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You were injured at work and you have a workers’ compensation claim. How do you move your claim forward and try to recover compensation for your injury?

The answer, hands down, is to get medical treatment and provide all necessary medical documentation to show evidence of the medical treatment you are receiving.

Without medical treatment, not only do you risk not getting better, but you also run the risk of stalling your workers’ compensation claim. (That’s just what some insurers may be hoping for.) If you do not have proper medical documentation, it makes it easier for the workers’ compensation insurance company to try to deny you the benefits you may be entitled to.

So it is important that when the insurance company is sending you for medical treatment, you follow the doctor’s orders. This means:

  • Attending all appointments as scheduled
  • Taking medication as prescribed
  • Communicating with the doctor about your injuries
  • Following all restrictions the doctor puts you under

You may have many questions and concerns about your medical treatment after a work injury. Here are some other frequently asked questions about workers’ comp medical benefits, along with answers based on extensive experience.

Will I Miss Out on Benefits if I Don’t See a Doctor Right After My Work Injury?

While there is no strict requirement that you must see a doctor immediately after a work accident, it is generally a good idea to see one as soon as possible. Having a medical doctor evaluate your injuries after an accident offers documented proof to the insurance company and your employer that you sustained an injury. The insurance company isn’t simply going to take your word for it. Without documentation, the insurance company or your employer may not believe that you were injured and they could try to deny your claim. I’ve seen this happen.

When you go to the doctor, they will document your injuries, how and when you said you received them, and they will outline a plan of care. Make sure you explain to the doctor exactly how you were injured and tell them all of the medical problems you are having related to the injury. It is important to be clear and direct when communicating with the doctor so hopefully they can document the circumstance surrounding your injury and accident. This way, your employer and insurance company can understand exactly what happened.

What Kind of Treatment Can I Get Under Workers’ Comp Insurance?

If you’re injured on the job and your workers’ compensation claim is approved, workers’ comp will pay for your medical treatment. So what is medical compensation?

Under the North Carolina Workers’ Compensation Act, “medical compensation” can include virtually anything that will cure your injury, give you relief from pain, and/or get you well enough to get back to work.

Medical treatment for your workers’ comp injury can include:

  • Medical
  • Surgical
  • Hospital
  • Nursing
  • Rehabilitative services, such as:
    • Attendant care services: At-home care or physical therapy
    • Vocational rehabilitation: In some circumstances, the insurance company will pay for retraining or for a specialist to help you find another job
  • Medicines
  • Sick travel: Reimbursement for any travel to authorized medical providers or pharmacies 20 miles or more roundtrip
  • Other treatment

How Do I Receive Medical Treatment for Worker’s Comp – and Who Controls It?

If you have an accepted workers’ compensation claim in North Carolina, you are entitled to medical benefits. This usually includes things like doctor appointments, physical therapy, prescriptions, and even surgery. Generally speaking, medical benefits for workers’ compensation are any treatments that help you recover from your injury.

In many cases, medical benefits for workers’ compensation even apply to travel costs to and from your medical appointments (if more than 20 miles round-trip), attendant care, medical equipment, and home or vehicle modifications.

Unlike a typical health insurance plan, there are no co-pays or deductibles in workers’ compensation cases. The insurance company is responsible for 100% of your approved medical expenses. It sounds pretty good, right? But there’s a catch.

Who Chooses the Workers’ Compensation Doctor?

In North Carolina, the workers’ compensation insurance company has the right to direct your medical care. This means they choose your workers’ compensation doctors and when you see them.

If you refuse treatment, the insurance company might try to cut off your benefits altogether.

If you request a second opinion, the insurance company might deny the request or try to force you to choose from a carefully-selected workers’ compensation doctor list before agreeing to pay for it. If you choose to pay for the treatment on your own, you might not be reimbursed.

So I Have to See a Workers’ Comp Doctor? I Can’t See My Own Doctor Instead?

Here’s the deal: When an insurance company admits liability for your North Carolina workers’ compensation claim, they have the right to direct your medical care. This means they get to tell you which doctors to see and when to see them. If you go to your own doctor, the insurance company will probably refuse to pay for it. If your doctor makes any new treatment recommendations, they will probably refuse to pay for those as well. Bottom line, if you treat with your own doctor, you may end up getting stuck with the bill.

Can I Trust a Provided Workers’ Compensation Doctor?

Under North Carolina law, if you are injured on the job and your employer agrees to provide workers’ compensation benefits for your injury, then your employer and their insurance carrier generally have the initial right to choose the physician who will treat your injuries. Some insurance companies may want to get you back to work as quickly as possible (even if you’re not ready). This is one of the many reasons insurance companies may benefit when they direct your medical care and send you to doctors they select.

Can I Request a Second Opinion?

As an injured worker, you have the right to request to be provided with treatment from a different physician. North Carolina law allows you to petition the North Carolina Industrial Commission to obtain a second opinion if the employer and their insurance carrier will not agree.

When you request a second opinion, the insurance company has 14 days to respond. North Carolina law encourages the parties to try to agree on a particular doctor during that time.

At the end of 14 days, if you still haven’t reached an agreement, you have the option of taking your request to the Industrial Commission, where an administrative judge will make the call. If your second opinion is approved, you may be able to switch over to the new doctor for the remainder of your treatment, but that process typically involves approval from the Industrial Commission.

If you feel that your employer sent you to a doctor that did not give you the best medical care, then you should consider contacting a North Carolina workers’ compensation lawyer. A workers’ compensation lawyer can make the process easier for you, while minimizing the risks of trying to handle this cumbersome and confusing process on your own.

Having Trouble Moving Your Comp Claim Forward?

Imagine this scenario: You’ve been injured on the job, and the insurance company finally accepts your claim and schedules an appointment for you with a doctor. On the day of your appointment, you spend 30 minutes in the waiting room, followed by a grand total of 30 seconds with the doctor. No one asks you how you’re feeling. No one asks whether you can safely return to work.

The very next day, the insurance company calls to tell you that you’ve been released from treatment and are expected to report to work immediately. All the while, the pain from your injury has gotten even worse. Is this really happening? Unfortunately, I’ve seen cases where this can and does happen.

The workers’ compensation attorneys at the Law Offices of James Scott Farrin can help you fight the insurance company if they try to pull any of these stunts. We know the law, we know how to try to protect your rights to medical treatment, and we have the tools, technology, financial resources, and know-how to try to get you the medical treatment you need.

But don’t wait to see if the insurance company denies your care. You need medical treatment when your doctor orders it, not after the insurance company delays.

One way to show the insurance company that you mean business when it comes to medical treatment is to contact us today or call 1-866-900-7078  so we can discuss working together to fight for your rights. Your case evaluation is completely free.

P.S. Here are more reasons to hire a workers’ comp lawyer about your claim.

Workers should be able to expect a safe working environment. Yet every day, workers across North Carolina are seriously injured or even killed on the job. In 2019, there were 186 fatal work injuries in North Carolina. This was up from the previous year. Nationwide, fatal work injuries were up two percent from the year before.

What Are the Top Jobs That Lead to Death?

Some of the deadliest occupations identified by one report were:

  • Fisherman
  • Logger
  • Pilot
  • Sanitation worker
  • Roofer
  • Iron worker
  • Farmer/Rancher
  • Trucker
  • Electrical power line worker
  • Taxi driver

The single hardest-hit industry in North Carolina in terms of workplace fatalities was private construction, with 39.

What Are Workplace Death Trends Over Time in North Carolina?

In 2020, North Carolina had its deadliest year for workplace fatalities in at least a decade. Nearly 60 percent of all workplace fatalities in North Carolina have been found to be caused by one of two things: either a transportation incident or a slip/trip/fall. Transportation incidents were also the biggest cause, nationally-speaking.

Workers in Peril

The North Carolina Department of Labor previously identified the following four occupational hazards that cause a great many work-related deaths in North Carolina.

#1: Falls from Elevation

Electricians, construction workers, firefighters – anyone whose job involves using a ladder or working at great heights – can be susceptible to deadly falls. Many are preventable. One worker in Carteret was not secured onto the roof when he bent over, lost his balance, and fell 50 feet below onto concrete. Other falls are just very unlucky. One victim from Person County fell through a tin roof and landed on a vertical rod protruding from a table.

How to Avoid Dying at Work from a Fall

The Centers for Disease Control recommends keeping work spaces free of clutter that could trip someone and cause a fall, making sure edges are protected, and checking all ladders or work surfaces for stability and proper positioning before applying weight.

