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.

Is my injury covered by Workers’ Comp?

How do I know if my injury should be covered by Workers’ Comp?  Whether your injury should be covered, or actually is covered, are two different questions. If the system worked the way it was supposed to, I wouldn’t have a job, and the insurance companies would do what they should in every case. But this isn’t fantasy land, it is real life.  Here are the type of injuries that SHOULD be covered by Workers’ Comp in North Carolina:

  1. Injuries by accident, arising out of and in the course of employment. If however, you are engaging in your “normal work routine” when you are injured, the injury may not be compensable.
  2. Back Injuries as a result of a specific traumatic incident are also considered compensable.
  3. Occupational Diseases are considered compensable.  NC Statute 97-53 sets out 27 specific diseases which are compensable.  In order to recover for an occupational disease claim, you must be diagnosed with a covered disease, and the disease must have been attributed to your employment.
There are many instances where a worker is injured in the normal scope of his or her employment, and thus has not suffered an “injury by accident“.  Oftentimes, in these cases the employer/insurance company will deny the claim.  However, it is important to review your medical records and determine whether you have also suffered an occupational disease or back injury as a result of a specific traumatic incident, in which case your claim may very well be compensable.
Any variation from the normal, regular work routine may be sufficient to constitute an “accident” at the workplace.  These cases can become very fact-intensive, and the only way to know for sure whether your claim is compensable is to consult a Workers’ Comp Attorney for an initial consultation.  Please feel free to call our office at 919-460-5422 if you have any questions regarding whether you have suffered a compensable claim.

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.