Just received a Form 24 – What now?

In North Carolina’s workers’ compensation system, many injured workers think that they can handle their case on their own, especially if the case is accepted by the insurance company (meaning that you are receiving weekly benefit checks and medical treatment from the insurance company). Unfortunately, many of these same workers don’t realize the mistake they have made (by not hiring a workers’ compensation lawyer) until their benefits have already been cut off.

One of the biggest threats to an injured workers’ benefits in North Carolina is called the Form 24. Under the North Carolina Workers’ Compensation system, once an insurance company accepts a claim, there are only two ways that they can stop paying benefits to the injured worker: 1) if the worker returns to work, or 2) if the Industrial Commission approves their Form 24 application.

What most workers don’t realize is that the fight to defend against a Form 24 begins long before the insurance company submits this application to the Commission. And unfortunately, once an unrepresented worker receives the Form 24, it is often already too late to do anything about it.

In order to be successful on a Form 24 application, the insurance company must have a legal basis for asking the commission to turn off benefits. Here are some examples of legally sufficient reasons that the industrial commission may grant a Form 24:

  • The injured worker has failed to comply with their medical treatment (a workers’ compensation lawyer will help you stay on track)
  • The injured worker has refused an offer of suitable employment (only a workers’ comp attorney can advise you on whether the job offered is “suitable”)
  • A doctor (usually one hired by the insurance company) has returned the worker to full duty work (a lawyer can help you request a second opinion from another doctor)

Getting an attorney involved early in the process, before the worker receives a Form 24, can greatly increase your chances of defeating this insurance company tactic, and more importantly, keep your benefits from being turned off.

FAQ – What if my workers’ comp check is late?

One of the most frequent calls I receive from my workers’ comp clients is that their workers’ compensation check is late. Unfortunately, (and I don’t believe that this is the client’s fault), the calls I receive are from the same client’s again and again. This means that the same insurance companies are routinely late in processing their weekly workers’ comp checks.

Is this surprising? Not at all. If you think about it, the insurance companies job is to make being on workers’ comp as difficult as possible. That way, when the time comes to try and settle your case, you will be thinking in the back of your head about all those late checks and how you just want that to be over. When your weekly workers’ comp check is late, it puts you and your family in financial jeopardy. I understand that the injured worker depends on these checks to pay their bills and feed their family. A check that is a week late can have devastating effects on an injured worker and their family.

Unfortunately, the insurance companies know this, so they will do everything they can to push the limits of the law.

What can you do if your check is late? If it is a routine occurrence, I recommend that you hire a lawyer. If nothing else, you would then have someone you can call when the check doesn’t come in and they can bother the insurance company until you receive your check. If the check is more than 14 days late, then you are entitled to a 10% penalty on the amount that is late by more than 14 days.

So, in a nutshell, here is what you do if your check is late:

  1. Determine whether there was a holiday that would have delayed the mail.  This frequently is a cause of late checks.
  2. Look to the history of your payments. Is this an isolated incident, or a more frequent problem. You may want to keep a log of your checks and the dates you received them since your case was opened.
  3. If this is an ongoing problem, or if checks are longer than 14 days late, you need to contact a workers’ compensation lawyer.
  4. Once you have a lawyer, contact them. My office will call the adjuster once or twice a day until the client receives their check or we receive verification that the checks have been paid on time.

 

The Workers’ Comp Doctor: What to do on that first visit…

I just finished up a report on what to do and what not to do on that first trip to the dreaded workers’ comp doctor. Here’s a quick overview/summary of my recommendations:

  • Be nice, even if you don’t like the doctor
  • Be prepared with notes explaining exactly how you were injured – explain this to the doctor. Rinse, and repeat.
  • Do like your parents taught you – don’t lie or exaggerate your symptoms. Workers’ Comp doctors have a way of knowing.
  • Don’t say or do anything that you don’t want the Industrial Commission to find out about.
  • Order your records after the visit to insure that they accurately reflect your visit.
  • Talk to the doctor about their opinion with regards to return to work restrictions.
  • Don’t let the doc have a meeting with the nurse without you.
  • Don’t talk bad about the nurse or Workers’ Comp carrier in front of the doctor.  You can call me and do that.
  • Even if you hate the doctor, don’t lose your temper. Again, call me and shout all you want.
  • Don’t get treated for an unrelated condition while you are seeing the Workers’ Comp Doctor.
  • Don’t tape the visit, unless you are being sent to an IME – in which case you probably need a lawyer. Feel free to call me.
  • If you decide not to tape your IME, make notes of the visit.