Have You Been Hurt at Work?

Safety is everyone’s responsibility. Unfortunately, when the U.S. Labor Department audited North Carolina in 2010, they found that the state “downplayed serious safety problems, issued weak fines to violators, and failed to properly handle whistleblower complaints,” according to the Charlotte Observer.

If you’ve lost a loved one in an at-work accident, please contact us immediately for some answers.

#2: Struck-By Events

According to the North Carolina Department of Labor, the largest number of workplace deaths in the state were caused by “struck-by” incidents. Although the Department of Labor does not count car accidents among their work fatality numbers (such as a truck driver who dies in a crash), they do count when a vehicle strikes someone outside of a vehicle – such as someone working on a highway construction site. Other struck-by events can include those who were killed by something falling on them or being hit by a type of machinery.

How to Avoid Dying at Work from a Struck-By Event

In an interview with WRAL-TV, Division of Occupational Safety and Health Division Director Allen McNeely said, “All of us – safety professionals, employers, and employees – must do better in identifying struck-by hazards…Staying vigilant around heavy machinery and construction material is critical.”

In recent years, the N.C. Department of Labor has increased its efforts to improve safety and to prevent workplace accidents from happening. The department’s Occupational Safety and Health Division has created partnerships with businesses in some of the most hazardous industries to improve safety measures. Outreach efforts have included posters in the workplace and focused training sessions.

#3: Caught In or Between Objects or Machinery

This category traditionally includes being caught in agricultural or manufacturing machinery, but may also include trench or excavation collapses and cave-ins. In fact, according to the Occupational Safety and Health Administration, 90% of their safety citations involve excavations. Even something as seemingly simple as laying pipework near a roadway can turn deadly in a split second, as it did for one Rocky Mount worker who was laying pipe near a pond when the ground collapsed, trapping and killing him.

In another incident, ABC Eyewitness News in Gastonia County reported on the tragedy of a 19-year-old young man who suffered an unthinkable death when he was pulled into a woodcutter. It was his first day on the job. The owner of the business was so distraught he suffered a heart attack.

How to Avoid Dying at Work from Excavations or Machinery

Cave-ins are the most deadly of any type of excavation-type job. Again, safety and precautions are emphasized. Excavators are recommended to have protective systems in place and inspect trenches every day. Sadly, the Rocky Mount worker was unprotected.

For other kinds of caught-in accidents, it is imperative to be diligent about safety training. Be mindful of things like loose clothing and hair that could get caught in a machine. When around machinery, whether conducting maintenance or when it’s not in use, make sure it is turned off and any wheels are blocked.

#4: Electrocutions

While electrocutions can happen anywhere an electrical current is tampered with, those that prove fatal often involve power lines. Crane operators and people working on scaffolds near power lines must be especially careful.

How to Avoid Dying at Work from Electrocution

In general, assume all lines are energized unless verified otherwise. You should also keep yourself and all equipment at a safe distance, and use a spotter and warning devices to avoid getting too close.

What Are the Most Dangerous Counties in North Carolina for Workplace Deaths?

The North Carolina Department of Labor compiles statistics of workplace fatalities by county. However, their figures exclude certain things outside their jurisdictional authority. This includes traffic accidents – which account for nearly half of all work-related deaths.

According to these limited statistics, 45 of North Carolina’s 100 counties experienced workplace-related fatalities in 2020, with 24 counties experiencing only one fatality.

Top 3 Counties for Workplace-Related Fatalities (2020):

  1. Mecklenburg County: 9
  2. Wake County: 8
  3. Guilford County: 6

Why the Cities That See the Most Injuries Don’t Always See the Most Death

Researchers on one study used data from the Bureau of Labor Statistics and compared reported incidents of workplace fatalities and worker deaths among the different states. The researchers discovered that in states where a high number of workplace injuries were reported, the number of workplace deaths was lower. The inverse was also true: higher fatality numbers were linked with lower injury numbers.

At first glance, this data made little sense. After all, it seems reasonable to assume that if there are more workers getting injured, the number of fatalities would also be greater.

However, a closer look revealed a probable cause for the odd relationship. In states where there are better worker protection laws and more generous benefits for injured workers, workers are more likely to report injuries. On the other hand, in states where there are poorer worker protection laws and where workers’ comp benefits are less generous, injuries may not be reported as frequently and workplaces, on the whole, may be much less safe.

When a worker reports an injury, it increases the count of workplace injuries in the state, but it also gives employers a chance to correct safety problems that led to the incident before they cause fatalities. On the other hand, if a worker doesn’t report injuries sustained, employers and regulators aren’t alerted to correct safety violations before a fatal accident occurs – thus leading to more workplace deaths.

Are Temporary Workers More Vulnerable to Fatalities on the Job?

The National Council for Occupational Safety and Health cites a report by the Labor Relations and Research Center at the University of Massachusetts indicating that 90% percent of U.S. businesses utilize temporary labor.

The report claims that temps sometimes receive insufficient training or are inexperienced in protecting themselves on the jobsite. Yet they are reluctant to ask employers for help because they fear they could be replaced. Moreover, temporary workers tend to be younger, less educated, and disproportionally consist of minority workers, many of whom might be immigrant workers.

Why Are Temps at Higher Risk for Job Injuries and Fatalities?

“There’s little incentive for host employers to rigorously train and supervise temp workers because staffing agencies carry their [workers’] comp insurance. If an agency has a high number of injuries within its workforce, they – not the host employer – are penalized with higher premiums,” a recent Center for Public Integrity feature on the plight of temporary workers reported.

Further, there’s little monetary accountability. The Occupational Safety and Health Act limits negligent employers to a maximum fine of $7,000 per safety violation deemed “serious” – even if the violations cause death.

What to Do If a Loved One Dies at Work

If you’ve lost someone, you have our deepest sympathies. You’re the reason we do the work that we do. We think these counseling and legal resources might be of some help in your time of grief.

You should know there are many workers’ compensation benefits surviving family members may qualify for. But don’t rely on your loved one’s employer or workers’ comp insurance company to make sure you get everything you may be entitled to.

If a NC worker is killed while on the job, or as a result of a job, his or her family may be eligible to receive workers’ compensation benefits. These could include:

  • Up to 500 weeks of compensation
  • $10,000 in funeral expenses
  • Reimbursement of medical expenses

Regrettably, even in a time of loss, we’ve seen some insurance companies turn their backs – or try to. But you’re not alone. We’re here to help.

NC Workers’ Comp Lawyers Offer Free Case Evaluation

If a loved one has died at work, we are ready to help you. Our experienced team is dedicated to fighting for justice and trying to get surviving family members the benefits they may deserve. Let one of our workers’ comp attorneys – many of whom are North Carolina State Bar Board Certified Specialists in Workers’ Compensation Law – fight for you.

We are here to listen to what you are going through and see if we can help get you the answers you need. Contact us or call 1-866-900-7078 for a free case evaluation.

Meet the Team! How can the James Scott Farrin workers’ compensation team help you?

What to Do If Denied a Second Opinion for Workers’ Comp

When you’re hurt on the job and the insurance company accepts your claim, they have the right to pick the doctors you see. And since they get to stop paying your benefits once you’re back to work, it’s not surprising that some insurance companies have been known to send you to doctors who may return you to work quickly – sometimes before you feel completely healed!

We see injured workers all the time who are released to return to work by their treating doctors too soon. Fortunately, North Carolina’s workers’ compensation laws give you a way to try to get a second opinion for workers’ comp from a doctor who isn’t chosen solely by the insurance company.

What Are My Rights Regarding Workers’ Comp Second Opinions?

North Carolina’s workers’ compensation laws protect your right to request a second opinion from a doctor you choose. There are two kinds of second opinions in North Carolina. One is called a “comprehensive” second opinion and the other is called a “ratings-only” second opinion.

Comprehensive Second Opinion

Once the doctor your insurance company selected gives you the green light and concludes he or she’s done all he can, you may have questions. You may want to know, “Is this really as good as I am going to get? Can I really go back to doing my job? Am I really not in need of more medical care?” To answer these questions, you may need a comprehensive second opinion with a doctor other than the one the insurance company handpicked.

A comprehensive second opinion is designed to let a doctor evaluate you so he or she can form an opinion about what’s wrong with you, what treatment you may need, what work restrictions you should be under, and any permanent disability you suffer.

This is similar to any second opinion you’re used to – like when you get a second opinion on your car after a mechanic says you need to replace your engine, but you want to know if other options are available.

