Archives for October 2010

NC Workers Comp Secrets – You were sent to a doctor for a reason

After you file your Workers Compensation claim in North Carolina, the insurance carrier has several choices – they can either deny your claim (in which case we strongly recommend that you contact a workers comp lawyer immediately), or they will accept liability for your claim.

If the insurance company accepts liability for your claim, then they have the option to direct your medical care.  That means that they can and will tell you which doctors to see for your injuries and medical treatment.  The insurance companies have been doing this for a long time, and they know which doctors will work with them to get you to back to work quickly (even if that is not what is right for you) and which ones will listen carefully when you tell them that you don’t think you can do your job.  Does the insurance company want you to see a good doctor?  Of course.  But the insurance company also wants you to see a doctor that will take their side in most disputes, and will try to get you back to work as soon as possible.

So the question remains, what to do if you disagree with the opinion of the doctor that the insurance company selected? In certain situations, (such as if you have been released to work but don’t feel like you can still do your job), you are entitled to seek a second opinion from a doctor of your own choosing.  In addition, if you receive a “permanent partial disability” rating, but you are not satisfied with your rating, then you may seek a second opinion under NC Statute 97-27(b).

The bottom line here is that if you are told something by your insurance company or adjuster – take it with a grain of salt.  Many adjusters will tell you that you have to go to their doctor and are not entitled to a second opinion.  This is simply not true.  If you have questions about your rights, than seek out a workers compensation attorney that can answer your questions.

What your Workers Comp Adjuster won’t tell you – #1 The insurance company is in the business of making money

North Carolina’s Workers Comp Statute and Rules are complicated and difficult for a normal person to understand without the assistance of a lawyer.  Insurance company adjusters know this and will hold back information from you to accomplish the #1 goal of the insurance company – to make money.  This is the first in a series of posts that will outline specific things that the adjuster for your Workers Compensation claim doesn’t want you to know.

As I just mentioned, topping this list is the fact that – your adjuster doesn’t want you knowing that the insurance company is in this business to make money, not to make sure you get the best treatment possible.

How does the insurance company make more money?  There are several ways:

  1. By increasing premiums – (Although they are not likely to do this, because the employer will just find another carrier).
  2. By paying out fewer claims
  3. By paying out less money with each claim they do pay out
  4. By denying claims
  5. By getting your back to work as soon as possible (thus stopping your Workers Comp checks)

When you talk to the insurance adjuster, they will probably be very nice to you.  They will do everything they can to reassure you that they will take care of you and that you will get the benefits you deserve.  In so doing, they will ask you to give a recorded statement – just so that they can “document their file” and authorize your benefits.  They will tell you that this is just routine, and that they aren’t trying to trick you with any of their questions.

What they don’t tell you is that they have scripted the questions they will ask you in such a way that you will give the answers they need so that they can deny your claim.  They are very sly about this, and most ordinary folks don’t even realize what is happening.

I don’t want to give the impression that these adjusters aren’t nice people – many of them are.  But they have a job to do just like anyone else, and their job is to make sure that the insurance company doesn’t pay out any unnecessary benefits.

How Texting While Driving may impact Worker’s Comp

Worker’s Comp Insurers and Employers are beginning to take notice of a disturbing trend in society today… more and more work-related fatalities that are caused by, you guessed it, texting while driving.  A recent article by Ira Leesfield cites a statistic from the National Safety Council that an estimated 200,000 traffic accidents per year are caused by drivers who have been texting.  Also cited in the article was a study by Car & Driver Magazine which “found that texting and driving was more hazardous than drinking and driving, with texting drivers three to four times slower in their response rates than drunk drivers.”

How does this impact Worker’s Compensation Insurance?  Many employers provide their employees with mobile devices, and require continued contact with them through email or texting – even while those employees are on the roads.  The problem with this, and the reason that employers and the insurance companies are taking notice, is that when an employee is involved in a traffic accident while texting, not only could the insurance company/employer be on the hook for paying the workers compensation claim, but they could also be responsible for paying the claim to the victim of the accident under a theory of respondeat superior or direct negligence.  And because more and more accidents are caused by texting while driving, that means that the insurance companies are going to have to pay out more and more money for these workers compensation and other claims.

A prudent employer would be smart to adopt written policies banning texting while driving for all employees, and make sure that these policies are frequently and adequately communicated to employees.  The problem arises when an employee is sent out for an isolated errand – but they don’t normally drive for that employer.  If the errand was for company business, than the employer could be liable under the Worker’s Comp statute.  (I’ve frequently thought about what might happen if my legal assistant was injured in an accident while driving to the courthouse for a last minute filing or to pick up office supplies.)

Since North Carolina has a “no-fault” workers comp system, an accident caused by an employee who was texting while driving would still generally be compensable – even though it may have been the employee’s fault.  Ultimately, the courts and/or legislature will decide whether employers are responsible to pay out workers compensation claims for an employee that was injured in a traffic accident, even though they may have been texting at the time of the accident.

In the meantime, I would advise anyone who drives for a living to shut the phone off and pay attention to the road.  If your employer requires you to text and drive at the same time, then you may want to consider whether this is someone you want to work for.  Whether the employer likes it or not, your safety is more important than productivity.