particular injury; the Commission resolves that dispute.

Q: What happens if I refuse the agency's offered treatment?
A: Under § 97-25, refusal to accept Commission-ordered treatment "shall bar said employee from further compensation until such refusal ceases." That can be a serious financial penalty. The right approach is not to refuse the agency-offered treatment, but to request a change of treatment through the Commission while continuing to accept the interim care.

Q: Why does the AG say "specific controls over general" if they don't use those exact words?
A: The opinion's reasoning is unmistakably the specific-over-general canon. The Workers' Compensation Act is the specific, exclusive scheme for work-related injuries; § 90-157.1 is a general chiropractic access rule. When two statutes apply to the same facts and conflict, the more specific one controls. The opinion's conclusion ("the provisions of the Workers' Compensation Act in N.C.G.S. § 97-25 must control") implements that canon without naming it.

Background and statutory framework

NC's workers' compensation system is the typical American no-fault scheme. Employees give up the right to sue their employer in tort for work injuries; in exchange, they get a defined-benefit medical-and-wage-replacement system administered by the Industrial Commission. The bargain depends on the Commission being the exclusive forum: if employees could route around the Commission through other statutes, the system's predictability would collapse.

The chiropractic free-choice statute (§ 90-157.1) is part of a broader pattern of NC chiropractic advocacy in the legislature. The chiropractic profession has historically faced restrictions on participation in mainstream health-coverage systems; the statute is the legislature's response, requiring most state-administered health programs to include chiropractic care as a covered option when the patient chooses it.

The 1994 opinion sits at the intersection of these two policy aims. The legislature wants chiropractic care included in state health programs; the legislature also wants the Workers' Compensation Act to be the exclusive remedy with Commission control over treatment. The AG's reading harmonizes both: chiropractic care can be part of workers' comp treatment, but the access mechanism is the Commission, not § 90-157.1's free-choice rule.

The Industrial Commission today routinely approves chiropractic care for appropriate injuries (back, neck, musculoskeletal). Modern practice has shifted toward including chiropractic care in many employer-approved provider networks. The 1994 opinion's procedural answer (request approval through the Commission) is still the right answer; the substantive outcome (chiropractic care often gets approved) has become more common over time.

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. (NC Workers' Compensation Act)
• N.C.G.S. § 97-7 (neither employer nor employee may reject the Workers' Comp Act's payment and acceptance provisions)
• N.C.G.S. § 97-25 (medical compensation provisions of Workers' Comp 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