Ratings-Only Second Opinion

At the conclusion of treatment in a workers’ compensation case, if you’ve suffered permanent damage, you’ll be given an impairment rating by your doctor. For example, a doctor might say you lost 10% of the use of your arm as a result of your work injury. This rating will determine how much you’re due for damages for your workers’ comp claim, so it’s extremely important.

You can choose to get a second opinion on this rating, during which a doctor will evaluate you to form an opinion only on how much permanent disability you have as a result of your work injury (your rating).

You should ask for a ratings-only second opinion only if you agree with your treating physician that you’re as good as you’re going to get, and you don’t need more medical treatment. If you get a ratings-only second opinion, the doctor you go to will not generally offer his or her opinion about your diagnosis, treatment, or work restrictions.

Is anyone actually on your side in this process? That’s where we come in. Get your free case evaluation right now.

Asking for a Comprehensive Second Opinion

If you’re unhappy with the treatment you’ve received from the handpicked insurance company doctor or the work restrictions he or she has placed on you, you can submit a written request to the insurance adjuster assigned to your claim and request that another doctor evaluate you. When you make this request, you shouldn’t just ask for an appointment with any random doctor. If you do, the insurance company may send you to another doctor of their choosing. Request a doctor you select.

Once you make this written request for a second medical opinion, the insurance company will do one of three things:

  • Agree to one of the doctors you suggested
  • Suggest a different doctor (rarely a good option for you, because you may end up with another doctor that you feel, is not sympathetic to your situation)
  • Deny or ignore your request for a second opinion altogether

It’s been my experience that most insurance companies have systematically tended to opt for #2 or #3. My two cents? Challenge those decisions. Neither is likely in your best interest.

If you and the insurance company do not agree to a second-opinion doctor within 14 days of your written request, you have the right to ask the North Carolina Industrial Commission, which runs the workers’ compensation system, to order the insurance company to authorize a second opinion evaluation.

This requires filing papers with the Industrial Commission asking them to make the insurance company pay for a second opinion for your work injury. The insurance company will respond to your request, and then the Industrial Commission will make a decision. Even if the Industrial Commission orders the insurance company to allow you to see the doctor of your choice, the insurance company can slow down the process by dragging their feet or refusing to pay what the doctor is charging to complete your evaluation.

Of course, as attorneys who have our clients’ best interests at stake, we have often helped injured workers navigate the second-opinion maze.

Asking for a Ratings-Only Second Opinion

If you’re asking for a ratings-only second opinion, North Carolina’s workers’ compensation laws allow you to select any doctor you would like to evaluate. The workers’ compensation insurance company is not supposed to have a say. But let me emphasize, they can (and many often do!) drag their feet or refuse to pay what the doctor is charging to complete the second opinion. This slows down the process or may prevent you from seeing the second-opinion doctor altogether.

Use your own doctor, go to the Industrial Commission, & hire an attorney when seeking a 2nd WC opinion

What Can I Do to Protect Myself From the Insurance Company?

The law gives you rights! The bad news is that many insurance companies have strategies they’ve used over and over to gain an advantage. The good news? We have strategies of our own.

They start with our workers’ comp team. Many of these folks have worked for the insurance companies we deal with every day. They know firsthand how to recognize the insurance company’s “delay and deny” maneuvers, and other legal, but not very nice, tactics. And they know how to mount a counter offense.

The most important issue is for you to get better so you can go back to work if and when you’re medically ready.

North Carolina Workers’ Comp Lawyers Evaluate Your Claim – FREE

We know worker’s comp laws inside and out, but don’t just take our word for it.

Meet Jack M. | Only a year after a severe injury, Jack was feeling pressure to settle his workers’ comp case prematurely. A friend referred him to our office to help level the playing field.

Peer-Reviewed, Award-Winning, Professionally-Recognized

In a peer-reviewed survey, the Law Offices of James Scott Farrin achieved the highest tier ranking possible for Workers’ Compensation in the Greater Raleigh Metro area by U.S. News – Best Lawyers® “Best Law Firms” for 2019, 2020, and 2021.3

Many of our workers’ compensation lawyers are North Carolina State Bar Board Certified Workers’ Compensation Specialists. There are only 152 Board Certified workers’ comp attorneys licensed to practice in the whole state.4 In addition, we have on the team two former commissioners for the North Carolina Industrial Commission (one of whom is also a former state senator!).

And here are a few more good reasons to choose the worker’s comp team at the Law Offices of James Scott Farrin:

Some of our attorneys speak at seminars for other workers’ compensation attorneys. Others have written books about other areas of law, and several have collected awards for NC workers’ compensation, including five who were named to the “Best Lawyer” list by Best Lawyers in America for 2021.3

All supported by skilled, experienced staff with dedicated, caring paralegals. And they are ready to fight for you.

Tell Them You Mean Business

If you want a second opinion, but feel like you’re getting the runaround, contact us online or call us for a free case evaluation any time at 1-866-900-7078.

 

 

Visit https://bestlawfirms.usnews.com/ and https://www.bestlawyers.com/ for more information about criteria for inclusion.

4 Figure provided by the N.C. State Bar as of February 2021.

Some people think the law protects them and that they’ll be treated fairly no matter what. Some people think that they can handle the claim themselves. Some people think hiring an attorney means they’ll get less compensation. Does it, though?

I’ve seen enough people damage, delay, or otherwise ruin their cases and end up without the representation, medical care, and compensation they really needed. Many people (especially insurance adjusters) may give you all sorts of reasons not to hire an attorney to help you.

We’ve actually got an entire page dedicated to why you should hire a workers’ compensation attorney. But, since people still resist the idea, we’ll break down the most common excuses we’ve heard for not consulting a workers’ comp attorney.

Excuse #1: The Law Clearly States What Workers’ Compensation Benefits I Am Entitled To

Does it, though? The law provides a formula for possible wage compensation, and it does require medical treatment to be provided as needed for qualifying injuries. Notice the wording there? “Possible” wage compensation? “Qualifying” injuries? The fact is, there’s a lot of gray area in the law, primarily because it simply cannot address every single injury or circumstance. A great deal is left to interpretation.

Yes, you are entitled to certain benefits if you’ve been hurt at work, with a few exceptions. How much you may get, how you’re cared for, and how long that all continues are all handled case-by-case. What could go wrong?

  • Did you know that if you’re injured at work in North Carolina, the insurance company has the right to direct your medical care? That means deciding which doctors you get to see, and having to sign off on how often you can see them and what treatments you can receive.
  • Who’s doing the math? It’s important to remember that, just because you may be receiving some workers’ compensation benefits now, that doesn’t mean it is everything you may be entitled to. Wage numbers can be “miscalculated.” Things like permanent disability or future medical needs can be left out of the equation – or negotiated.
  • Who’s watching out for you? Typically, it’s in an insurance company’s best interest to get you into a job and off of workers’ compensation benefits as soon as possible. What if you are cleared back to work before you feel physically ready, or into a lower-paying job, or even into a “made-up” position that is later eliminated?

The truth is, the North Carolina Workers’ Compensation Act is a long, complex compilation of legal rules and procedures that apply to work-related injuries and occupational diseases. While it’s true that the law provides a way for injured workers to potentially be compensated, clarity can be hard to come by. The nuances of handling a workers’ comp claim already fill many books, large and small, trying to explain it adequately. Experience tells us that seeking fair compensation is often easier said than done.

Excuse #2: I Can Handle My Workers’ Compensation Claim Myself

This is technically true (again, with exceptions), though it may be ill-advised. You are by no means required to hire an attorney to represent you. However, there are good reasons to consider doing so.

Sorting through North Carolina’s workers’ compensation laws can get pretty confusing. Laws require injured workers to follow meticulous steps, file specific forms, and comply with various deadlines, all while recuperating from an injury under the care of a physician they didn’t even get to choose. If you fail to meet any of these requirements, you could miss out on potential benefits or, in extreme cases, lose your right to pursue your case.

