What is Fair?

What is fair? Today’s post is a bit off the beaten path. I’m on the “legal documents” committee of my homeowner’s association.  Basically, our committee’s job is to review all the legal documents for our HOA (bylaws, covenants, articles of incorporation, etc.) Exciting stuff, right? Well the whole point of this little exercise is that some of the homeowners in our community are charged higher homeowners dues than other members. The homeowners that pay higher dues live in million dollar homes, while the homeowners that pay less live in “regular” homes.  I fall into the latter camp.

Fortunately, we have legal documents that govern how our dues are calculated and what we pay.  It is very difficult to change these documents. Thus the question – what is fair? Is it fair that I pay less in HOA dues than someone in a million dollar home? Is it fair that I have access to the same amenities and community property that they do? I knew what I was getting into when I bought my house – so yes, I think it is very fair. Trying to change the rules now, after I’ve bought my house – that’s not fair.

What in the world does this have to do with Workers Compensation law? Everything. You took a job with an employer. You work hard for them and they pay you a wage which may or may not be fair. You work for the same company, year after year, and then the unthinkable happens. You get injured on the job.

What is fair? Fair is an employer that does what they are supposed to do under the law. They (or their insurance company) pay you for your time out of work, they provide you with medical treatment, and they do all of this promptly so that you can get better and get back to work.

Unfortunately, all too often the employer is the million-dollar homeowner. They are completely fine using you as an employee, and as soon as you are injured and unable to work, they want to change the rules. They will either deny your claim outright, they will pay your medical bills but refuse to pay for your time out of work (forcing you to go back to work before you are physically able), or they’ll pay you, but payments will be consistently late and unpredictable.

I bring this up now because election season is quickly approaching. Last year, we had a tough battle with the insurance companies that tried to shred our workers’ compensation system under the guise of “getting North Carolinian’s back to work”. Fortunately, we had a Governor with veto power who was able to keep lawmakers from taking things too far. This year, the governor’s race is up for grabs. Pat McCrory is a million-dollar homeowner who wants to change the rules, make it easier for insurance companies to justify denying your claims and make it more difficult for you to prosecute your case, if you need to. Simply put – that’s not fair.

We have a good system in place. It’s a fair system. Let’s keep it that way.

 

 

Average Weekly Wage – What’s that all about?

If you are injured at work in North Carolina, then you are entitled to Workers Comp benefits.  One of the most important calculations that you or your attorney will make at the beginning of your case is your “average weekly wage”.  Many people mistakenly believe that this amount is simply your stated weekly salary – but that’s not the whole truth.

Your average weekly wage includes a number of other inputs that the insurance company will conveniently leave out if they are allowed to calculate this number for you.  For example, your average weekly wage should include the following items:

  • Any overtime you have been paid
  • Mileage checks
  • Per diem checks
  • Tips
  • A value for the use of company vehicles
  • Any other item which comes to you as salary or pay in the form of either cash or goods (excluding health insurance or other benefits)

The reason this number is so important is because the Average Weekly Wage is used to calculate your weekly benefit checks if you are unable to work because of your injury.  The insurance company will pay you 2/3 of your Average Weekly Wage – so if this number is not correct, then you could be short-changing yourself hundreds, if not thousands of dollars over the course of your claim.  To make matters worse, if and when you go to mediation to resolve your claim, the insurance company will use the average weekly wage calculation to determine a potential lump sum payout amount.  The wrong calculation could lead to an artificially low settlement amount.

If you have questions about your average weekly wage, and feel that it is lower than it is supposed to be, then please call us at (919) 460-5422.  We would be happy to review this information with you so that the insurance company can get it right.

*In Most cases, the average weekly wage amount in improperly calculated in favor of the insurance company.  However, if you ask for a recalculation and you received too much compensation, then you run the risk of the insurance company either asking for a lump sum payment from you, or withholding checks until the arrearage is paid back.  For this reason, it is important that you consult with an attorney prior to requesting a recalculation of your average weekly wage.

Injured at Work in NC – Here’s what you do

One of the scariest things that can happen to a worker who depends on their hourly wage to support their family is to get injured and be unable to work.  If you live in North Carolina, and you are injured on the job, than you will be covered under the Workers Comp statutes.  In North Carolina, Workers Comp is administered by the NC Industrial Commission, which has provided similar guidelines in the even you are injured on their webpage.

The steps you take in your first few hours and days after your injury are important, and if you don’t take the right steps, the insurance company is going to do everything it can to deny your claim or cut off your benefits.  If you don’t properly document and report your accident, you will be facing an uphill battle from the very beginning of your case.  So here are some things that you need to do when you are injured on the job in North Carolina:

  1. Report your accident as soon as it happens.  I know this sounds like common sense, but many people fail to take this critical step, and keep working as if nothing happened.  Maybe it is because you don’t want to “ruffle any feathers” with your boss, or perhaps you don’t want to look weak to the other employees.  But this is extremely important.  As soon as you have been in an accident, you absolutely must report it to your supervisor.  The law says you have 30 days to report your accident, but insurance companies will routinely deny claims where the worker waited until after the weekend to report it.
  2. Remember that your employer is not a lawyer.  Often, employers will try to give you “helpful” advice, such as – you can’t bring this claim because you didn’t report it immediately.  They may also ask you to rest a little while, and then see how you feel.  While helpful, this advice will hurt your claim.  So just remember that anything your employer tells you is probably wrong from a legal standpoint, and is very likely to hurt your claim.
  3. Report your accident to the right people.  Don’t just tell a co-worker.  Don’t just tell your supervisor.  Tell everyone you can.  Tell your supervisor and your human resources officer or safety officer.  Write down what happened to you and who was with you when it happened.  Make sure your supervisor makes a written report and gives you a copy.  Be as accurate and specific as possible in the report and include as much detail as you can.
  4. Get information from your co-workers that were with you.  Get their names and telephone numbers.  See if they will write you a quick paragraph about what they saw.  Be nonchalant about it – most co-workers will be happy to help.  Later on when the insurance company instructs your supervisor to tell them to stop talking to you, then the fact that you already have their statement will be extremely helpful.
  5. Go see a doctor.  Your employer may have a doctor that they want you to see, or you may be able to pick one on your own.  Regardless, when you see the doctor, explain to them in detail what happened to you and how it has affected you.  Be sure to tell the doctor that your accident occurred on the job – you would be surprised how often this fact gets left out.  Ask for a copy of your medical records so that you can review the doctor’s narrative and make any corrections if necessary.
  6. File a Form 18.  Don’t rely on your employer to do this for you – make sure you complete this form and file it yourself.  You can download a copy of Form 18 here.  If you have questions or need help completing and filing the form, let us know.  We would be happy to assist you with this without charge or obligation that you hire us.  If you do it yourself, send it by fax and keep a copy of the fax confirmation sheet showing that it was received.

Bottom line – dealing with the insurance company can be difficult enough, even when you do everything right.  Don’t put yourself at a further disadvantage – make sure you properly report and document your workplace injury as soon as it happens.

As always, if you have any questions along the process, please feel free to call The Hart Law Firm at (919) 460-5422 or fill out our contact form.

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.