If that is too much for you to read – remember to be nice, keep notes, don’t lie. That’s about it. Questions? My number is (919) 460-5422.

Who does your nurse really work for?

In some Workers’ Comp cases in North Carolina, the case and employee will be assigned a Nurse to help coordinate benefits, schedule doctor’s appointments, and basically make sure that the medical treatment is progressing as it should.  The nurse is supposed to be employed by an independent company, such that they are not unduly influenced by the insurance companies.  Most nurses that I’ve dealt with are great to work with, and I’ve generally had very few problems. The purpose of this post is not to bitch and moan about how the rehab nurses are really working for the insurance company, however…

Today I received a call from a new nurse on a case.  The old nurse had been taken off the file – for reasons unknown to me (again, I’m not going to speculate that she was doing too good of a job for MY client, as opposed to doing what the insurance company wanted her to do).

That being said, when I returned the call, the number went straight to the insurance company, and my newly assigned nurse has an extension at the insurance company.  (Although she does “technically” work for an independent agency – for all I know her office is next door to the adjuster’s office).

So next time you (injured worker) start up a conversation with your rehab nurse about the status of your condition and your case in general, just remember who they are really working for.  Just my 2 cents for the day.  That’s all.

Insurance company myth: If you don’t report your injury in writing immediately, you have no claim

In speaking with other Workers Comp attorneys, and in my own experience as a Comp Lawyer, I have notice a disturbing trend.  In a system that was created to provide workers and employers both with a swift and low-cost way to manage benefits for workers who have been injured at work, we are seeing more and more insurance companies routinely denying claims without any legal justification for doing so.

One justification that insurance companies use when denying claims is that the employee failed to immediately report the incident to their employer in writing.  The law says that you have 30 days – but insurance companies don’t seem to care (See this post).  Their rationale is that if you didn’t report the injury immediately, then you must not be injured, or the injury must have been caused by something other than an accident at work.

However, most injured employees do not report the injury in writing – but rather they tell their supervisor verbally and off to the urgent care they go.  If written notice is ever given, it is usually only after an attorney is retained.

If you haven’t hired an attorney yet (call me at (919) 460-5422 for a free consultation), then you can send in your own notice pretty easily.  If you include the following information in your notice, you should be covered legally:

  • Your Name and Address
  • Time, place, nature and cause of the accident
  • A brief description of the resulting injury
  • The notice should be signed by the employee or someone on his/her behalf

Here is a sample letter than you can use to give legal notice to your employer that you have been injured.  Make sure to send a copy to anyone and everyone at your workplace that may need to know (Human Resources Department, your immediate supervisor, your manager, and anyone else you think should have notice that you are out of work with an injury).

Choosing your Workers Comp Doctor in NC

Anyone who is injured on the job in North Carolina must be careful when researching their rights on the internet.  As Mike Helfand points out in this post on his Illinois Workers’ Compensation Law Blog, workers in Illinois are able to choose their own doctor and medical facility for treatment.

Unfortunately, workers in North Carolina are not afforded such luxuries, except for in rare circumstances.  In North Carolina, once the insurance company accepts liability for your claim, they are able to direct your medical care.  That means that they can pick the doctors who treat you, and tell you where to go for your appointments.

In some cases, you are able to object and ask for a second opinion, but for the most part your adjuster can tell you where to go and who to see for treatment.

Based on Mr. Helfand’s post, it appears that in Illinois workers are given the right to pick their own doctors and hospitals for treatment.  Is this a better system that North Carolina?  It’s hard to say without more information.  It would appear to be more fair to the injured worker, and lead to less incidents of fraud on the part of the insurance company.

However, some of the other rights that residents of Illinois receive, such as being able to visit providers without having to pay a co-pay or other out of pocket expenses are similar to the policies in North Carolina.  Here, if you claim is accepted, you need not worry about paying your medical bills, they will be paid for by the insurance company.