We have put together some information to help those who choose this path, but we do not recommend it. The insurance company knows the laws, and it may recognize opportunities to trip up workers who choose to represent themselves. For example, what would you do if:

  • The Insurance Company Withholds Benefits Checks (or Stops Them for Reasons You Disagree With) – Workers’ compensation clients typically receive checks every week. Some adjusters may try to keep you from getting on “repetitive pay,” which is when the checks are delivered on the same day each week.
    Instead, they’ll issue a check on one day one week and then another day on the next week, forcing you to go almost two weeks without a check. Your hands are tied, though because technically, you’re getting a check every week. It’s not until there’s a 14-day lapse between checks that a violation occurs. How would you prevent this situation? And what if the checks stopped coming?
  • Miscalculation or Disagreement Regarding Benefit Amount and Mailing Checks Irregularly – We have seen insurance companies fail to calculate the weekly amount due to an injured worker correctly. Such miscalculations can lead to you receiving substantially less benefits for several weeks or months while you’re receiving medical care. Sometimes, insurance companies may fail to enroll you in a direct deposit or automatic payment plan, and make you go almost two weeks without payment (which should technically be weekly). An experienced attorney can investigate what they think is the correct weekly amount and fight, if necessary, with the insurance company to try to get those benefits corrected and promptly paid to you.
  • You Disagree With the Care Provider the Insurance Company Has Chosen – Yes, in North Carolina, the insurer/employer gets to choose where you go for treatment. They’re not going to send you to your general practice physician in all likelihood. What if you’re not happy with their physician, the care they recommend, or their evaluation of your injury? What if they clear you to return to work when you know you’re not ready? The law provides ways to appeal, but knowing when and how to file is vital.

North Carolina workers’ comp laws are packed with rules. If you fail to meet any of these requirements, you could miss out on potential benefits or even lose your right to pursue your case.

Excuse #3: I Don’t Need an Attorney Until the End of My Case, and I Don’t Want to Pay One the Whole Time

Let’s say for the sake of argument that your particular case proceeds without incident. That’s not common in our experience, but assuming it does, you want to wait because you’re not willing to pay an attorney.

While it is never too late to discuss your case with an attorney, there does come the point when an attorney cannot help you anymore. The longer your case goes, the more likely doors will close on our opportunities to try to make a positive difference for you.

As for not wanting to pay a fee, our firm works on what’s called a contingency fee basis.2 In other words, you are not billed by the hour. The fee is a percentage of any compensation and/or settlement you receive.

This is a good thing for two reasons.

  • First, working on a contingency fee motivates us to try to maximize whatever compensation we can get for our clients and try to obtain that compensation as quickly as possible. We’ll end up being paid the same percentage whether we work for 20 hours or 2,000 hours on your case.
  • Second, because your attorney is working on a contingency fee basis, you don’t have any out-of-pocket costs to hire one.2 It literally costs you nothing to start working on your case.

Generally speaking, then, hiring an attorney early in your case doesn’t cost you any more or less than it would if you hired one at the last minute (more on that below). Hiring us earlier means we can safeguard your rights, advise you on decisions, ensure all forms are correct and complete, meet deadlines, deal with issues as they arise, build your case, and fight for the most compensation possible on your behalf.

Excuse #4: I Can Negotiate My Own Settlement

Are you a professional negotiator? If that’s true, then you may be right. However, with the many different facets of workers’ compensation law in North Carolina, you may not know precisely what you could be entitled to.

Furthermore, can you reliably predict and account for future care costs if your injury causes more harm down the road? What do you ask for? How much, and how do you back up your claim? Many insurance companies know how to play hardball, and some are happy to do it. Here are a few tactics we’ve seen used:

  • Delaying: They may drag their feet forever, taking far too long to respond or react to issues you’re having. They might try to extend or delay settlement multiple times, during which time you may have bills piling up. They may hope that you’ll take less to get paid more quickly.
  • Rushing: Some will quickly offer a settlement to you. It may even seem generous. Beware, though. If you haven’t healed yet, how can you know what your medical treatment will cost in the long run? What if there are complications? The rapid settlement offer is often a red flag.
  • Friendliness: People can be friendly. Insurance companies can seem friendly. Your adjuster may very well be a nice person. However, he or she is paid by the insurance company and part of that may be to limit their payout in cases just like yours. This isn’t about friends. This is about your health – physical and financial.
  • Hardball: Some insurance companies may issue ultimatums to injured workers. They might say the settlement is their “best offer” and even invite you to “take it or leave it.” But how do you know that’s their best offer? An attorney could help you deal with this tactic.

If you do nothing else, absolutely consider hiring an attorney when the time to settle your case arrives. Having an experienced workers’ compensation attorney review settlement offers and documents can save you from a huge mistake. When this kind of case comes along, and we are hired near the end, we have often been able to spot ways clients could have received better compensation or care. Opportunities lost, in other words.

Excuse #5: It’s Too Late to Hire a Workers’ Compensation Attorney to Help Me

Unless your case is settled or closed, there may still be something a workers’ compensation attorney can do for you. There are obviously things we cannot undo, like statutes of limitations and you signing settlement documents.

The truth of the matter is, the only way to know if it’s too late for a workers’ compensation attorney to help you with your case is to ask one. We work in this system every day. We know the rules and how to try and claw back missed opportunities when that’s possible. Most of all, we work for you. Unlike an insurance company, we’re 100% working for you, and we’ll tell you what your options are so you can make the right decisions for yourself.

Even if you think it’s too late to get an attorney’s help, it costs you absolutely nothing to call us. We’ll evaluate your case for free.

Workers’ Compensation Is Complicated – Hire an Attorney

Attorneys do not create rights. Under the workers’ compensation system, your rights are established by our state legislature and enforced through the North Carolina Industrial Commission.

We discuss those rights with injured workers on a daily basis. We see firsthand how some insurance companies sometimes try to circumvent those rights. We have talked with people who are near or at the end of their case who believe they have been treated “fairly.” When we explain what the law actually may provide, these people often feel betrayed by the insurance company.

Why Would You Want a North Carolina State Bar Board Certified Workers’ Compensation Specialist?

The North Carolina Bar is very particular about using the word “specialist,” and for a good reason. The word denotes a specialized level of training and skill.

In the case of workers’ compensation, the law is open to interpretation, and everything frequently depends on how well you know the law, how much specific education you have, your experience in dealing with unique and difficult circumstances, how thoroughly you build your case, and how well you communicate within the system. If you need any more evidence that the workers’ compensation system is complicated, consider the fact that the North Carolina State Bar offers a specialization in this aspect of the law.

We have several North Carolina State Bar board-certified specialists on our team, and our dedicated team does nothing but workers’ compensation, morning, noon, and night.

What’s the Worst That Could Happen If I Don’t Hire a Workers’ Compensation Attorney?

If you want to talk about worst-case scenarios, there are several. Here are some nightmare consequences that could happen if something goes wrong in your case and you do not have an experienced workers’ compensation attorney in your corner:

  • Lose any opportunity at compensation because you fail to file a claim in time or sign something you should not from the insurance company or your employer
  • Drastically reduce the possible compensation you receive because you agree with an interpretation of the rules that is not in your best interests, or fail to fight for the actual compensation you may deserve because you’re unaware of the rules and how the formulas should work
  • Receive incomplete or subpar care for your injuries because you don’t know how to request a second opinion or appeal the decision of the workers’ comp physician (whom you did not get to choose)
  • Return to work too soon, which can mean: reducing or eliminating your compensation; taking a position that is not right for you or that may be quickly eliminated; making yourself vulnerable to reinjuring yourself
  • Settle for less compensation than you may have been entitled to receive because you didn’t know what to watch for or underestimated your future medical needs

The most mind-bending fact of all is that these excuses can be easily overcome at no cost. Our firm will evaluate your workers’ compensation case at no charge whatsoever. You’ve got nothing to lose by speaking to us. And a whole lot you can lose if you don’t.

People get hurt on the job every day. Maybe it’s happened to you recently. If so, you probably have a lot of questions about how to get through this stage of your life – especially if you can’t return to work immediately. In North Carolina, most employers who have 3 or more employees are required by law to carry workers’ compensation insurance. This no-fault insurance can provide workers with medical benefits and wage replacement benefits when they get hurt at work, and it protects employers from being sued by injured workers.

Workers’ compensation laws spell out exactly what employers owe to their eligible workers who are injured on the job. Many injured employees do not realize that workers’ comp does not just cover medical bills – it also may include compensation for lost wages. Unfortunately, not all employers want to follow these laws, and the laws themselves can be complicated. We urge you to seek the advice of an experienced workers’ comp lawyer if you find yourself in this type of situation.

NC requires employers with over 3 employees to have workers' comp insurance.

In this article, I have provided an overview of the major types of workers’ compensation benefits – it’s important to know what benefits may be available to you when you need them most. I’ve also included plenty of links to other pages if you want more details on specific workers’ comp topics.

Red Caution SignPay close attention to the warnings throughout the article where I’ve touched on the ways some insurance companies may try to avoid paying for your benefits. It’s important to be aware of these possible threats.

