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).

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.