Mr. Helfand also states that in Illinois, the worker may “speak to your doctors freely without fear that your privacy is lost”.  In North Carolina, you must be careful when you talk to your doctor, because anything you tell them is likely to become part of the record in your case.  Therefore, you must be very careful about how you talk to your doctors and what you tell them about your injury.  Seemingly inconsequential statements can have disastrous effects when taken out of context.

Bottom line – if you have been injured in North Carolina and are researching Workers Comp laws online, make sure that the website you are reading deals with North Carolina laws – not the law of other jurisdictions!


Why do I need a lawyer for my Workers Comp case?

Lot’s of people believe that they have no need for a Workers Comp lawyer.  This could be for a number of reasons, including:  they don’t think they have a claim or don’t wish to file a claim, they believe that the system is “fair” and they they can handle their case on their own, or perhaps they just don’t like attorneys and don’t want to hire one.  Still others are scared of some sort of retaliation by their employer (which is illegal, by the way).

Obviously, I am a bit biased here, but if you have been injured at work, and there is any chance at all that you might miss a prolonged period of work, I strongly recommend that you contact a lawyer.  Here are a couple of reasons why:

  1. Worker’s Comp lawyers generally will not charge you for the initial consultation
  2. There are a lot of “issues” or “disputes” that might arise that would most people won’t fully comprehend
  3. A lawyer can help you the most when they have been involved from the very beginning – i.e. they can coach you through the recorded statement and other communications with the insurance company
  4. They can answer your questions so that even if you decide to proceed without a lawyer, you will have information you need

Although workers comp may appear to be fairly straight-forward and simple, there are a number of “disputes” that can arise during the course of your case.  One dispute might be as to the amount of your weekly average wage, another might be as to your right to be compensated at all.

When the employer has workers comp claims made against it, the insurance company will increase the insurance premiums it collects to cover the increased risk of future claims or payouts.  Accordingly, the employer has a substantial incentive to decrease the number of claims filed against it, and assist in getting them settled for as little as possible – leading to conflict between the worker and the employer when there is a potential claim.

On the flip side, the insurance company makes money by paying out as little money as possible.  They have lots of very smart attorneys working for them to interpret the rules and statutes in a way that most favors the insurance company – which leads to lots of “disputes”.

Many people feel that they don’t need an attorney if the insurance company accepts their claim.  However, even in those cases where liability is undisputed, the lawyers working for the insurance company will make sure that you are paid the least amount possible – sometimes much less than you would receive with competent counsel.

If you have been injured at work and aren’t sure about your rights, give us a call at (919) 460-5422 for a free consultation.

The Rehab Nurse – Who do they really work for?

If the insurance company decides to accept liability for your workers comp claim, then they are able to direct your care.  As part of that care, the insurance adjuster will assign you to what is called a Rehabilitation Nurse to manage your care.  According to the NC Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims, the purpose of these Rehabilitation Counselors is to provide for the “medical and vocational rehabilitation of the injured worker”.

The North Carolina Industrial Commission has also provided a brief summary of these “Rehab Rules” for the injured worker.

Although the Rehab Professional is supposed to be working to help you with your care, in reality they are working for and with the insurance company to assist in the effort to terminate your Worker’s Compensation benefits.  The Rehab nurse is an employee of the insurance company, and often times works side-by-side with the adjuster assigned to your case.  These nurses have a clear understanding of who signs their paychecks and how their company makes money.  No bones about it – they will do what they can to turn off your benefit checks.

While we encourage all of our clients to follow closely the instructions of the Rehab nurse very carefully, there are some things that you need to watch out for which are clear violations of the Rehab Rules outlined above.  If you nurse engages in any of the following behaviors, it is a violation of the Rehab Rules and you should contact an attorney immediately:

  1. They attempt to tell the doctor what to do or when to release you to return to work;
  2. They attempt to tell the doctor where to send you for an MRI or physical therapy, or they tell the doctor which specialist to refer you to;
  3. They attempt to give you legal advice regarding the merits of your claim or tell you what will happen if you go back to work;
  4. They are corresponding with doctors or other healthcare providers or to the insurance adjuster without copying you on those communications;
  5. They are talking to your doctor without you being present, or they insist on sitting in on your examination with your doctor; or,
  6. They try to get you to sign a release that authorizes them to talk to your doctor without you being present.

There is another type of rehabilitation specialist called a Vocational Rehab professional, whose job is to find you a new job.  The pitfalls related to these professionals will be discussed in a future post.

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.