Types of Medical Benefits Covered by Workers’ Compensation

Medical care prescribed by an approved doctor is 100% covered by workers’ compensation if your workers’ compensation claim has been approved. This is good news! And there are no co-pays or deductibles. Even better news! And you get paid for travel expenses if you have to drive over 20 miles roundtrip. Great! So, let’s dig a little deeper to help you understand some of the specifics about the medical benefits to which you may be entitled.

If you’re injured at work, medical care benefits may be paid to you for products and services that are prescribed to help you recover from your injury – treatments focused on curing your injury, lessening your disability, and relieving your pain.

You might guess that benefits include physical therapy, surgeries, and visits to the doctor. But you might be surprised that workers’ comp may also cover the following:

  • Travel costs to and from medical appointments (if more than 20 miles roundtrip)
  • Attendant care (even if a spouse or family member is taking care of you)
  • Medical equipment
  • Home or vehicle modifications

Although approved medical benefits are 100% covered by your employer’s workers’ compensation insurance, the insurance company has the right to direct your medical care – including choosing which doctor(s) you see. The insurance company also has the option of sending you to a doctor of your choosing for a second opinion, but they rarely do. Instead, they often try to pick a doctor that will be helpful to them, not you.

Red Caution SignWARNING: Some insurance companies may try to delay or deny your medical treatment. The law is clear that if you are hurt on the job, the insurance company must pay for the medical treatment that your authorized doctor recommends. However, some may refuse to authorize treatment or send you to a doctor they think will be more conservative about your treatment.

You may want to spend some time researching workers’ compensation lawyers in NC if you’re receiving workers’ compensation medical benefits and are unhappy with your medical care in any way. My firm will give you a free workers’ comp case evaluation.

Workers’ Comp Will Not Pay You for Pain and Suffering

Physical pain, mental suffering, strains on your finances and personal relationships, and a general sense that life is spinning out of control are often part of the recovery from a work injury. When it comes time to settle your workers’ compensation case, you might think you’ll be paid for the pain and suffering you’ve gone through. Unfortunately, that is incorrect.

Woman rest face on hand while filling out workers' compensation info on her laptopFair or not, the law doesn’t require insurance companies to pay you for pain and suffering when you are hurt on the job. So, it’s important to try to make sure the insurance company pays you the full benefits the law does require. Sadly, some insurance companies may try to save themselves money by denying benefits to injured employees.

As part of the “workers’ compensation bargain,” workers are not permitted to sue their employer personally (unless the employer intentionally caused the accident) and can therefore only receive benefits related to their medical needs and ability to work.

However, if your injuries were the result of a third party, then you might be able to pursue a claim against that party that takes into account the pain and suffering you have suffered because of the accident.

For example, if you are a truck driver and are involved in an accident that was not your fault while working, then you might be able to make a claim with the other driver’s insurance company. This claim might be able to include reimbursement for your pain and suffering. And this is in addition to your workers’ compensation claim.

Wage Replacement Benefits Covered by Workers’ Compensation

When you’re hurt on the job and are unable to work while you recover, the law requires that your employer’s insurance company pay your approved weekly wage replacement benefits. You may receive wage replacement benefits when:

    • You have to take time off to rest and recover
    • You can work some, but not as much, while you’re recovering
    • Your injuries resulted in permanent damage, but you can still work (at least some)
  • Your injuries resulted in permanent damage, and you cannot work at allinjured person with cast on right arm opens wallet to look at cash

In general, wage replacement benefits cover two-thirds of an employee’s average weekly wage and are distributed in the form of weekly checks during the claim and sometimes as a lump sum settlement at the end of the claim.

For example, let’s say you work in construction and make $600 per week on average. But one day, you fall off a ladder, break your leg, and have to stay out of work for a while. Ouch! If your workers’ compensation claim is approved, you may receive $400 per week (which is two-thirds of $600) for the time you’re out of work.

Red Caution SignWARNING: Some insurance companies have been known to drag their feet in sending you these checks. Other insurance companies have sent workers less than they were entitled to receive. And sometimes, wage replacement benefits are calculated incorrectly.

If you’re receiving wage replacement benefits, you may want to have a North Carolina State Bar Board Certified Specialist in Workers’ Compensation Law look over your case. You can contact the Law Offices of James Scott Farrin for a free case evaluation.

Wage replacement benefits can be divided into two ways – benefits for the time you had to take off of work and benefits to make up for wages you might lose in the future.

Benefits for Time You Had to Take Off of Work

This category is fairly straightforward. Continuing with the example above of you breaking your leg at work: If you then had to stay at home and rest for six weeks per the doctor’s orders, you would likely receive benefits for the six weeks you were unable to work.

Benefits for time off of work might also include trips to the doctor, time out for physical therapy, working fewer hours or less strenuous jobs that pay less, etc. The workers’ compensation benefits in this category are Temporary Total Disability (TTD) and Temporary Partial Disability (TPD).

Benefits to Make Up for Wages You Might Lose in the Future

This category of wage replacement benefits can be a bit more complicated. If your work injuries leave permanent damage that may make your job difficult in the future or may prevent you from being able to return to work, you may be eligible for benefits in this category.

For example, let’s say instead of breaking your leg, you fall off a roof at work and hurt your back. And after it’s healed as much as possible (or you have reached “maximum medical improvement” – or MMI – in workers’ comp terms), you cannot stand on your feet for long periods of time as is required of your construction job.

Once you reach MMI, a workers’ compensation attorney can help you negotiate a settlement with the insurance company for future Temporary Total Disability benefits or Permanent Partial Disability (PPD). PPD is a system where your level of disability is given a Permanent Partial Disability rating from your approved doctor, and your benefits are calculated based on that rating. In cases of some severe injuries, you might be eligible for Total and Permanent Disability, which is when you can no longer work at all.

Red Caution SignWARNING: Some insurance companies may try to save money by sending you to a doctor who they think will give an opinion about your disability that is more favorable to the insurance company.

NC workers’ compensation lawyers can’t help you heal faster, but they may be able to push insurance claims adjusters to resolve your claim more quickly once you have reached MMI and help you set up medical treatment in the meantime to try to help lessen your financial burdens.

Other Types of Workers’ Compensation Benefits

In addition to the two major categories of workers’ compensation benefits, medical benefits and wage replacement benefits, you may also be eligible for:

  • Vocational rehabilitation, which pays for resume help, job placement services, and educational assistance, if you need to switch careers due to your injury
  • Death benefits, which pay for funeral expenses and wage replacement benefits, if your spouse or parent (if you’re a minor) died while working

Read Next: The Different Types of Workers’ Compensation Benefits

Does Workers’ Comp Cover Long-Term Health Conditions Caused by the Job?

North Carolina workers’ compensation law may provide coverage for people who have suffered a long-term health condition as a result of their work. Qualifying conditions can be caused by an injury that resulted from the job or exposure to harmful chemicals or conditions on the job.

The law determining whether a person is entitled to workers’ compensation benefits for a health condition believed to be caused by working is fairly complex. Essentially, you must show that your work caused the specific condition and that your job placed you at a higher risk for that condition than the general population.

For example, Black Lung Disease is generally caused by exposure to coal dust, so workers in coal mines are at higher risk of developing Black Lung Disease. Coal workers who developed this illness would likely be entitled to workers’ compensation benefits in North Carolina. Another example includes industrial workers who developed the deadly cancer mesothelioma as a result of exposure to asbestos.

If You Have Been Hurt On the Job, Call an Experienced Workers’ Comp Lawyer Today

In my experience, some insurance companies may not tell you about all the benefits for which you may qualify. And some might even employ delay and deny tactics to avoid paying your expenses. If you’ve been hurt at work, I strongly recommend that you speak with an experienced workers’ compensation lawyer about your rights.

You can check out our workers’ compensation team’s credentials. We’ve dedicated ourselves to helping injured workers fight for the benefits they need. If you would like a free case evaluation, give us a call at our 24/7 hotline – 1-866-900-7078 – or contact us online today.

When you sustain an injury on the job, it’s crucial to report your injury to a manager or supervisor right away. You should also file a Form 18 with the North Carolina Industrial Commission, which can be submitted electronically.

After you file your workers’ comp claim, the insurance company must follow an investigative process to determine if your case will be accepted or denied. They will review medical records regarding the injury and talk to your employer.

The first contact you have with the workers’ comp insurance adjuster will likely be in the form of a recorded statement. The adjuster will call you and ask your permission to interview you over the phone while they record the conversation.

