Neurosurgery and Pain Specialists of the Carolinas, PC
Information for Schedulers or Referral Sources
General Information--Dr. Curling:
Dr. Curling offers a broad array of new patient evaluations, tailored to various needs and situations. Basically, non-medicolegal cases can be seen for a general neurosurgical consult (NP0) and the appropriate medical issues will be addressed and further follow up and treatment offered as appropriate. Note carefully, however, that if scheduled for this level of service, Dr. Curling will specifically not address any medicolegal issues (work status, ratings, causality, etc.). Therefore, if being referred for any type of medicolegal claim (accepted or denied workers' comp claim, MVA or other personal injury, etc.) for which the requesting party is in need of such information or potentially will require Dr. Curling to serve as an expert witness regarding the issues of the case, then a higher level of service must be requested.
For medicolegal claims, four levels of service are available. If the patient is within 4 months of the date of injury at the time of scheduling request to our office, Dr. Curling will schedule an "Early Intervention Evaluation" (NP1), which will include a comprehensive evaluation of all appropriate medical and medicolegal issues and will usually be followed by further evaluation and treatment in our office, if determined to be necessary (and pending approval of the treatment plan by the appropriate party). If it has been greater than 4 months since the date of injury, the patient/claimant will usually be scheduled for an "Independent Medical Evaluation" (NP3). Unique to North Carolina workers' compensation claims, another type of medicolegal evaluation is available--"Additional Opinion on Rating" (NP2). Patients previously seen by Dr. Curling and being referred back for pain management after more than a one year hiatus and/or following some substantial change since being last seen (e.g., surgery) can be scheduled for a "Comprehensive Reevaluation for Pain Management" (NP4). NP2 and NP3 visits are scheduled as an "evaluation only", and further treatment is not usually offered, unless felt to be necessary and appropriate and agreed upon by all involved parties following review of the report of the evaluation. A signed Memorandum of Understanding will be required to schedule any medicolegal case and prepayment will be required for all but an Early Intervention Evaluation. The five types of new patient appointments with Dr. Curling are summarized in the table below:
Type of Referral
Type of visit
Treatment at initial appt
Neurosurgical or Pain Consult
No (but appropriate copay required)
Yes, if indicated
Early Intervention Evaluation
Yes, if indicated
Additional Opinion on Rating
Independent Medical Evaluation (IME)
Comprehensive Reevaluation for Pain Management
Only if authorization already received
Please note that the NP1 level of visit (less than 4 months since DOI) is aimed at improving the level of service that is often seen in workers' compensation and other medicolegal cases, hopefully leading to a more expeditious and efficient resolution of these cases for the carrier, while providing a more pleasant and effective course of evaluation and treatment for the patient. Rather than the typical course of working up the ladder and bouncing from provider to provider, from ER to primary care, to urgent care, to physiatrist, to orthopedist, to physiatrist, to spinal orthopedist, to neurosurgeon, and back again, the goal is to get the spine (and brain) injured patient directly to a neurosurgeon at the outset. If surgical treatment is clearly indicated, Dr. Curling can facilitate expeditious referral to another operating spinal surgeon for that procedure. However, if non-surgical treatment appears initially to be most appropriate (as is the case in the majority of situations), then Dr. Curling will offer to coordinate care, ideally moving the patient expeditiously to MMI. He will participate in referral for any appropriate testing or treatment and will schedule follow up visits at appropriate intervals to "maintain control" and keep an eye on the "big picture" as the patient flows through the system. While many services can be provided in the office of Neurosurgery & Pain Specialists, for services not presently available (e.g., MRI, major surgery), Dr. Curling will assist with scheduling and have the patient return to his office for follow up recommendations after the referral.
For patients seen early in their course for consultation, further evaluation and treatment will usually be initiated, but only after approval by the requesting party or the appropriate representative (e.g., a case manager authorized to approve treatment). All IME and Additional Opinion on Rating patients are seen for "evaluation only" and no treatment will be initiated at the time of the initial appointment. However, in specific circumstances in which the IME patient/claimant is not felt to be at MMI, Dr. Curling may be available to facilitate obtaining additional studies and further non-operative treatment that may have been recommended to help achieve MMI. In these cases, treatment will not be initiated prior to completion of the IME report and review by all appropriate parties of the final recommendations contained therein. If following review of the report, additional treatment in this office is desired, then you may contact our office to determine if this can be arranged. As noted above, if the patient is felt by Dr. Curling to be a candidate for surgical treatment, he can assist with referral to an appropriate operating neurosurgeon (or other spinal surgeon) if requested.