The recorded statement should be approached with great caution, and it is prudent to consult with an attorney prior to providing one. The primary purpose of the questions the adjuster asks during the recorded statement is to gather facts and information about your workplace accident. The recorded statement is a key phone call for them – and for you. What you say can lead to acceptance of your claim or denial.

Is My Insurance Company on My Side?

Many people believe that the insurance company is working in their best interests. However, I often have to remind them of a basic fact about insurance companies. The majority of insurance companies are for-profit businesses.

Adjusters are typically highly-trained at finding ways to undermine your claim. If they see an opportunity to reduce the insurance company’s payment and don’t take it, they’re not doing their jobs. If they offer you more money for something than the bare minimum you would accept, they’re not doing their jobs.

An insurance company’s greatest expense is what it pays out in claims. If it pays out less in claims, it keeps more in profits. As such, even though an insurance company can be very pleasant to work with at times in a workers’ compensation matter, they are deeply interested in doing what is best for their company.

That’s why you must be careful when you explain what happened to cause your injury. And be careful how you answer seemingly harmless questions. You want to tell the truth, of course, but we have seen instances where the insurance adjuster spun the truth out of context in their efforts to deny a claim:

“Anything Unusual Happen?”

Let’s say, for example, after you describe your work accident, the adjuster asks you if anything unusual happened. Were you doing a task that is part of your regular job and were you doing it the way you normally would? The purpose of this question is not to judge whether or not you are a conscientious and careful employee. The answer you give might be directly related to the compensability of your case.

Injury by Accident

Generally, in order for an injury to be considered compensable, there must be an “injury by accident,” which means that something out of the ordinary or unusual must have happened.

“Unusual” to the insurance company might mean that one particular shelf you were stocking had been moved higher than usual and you lost your balance and fell while reaching. To you, reaching for a high shelf is all in a hard day’s work. Unusual to you might mean the electricity went out and you were stocking shelves in the dark. So you might reply that nothing unusual happened.

If you tell them you were doing your job as usual at the time of injury and omit any unusual circumstances, such as the shelf having been moved a bit higher than normal, your case may potentially be denied.

To the insurance company, this critical piece of information could be a key factor in accepting or denying your claim. Adjusters know you are not aware of this. (But they know we are!)

Why Do Some Adjusters Tell You Not to Hire an Attorney?

The insurance adjuster has a job to do. Usually, that job is to award you as little money as possible.

I have had clients tell me that an insurance adjuster told them that hiring an attorney will only hurt their case, and the attorney will only be seeking to take money out of their pocket. Why? Because they know we are potentially able to point out deficiencies in the way they are assisting in the claim or any additional benefits the injured worker may be entitled to that the insurance company is not providing in the claim.

When an injured worker has an attorney who can try to make sure they receive what they may be entitled to, then that can affect an insurance company’s bottom line – and not for the better. Insurance companies are keenly aware of this. Despite what they might otherwise say to an injured worker, many insurance adjusters are ultimately interested in what is best for the insurance company — and only the insurance company.

Should I Use My Private Insurance After an Injury at Work?

At this point, you may be wondering: Is it easier and less stressful to just use your own insurance, even for an injury suffered while at work?

No.

Do not use your personal health insurance if your injury should be covered under workers’ compensation.

Even if your employer asks you to do so and you don’t want to make waves, don’t do it. Don’t put yourself at risk so your employer can save on insurance premiums.

Your doctor likely won’t treat you under your insurance if you say you suffered a work-related injury. They know that workers’ compensation should be covering that and they might not get paid by your insurance. Will you lie to your doctor?

What if the injury is greater than expected and your insurance runs out? Any claim for workers’ compensation will likely be too late.

Can the Insurance Company Stop Sending Workers’ Comp Checks?

Congratulations! You recruited an experienced workers’ comp attorney and successfully avoided common insurance adjuster traps during your recorded statement. Your checks are coming regularly and for the proper amount. Can you relax, or can the insurance company suddenly stop sending you your check?

The concern about continuing to receive a weekly check is something we see often, and understandably so. When you are out of work due to a work injury, your only source of income is often that weekly benefits check, and it’s important to protect it while you’re recovering from your work injury.

Here’s the deal. If you go back to work, even for a day, the insurance company can stop your weekly workers’ compensation check immediately, without going before a judge. If you are, for any reason, unable to continue working after you’ve returned to work, it is very difficult to get that weekly check re-started.

If the insurance company is asking you to go back to work and you do not feel ready or able to perform the job they are asking of you, the only way the insurance company can stop your weekly check is to go before the Industrial Commission and obtain an order allowing them to stop it.

If the insurance company goes before the Industrial Commission, you or your attorney will have an opportunity to explain why you do not feel able to return to work. After that time, the Industrial Commission will make a ruling. Only if they side with the insurance company is the check stopped. This process can take several weeks.

Tip: In North Carolina, your doctor must review and approve a written job description before you go back to work.

Why You Want an Attorney to Deal with the Insurance Company for You

There are many nuances to workers’ compensation law, like the “injury by accident” rule. That is why we urge anyone who is faced with giving a statement to an insurance representative to consult with a workers’ compensation attorney first. An attorney can help you understand the types of questions you may be asked and possible pitfalls and nuances in language to heed. Your attorney can also be part of the conversation during your recorded statement. If inappropriate questions are asked, they can object.

Two Clients, Two Very Different Outcomes

We had two clients recently who had to deal with the insurance company, and they had very different outcomes based on their actions.

One client was contacted by the insurance company and told to return to work. He had been assigned work restrictions and was unable to perform his pre-injury job due to the injury. He felt he had a good relationship with his boss, and thought his employer would work with him. He did not know that the insurance company was required to have a doctor-approved job description.

So he went back to work. His employer, however, made him do more than he was physically capable of doing, and he was unable to continue working. Yet, because he returned to work, the insurance company was able to cut off his check, and he eventually had to seek relief by going before a judge.

Returning to work after a WC injury may mean demanding activity and less money from insurance.

Another client was rightfully hesitant about returning to work when the insurance company asked him to. He contacted us and we told him to wait until he had a doctor-approved job description. As it turns out, his employer was never able to put together a job description because they didn’t really have “light duty” work available. He remained out of work and focused on healing from his injury.

Sadly, you simply cannot trust some insurance companies to act in your best interest. Too much money is at stake.

Need Advice? Get a Free Case Evaluation

We have several North Carolina State Bar Board Certified specialists in workers’ compensation law on our team. Several of our staff used to work for the insurance companies – and two even worked at the North Carolina Industrial Commission.

Before you talk to any insurance representative, especially on a recorded statement, contact us or call 1-866-900-7078. We’re available to take your call 24/7.

Will Workers’ Comp Pay For New Injuries That Develop After My Initial Work Injury?

“I injured my left knee at work, but now my right knee is hurting because I am putting more weight on it. Will workers’ compensation pay for treatment to my right knee?”

I guess some insurance company adjusters never learned the children’s song, “Dry Bones” … “The foot bone’s connected to the leg bone … and the leg bone’s connected to the hip bone…”

While I mention this example in jest, there’s nothing to joke about when another part of your body starts hurting after your initial workers’ compensation injury. While this can happen quite often, just as often I have found that many insurance adjusters try to refuse to pay for medical treatment for other body parts that start hurting after the initial injury. This is called “referred pain.”

What is Referred Pain?

Referred pain refers to the pain or injury you feel in one part of your body that is actually caused by pain or injury in another part of your body. It occurs because, when you injure a part of your body, other parts must work harder to compensate. (These are also sometimes called “subsequent injuries” or “consequential injuries.”)

Overcompensating for an initial injury can lead to pain in other parts of the body, called "referred pain."

Common Examples of Referred Pain

Referred pain is common. For example:

  • Joe injures his right foot. After using a cane for month or so, he starts having pain in the left hand from the pressure of leaning on the cane. Will the insurance company pay for left hand treatment?
  • After a shoulder injury, Mary starts feeling pain in her neck which radiates down her arm. Will the insurance company pay for her to have an MRI of her neck?
  • Martin hurts his knee at work. After a few months of limping, he starts having low back pain because of an altered gait. Is the insurance company going to pay for back treatment?

Will Workers’ Comp Pay for New Medical Issues Like Referred Pain?

In each of these instances, my experience has been that many insurance companies will do everything they can to deny new treatment. Here’s why.

A bright red "denied" stamp an insurance claim paperwork.

The majority of insurance companies are for-profit businesses. They may try very hard to pay as little as possible in workers’ compensation benefits because this is more money they get to keep. That is why, when you report your work injury, you had better tell them about every single body part you injured.

If you fail to mention a body part at the beginning of your workers’ compensation claim, it can often be difficult to get the insurance company to pay for any medical treatment for it. Our experienced workers’ comp lawyers know this one-sided tactic, and will fight hard to try to prevent them from getting away with it. (That is why we suggest injured workers to contact us immediately after an injury. We can help you fully describe initial injuries in a way that may potentially help get other parts paid for if they stem from the work injury.)

There is Hope Under the Law

It may be difficult to get insurance companies to pay for new medical problems that arise while your body is recovering from the initial work injury. Let’s say an infection set in after surgery from a work injury, and you had to take strong antibiotics, which resulted in severe ulcerative colitis.

However, according to workers’ compensation law, a subsequent injury or secondary injury while on workers’ comp, whether an aggravation of the original injury or a new and distinct injury, is compensable if it is the direct and natural result of a prior compensable injury.

What to Do If You Are Experiencing Referred Pain or Subsequent Injuries

In order to get the insurance company to accept responsibility for the new medical problems that crop up after a work injury, you must have medical evidence from doctors that the new problems are the direct and natural result of the work injury. But don’t think that the hand-picked workers’ comp doctor will simply agree that subsequent issues are indeed the direct result of your initial injury. I have often seen the opposite to be the case.

This is why we recommend that you seek the counsel of an experienced workers’ compensation attorney. We know what to look for, and how to approach, support, and word the claim. And we know how to fight insurance companies and the tactics they may use.

Contact NC Workers’ Comp Attorneys Soon After Your Work Injury

Err on the side of caution and contact the Law Offices of James Scott Farrin as soon as possible after your work injury. Our experienced and formidable team will fight for your right to get medical treatment, not only for your immediate work injuries, but also for all the medical conditions that you may develop as a result.

There is a lot to know about workers’ compensation law, and the system is difficult, if not nearly impossible, to navigate successfully on your own. The sooner you hire the skilled professionals at James Scott Farrin, the better we can fight to protect your rights.

Even if you don’t think you need a lawyer, contact us anyway, or call 1-866-900-7078 for a free case evaluation. Sometimes, we are able to offer simple and direct advice even if we don’t think you need a lawyer.

I Got Fired After I Filed for Workers’ Comp. Now What?

Employees in North Carolina are generally considered “at will” employees. What this means is that your employer can fire you at any time for any reason – unless that reason is against the law.

Some employees are fired because they file a workers’ compensation claim. This is illegal.

Even so, what I have experienced is that many employers are crafty enough to come up with another explanation for why they are terminating an injured worker who coincidentally filed a workers’ comp claim. Unless you have a contract of employment, such as through a union, your employer can potentially terminate you even while you are out of work recovering from a work injury.

But if they fired you for filing a workers’ compensation claim, they won’t admit it. Based on my nearly 15 years litigating workers’ compensation cases, I have seen some employers make up all kinds of reasons why they had to fire an employee. One employer actually told an employee that he was being fired because he “took too long to heal.”

Find out how that employee turned this situation into an inspiring story after he contacted us for help.

Below, I’ll break down for you what your employer can and can’t do. After you’ve learned about your rights, feel free to contact us for a free case evaluation.

Can I Get Fired for Filing Workers’ Compensation?

Employer retaliation is strictly illegal. But that doesn’t mean it can’t happen to you.

I’ve worked with many, many clients over the years who got the clear impression that their employer was out to get them after they filed a workers’ comp claim. Most employees are at-will, which means they can be fired (or quit) for nearly any reason. Prohibited reasons would be things like retaliation or discrimination. But your employer could cite a different reason for your firing, such as a layoff following corporate restructuring.

Can an employer get away with this lie? As with everything, it comes down to what can be proven. If you think you are about to get fired in retaliation, it may be possible to pre-emptively gather evidence (like positive performance reviews). Generally speaking, evidence gathered beforehand may be more convincing than evidence you can access after being fired. A workers’ compensation attorney may be able to help leverage this evidence if you’re fired for filing your claim.

Tip: Contract employees have more protections. Their contracts will typically include specific conditions under which they can be terminated.

Can I Get Fired While on Workers’ Comp?

Short Answer: Yes, eventually, if the reason is not because you filed a claim.

Longer Answer: If you can’t return to your job after reaching maximum medical improvement, then you may be fired. You may also be fired during your recovery under the rules of the Family Medical Leave Act (FMLA). The FMLA gives employees a certain amount of time they can be out from work and still expect things to wait for them until their return (think: maternity leave). The Family and Medical Leave Act (FMLA) provides eligible employees up to 12 workweeks of unpaid leave a year, and requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave. Employees are also entitled to return to their same or an equivalent job at the end of their FMLA leave.  If you stay out longer than that allotted time, whether because of injury or because of some other reason, your employer will likely terminate you.

In this case, even though you have an open claim, you are being treated the same as employees who are out of work for non-injuries and non-work-related injuries. When employee treatment is consistent, the North Carolina Department of Labor does not consider such a termination a violation of the law.

Tip: In this particular instance, while you may not be able to keep your job, you may be entitled to receive workers’ compensation benefits until you are able to find a new job.

You Can Still Get Workers’ Comp Checks If You Were Fired

Even after you are terminated, if you are receiving workers’ compensation, you will still be entitled to receive weekly wage loss checks from workers’ compensation until your doctor says you are able to return to work.

What If I Can Return to Work But I Have Restrictions?

While you are recovering from your injury and still under a doctor’s care, your employer must make reasonable efforts to accommodate you. An example of a reasonable accommodation might be a special chair or more frequent breaks. Your employer may also provide you with a “light duty” job as a less physically demanding alternative – though “light duty” alternatives are often unsatisfactory.

What Do I Do If I Was Fired While on Workers’ Comp?

If you believe that you have been terminated, suspended, or demoted solely because you filed a workers’ compensation claim, you may file a written complaint with the Commissioner of Labor under the Retaliatory Employment Discrimination Act (REDA). Your complaint must be filed within 180 days of the alleged violation.

You can’t obtain the legal right to sue your employer for wrongfully terminating you without filing this complaint first. Even if you do file a complaint, you may still have an uphill battle ahead of you. What I’ve experienced over many years of representing injured workers is that the Department of Labor will most likely do a minimal investigation and then close your file. Of course, they will likely interview the employer to determine what they claim was the basis for your termination. As you might expect, employers typically will not admit they terminated you because you made a workers’ compensation claim.

What is a “Right to Sue” Letter?

While the North Carolina Department of Labor rarely takes an employer to court for wrongful termination, they may at least issue you a “right to sue” letter. You then have the legal right to take your employer directly to court to have a jury decide whether your employer retaliated against you because you filed a worker’s comp claim. If you prevail, you may win your job reinstatement and receive back lost wages.

Can I File Workers’ Comp After Being Fired?

If the injury you suffered qualifies and happened at work, you may still be able to file after you’ve been fired. The main barrier is not that you’re no longer employed by the business. The main barrier is likely to be the amount of time that’s elapsed since you got hurt.  A claim of workplace injury must be filed within two years of the injury date. However, the longer you wait, the more likely the employer will deny payment of your claim.

Best Practice: Notify your employer of an injury as soon as possible and no later than 30 days after the incident.

Know Your Rights!

Some employers know their way around the law and may be betting that you won’t put up a fight. If you believe you may have a claim, contact my firm at 1-866-900-7078 to see if one of our experienced workers’ compensation attorneys can help. Your case evaluation is completely free.

Tips on How to Handle a Recorded Statement for Your Workers’ Comp Claim

While no two workers’ compensation cases are alike, all of them have one thing in common. When you file a claim for workers’ compensation benefits, the insurance adjuster will likely ask you to give a recorded statement, and then the adjuster will ask questions and you will answer them.

This blog addresses a critical question you will probably be asked that can make or break your North Carolina workers’ compensation claim: “Were you doing your usual work routine when this happened?”

What is Considered “Usual” or “Unusual”?

In North Carolina, if you have sustained an injury to a body part other than your back as a result of a specific incident at work, the injury must generally be the result of an unusual set of circumstances for you to obtain coverage. However, if the injury is the result of a usual activity that you routinely do at work, it may not be covered.

  • For example, an auto repairman may routinely get down on one knee to change a tire. If, on a particular occasion, he kneels in the same manner as he routinely does and sustains a meniscus tear to his knee, the injury will probably not be covered.