Also note carefully that Dr. Curling strictly limits his practice to the realm of neurosurgery and related pain conditions. He does not perform general occupational injury evaluations, nor will he address issues that he deems to be outside of his area of expertise. If evaluation by another specialist is felt to be most appropriate, Dr. Curling will facilitate that referral if desired. If it is unclear whether an evaluation of a particular patient by Dr. Curling is appropriate, we would recommend that you contact us to discuss the specifics of the situation. While Dr. Curling does not routinely require that records be submitted for review prior to requesting an appointment, he may do so in these situations in order to determine the appropriateness of a referral.
Dr. Curling realizes the importance of communicating with case managers, adjustors, attorneys, and others involved with medicolegal cases. However, in order to complete the most objective evaluation possible while also encouraging the patient/claimant to feel comfortable and to enjoy the appropriate amount of privacy and confidentiality during the evaluation, our providers do not allow these individuals to accompany the patient during the evaluation. However, if you choose to accompany the patient to the appointment, he will gladly sit down with you and the patient immediately following the evaluation to review the initial findings and impressions and to address any questions that you may have. Please note that Dr. Curling's new patient appointments are lengthy, and probably quite a bit longer than those to which you are accustomed. As a general rule, if you wish, you can plan to arrive about 30 minutes after the scheduled appointment time for NP1 appointments and 60 minutes after the scheduled appointment time for NP2, NP3, and NP4 visits in order to minimize your wait time while Dr. Curling is with the patient/claimant. Note that our office does have a lounge area specifically for case managers waiting for conference following their patient's visits with our providers.
Attorneys and Expert Opinion
Dr. Curling recognizes that all patients/claimants seen for evaluation of medicolegal claims are potentially cases that will require legal testimony at some point in the future. He is available for consultation with attorneys, deposition, or other sworn testimony upon request, and will attempt to work with the requesting attorneys to accommodate these needs should they arise. Time is actually allotted on his schedule each week for these activities.
It is Dr. Curling's goal to publish the reports of initial evaluations as expeditiously as possible following the appointment. Obviously, however, that is not always possible, particularly if additional information (either records or studies) is necessary in order to provide a complete and useful evaluation. Dr. Curling's goal is to get reports out within 10 days of the appointment; if you have not received the report within that time, please feel free to email him directly to let him know that you are "patiently waiting". If the necessary information is not available at the time of the appointment to complete a useful evaluation, preliminary impressions will be shared with the patient (and the case manager following the appointment if present) and the report will be produced after the additional information has been provided. If you have a genuine pressing deadline to receive a report (pending hearing, mediation, etc.), please relate that information to us at the time of scheduling, as Dr. Curling does make an effort to accommodate such requests.
Initial evaluation by Dr. Curling: To begin the process, please complete and submit a referral form containing the basic demographic information. You may contact us for a form, or the form for a medicolegal referral (NP1, NP2, NP3, or NP4) may be found online at the bottom of this page in Word or pdf format. Once the referral request is received (via fax/mail/email), our staff will contact you with additional information including a commitment letter and prepayment requirements (prepayment is required for all initial medicolegal evaluations). Once prepayment and a signed agreement have been received in our office, an appointment can be scheduled via the requesting party (adjuster, attorney, case manager, etc.). For non-medicolegal referrals (NP0), the referral form can be found at the bottom of this page (make sure to choose "non-medicolegal" form).
NB: Initial evaluations in our practice are very comprehensive and detailed, with dedicated appointment times ranging from one to three hours. As such, there is a significant charge for no show or late cancellations; should such occur, the appointment will not be rescheduled until that payment has been received in our office. These policies are further detailed in the commitment letter that will be provided subsequent to receipt of the initial referral request.