Insurance companies are typically for-profit businesses. And some may look for any reason to try to deny some claims. Leaving out factors that show that the circumstances resulting in your injury were unusual at the time of the injury may result in an initial denial of your claim or a denial within 90 days of the notice of your claim.

How to Answer Insurance Adjuster’s Questions

When you sustain a work-related injury, it is important that you provide a detailed explanation about how your injury occurred. Omitting relevant facts could result in denial of your claim even if your employer or the workers’ compensation carrier initially authorizes you to receive medical treatment and compensation payments.

The North Carolina Workers’ Compensation Act allows your employer and the workers’ compensation carrier to make these payments from up to 90 days after receiving notice of your injury.

The more serious your injury is or becomes, the greater the financial incentive the employer, and/or the workers’ compensation carrier, may have to deny your claim – especially if you have left out relevant factual information in a written accident report and/or a recorded statement. There are several ways that what you say in your workers’ comp recorded statement can trap you, so we recommend that you have an attorney present or on the phone with you when making this statement.

How to handle a recorded statement for workers' compensation - have an attorney present or on the phone.

What to Watch for in the Recorded Statement

If you have been injured at work, the insurance adjuster may still request that you participate in a recorded statement even if you’ve been authorized to receive medical treatment for the work-related injury and/or have received compensation payments. North Carolina insurance claims adjusters know that if they are able to get you to agree that the injury was the result of how you usually performed the activity, then they may be able to legally deny the claim.

The Workers’ Comp Adjuster’s Open-Ended Questions

Adjusters sometimes ask fair open-ended questions during the recorded statement to try to get you to say nothing unusual happened.

Example: “What, if anything, unusual occurred that resulted in your injury?”

It is important when asked an open-ended question by a workers’ comp insurance adjuster that you describe all possible unusual factors that may have resulted in your injury.

The Workers’ Comp Adjuster’s Trick Questions

On the other hand, some workers’ compensation adjusters seem to try to trap the injured employee. They might ask a leading question to try to get a specific answer in their favor.

Example: “Isn’t it true that you were doing your usual job routine when you were injured?”

Be truthful, but careful in how you answer this question. They may ask it several times and in several different forms during the recorded statement. It is important that you describe all possible unusual factors that may have resulted in your injury.

We recommend that you secure legal advice before going on record with an adjuster. A lot is at stake, and every word you use or do not use to describe a work-related injury can affect the outcome of whether your claim is ultimately accepted or denied.

Get a FREE Evaluation From an Experienced Workers’ Compensation Lawyer

The workers’ comp insurance company may have its own financial interests in mind instead of how to help you heal and get back on your feet. If your claim is denied because you left out relevant facts in a written accident report or in a recorded statement, we urge you to seek legal counsel. Ideally, contact us or call us at 1-866-900-7078 before you proceed with a recorded statement.

Here at the Law Offices of James Scott Farrin, our workers’ compensation team has successfully helped thousands of injured employees.1 And we can fight for you, too.

What You Can Do if Worker’s Comp Has You Under Surveillance

Some insurance companies may look for ways to stop sending you a weekly check while you’re recovering from your on-the-job injury. They’re in business to make money, not give it away.

When you receive workers’ compensation benefits, that is usually money coming out of the insurance company’s pocket and going into yours instead. That’s why some insurance companies may try to find ways to avoid paying you benefits. Sometimes, that means an insurance company may completely deny responsibility to pay for your injury. When this happens, they pay you no benefits at all, while you fight (sometimes for years) for what you potentially deserve.

Worker’s Comp Insurance Tactics to Pay You Less

Delay

We have seen some insurance companies try to wait out the injured worker while they’re hurt, out of work, and in financial distress. The longer they wait, the more urgent your need for money becomes, and the less compensation you may be likely to settle for. And that means less money they have to pay out.

Deny

Delaying compensation is not the only way some insurance companies may try to help themselves. Even when an insurance company accepts responsibility for your work injury, they can – at any time – try to reduce or even stop paying you benefits. We have seen them try to cut off injured workers’ weekly checks. Other times they may try to avoid paying for a recommended medical procedure.

No matter how some insurance companies may try to keep money for themselves, it is you, the injured worker, who is simply trying to get better and go back to work, that can end up paying the price.

Surveillance

Do insurance companies randomly decide one day that they are not going to pay you? Of course not. They must have proof that they don’t have to pay you. To help them in their efforts, they may try to piece together evidence to prove your benefits should be decreased or stopped altogether.

We have seen some insurance companies resort to hiring a private investigator to spy on injured workers to try to gain the evidence they need to reduce or stop workers’ comp payments.

They may hire investigators to follow you to the gas station, or the grocery store, or any errand you may be on. They may watch you pick up your kids at school. They may stake out your house and neighborhood at all hours of the day and night. These are just the obvious workers’ comp private investigator tactics.

The goal is to compile reports, photographs, and video to see if you are as badly injured as you claim. Then, if the insurance company can create a question in the mind of a doctor or judge, they may be able to cut you off or reduce your benefits – even if they have previously admitted responsibility for your injury.

Insurance tactics to pay you less including delays, denials, and surveillance.

5 Ways to Handle Insurance Company Spying

You cannot stop the insurance company from hiring an investigator to watch you. But you can be smart about your behavior so that you aren’t making it easy for them to avoid paying you benefits. Here are five ways to help you avoid falling prey to workers’ comp surveillance.

1. Always follow your doctor’s orders.

Your doctor knows best what activities you should avoid while you heal. If the doctor tells you not to lift more than 10 pounds, don’t lift more than 10 pounds. The biggest risk of surveillance is that the workers’ comp private investigator will see you doing something outside the restrictions put on you by the doctor.

If that happens and the doctor is allowed to see the surveillance, the doctor may think you have been exaggerating your symptoms. In a worst-case scenario, the doctor may decide to no longer treat you.

2. Be thoughtful.

If you aren’t following your doctor’s orders about activity restriction, it may not necessarily be because you are not injured. More likely it might be because you weren’t thinking about what you were doing, or you were in a hurry or distracted. Life happens, and you have to lift your 20-lb toddler out of her car seat. That happens to all of us.

But when you have a work injury, and an insurance company may be paying someone to watch you, the cost of being thoughtless can be significant. Violating your doctor’s restrictions just a handful of times could suggest to the insurance company and the doctor that you’re not as injured as you claim to be.

Also, mind what you post on social media. Even if there is not an investigator directly watching you, they could find photos or posts on Facebook, Twitter, Instagram, or some other social medium that do their work for them. If you’re not thoughtful, they may use your posts against you.

3. Remember that appearances count.

Sometimes, insurance company surveillance can be harmful even when you are not caught doing something against your doctor’s orders. Even simple appearances can be enough to cause problems. For example, let’s say your doctor told you not to push more than 10 pounds. And let’s say you’re mowing your lawn with a self-propelled lawnmower that doesn’t require pushing more than 10 pounds. And let’s further say there’s an investigator recording you.

All the doctor may see when he watches this video is someone who is well enough to do yard work, including pushing a potentially heavy lawnmower. You can explain to the doctor that the mower is self-propelled, but the damage may already be done. We are not suggesting you become paranoid, but it is important to be aware of how your activity may look to an outsider.

4. Don’t talk to a suspected investigator.

Workers’ comp private investigators are likely to be very discreet, and you may never know you’re being watched – as long as that works in their favor. However, if they deem it necessary, they may approach family members or friends, and interact with them to try and get them talking.

If you think you’ve spotted an investigator who is watching you, don’t confront them or interact with them. This goes for you, your family, and your friends. The investigator will not be intimidated, and will only use the interaction to gather information from you that the insurance company may later try to use against you.

5. Hire a workers’ compensation lawyer.

When you try to take on the insurance company yourself, it is not a fair fight. History tells us that many insurance companies may try to figure out ways to maximize their profits and minimize your compensation. Surveillance is just one tactic they sometimes rely on. They have adjusters and lawyers, many of whom spend their time trying to determine the best ways to reduce their payout.

5 ways to handle insurance company spying including following doctor's orders and hiring a lawyer.

Get Your Free Case Evaluation From Workers’ Comp Lawyers

To try to make sure the insurance companies do not use surveillance or any other tactic to deny you benefits, call the Law offices of James Scott Farrin. Our workers’ comp attorneys have the knowledge, experience, and dedication needed to try to see to it that the insurance company doesn’t get away with claiming your injuries are less disabling than they really are. Contact us today or call 1-866-900-7078. Your initial case evaluation is absolutely free.