Posted on Thursday, December 5th, 2019 at 11:51 am
In a recently-posted article, we discussed the various types of workers compensation benefits that may be due to an injured worker when an amputation occurs as a result of an on-the-job injury.
Here we discuss the various types of prostheses that may be employed to help amputees return to more functional lives.
According to Amputee Coalition, there are many different types of prosthetic devices that workers who lose an arm, leg, or other body part should know about. The devices vary depending on which limb is affected. Workers need to understand what to be expect when being fit for a prosthesis.. They also need to understand how often the prosthetic will need to be replaced and what rehabilitation treatment is required.
There are a variety of workers’ compensation issues involved with prosthetic devices. Generally, workers should fight, to hold employers to their requirement to provide quality prosthetic devices. The primary consideration should be how well the prosthesis works – and not the price of the prosthesis. Injured workers should consult with both their physicians and their North Carolina or Virginia workers’ compensation attorney to choose the right prosthesis for their medical needs.
Prosthetics is the science behind creating prosthetic devices. It’s a field of study. The singular device amputees use/wear as a substitute limb is known as a prosthesis. The plural of prosthesis is prostheses. The aim of the prosthetic is to give the worker who requires the prosthetic as much mobility and function as possible. Prostheses are also designed to help with the wearer’s lifestyle and appearance.
A worker who requires a leg amputation surgery will either have his/her leg amputated above or below the knee.
This type of amputation is performed between the knee and the ankle. “The prosthesis is designed with moveable and adjustable joints and pylons. These components replicate a human thigh, ankle, and foot.” It’s generally much for advantageous for the person who needs a prosthesis that the amputation be below the knee. In general, a prosthesis works better if the amputation is below the knee.
This type of surgery is performed above the knee joint. Like the below the knee prosthesis, this “prosthesis is designed with moveable to joints and pylons to replicate a human knee, thigh, ankle, and foot.”
Some of the factors that workers need to consider when choosing a knee joint prosthesis are the amount of rehabilitation that is required, “the various stability and motion control options available” and the different price points.
The worker/patient doesn’t generally wear the prosthesis immediately. They injured leg must heal first. Most workers who need a prosthesis use a temporary prosthesis during the first few months after the amputation. The test prosthesis should allow the worker to get the training and physical therapy he/she needs.
“A plaster cast of the residual limb or a 3D laser scanner creates a custom prosthetic socket. The initial test socket is flexible to adjust to the reduction of swelling in the residual limb. It serves to minimize pressure and abrasion.”
While you’re rehabbing your knee, you will give the prosthetic designer the information needed to make cast a final socket.
The Amputee Coalition recommends the following resources:
The aim of an arm prostheses is to allow the user to grip and manipulate objects such as eating utensils and the things they need to live and work. The amputees are fitted either for above the elbow or below the elbow devices. “Electric prostheses can even move based on signals from the wearer’s muscles.”
“Below the elbow amputations are performed between the hand and elbow. Prostheses are designed to replace the forearm, wrist, and hand.”
“Above the elbow amputations are performed at or above the elbow. As most of the arm is removed, a hybrid prosthesis is the best option to provide the motion of the elbow and also provide grip.”
Many of the same principles that apply to being fitted for a leg prosthetic apply to being fitted for an arm prosthetic. With an arm prosthesis, special attention is given to how the prosthesis affects the skin.
Amputee Coalition recommends the following resources for arm amputees.
Attorney Joe Miller has been a strong advocate for injured workers in North Carolina and Virginia for more than 25 years. He understands that a good part of every workers’ compensation is working with your doctors and medical team to help maximize your chances for the best recovery possible. He fights to get all your medical paid for the rest of your life. He also fights to show you inability to work is properly classified so you can the maximum wage loss benefits you deserve. For help with any work injury, including amputation, call attorney Joe Miller at 888-667-8295. or fill out my contact form to schedule an appointment.
Posted on Tuesday, December 3rd, 2019 at 2:54 pm
Workers Compensation lawyer Joe Miller of The Work Injury Center warns about the dangers of engaging in types of jobs where it is likely that there will be no workers compensation coverage.
Posted on Monday, December 2nd, 2019 at 11:47 am
Workers can suffer the loss of a limb or body part for many reasons. They may be injured in a vehicle accident or a fall. Often, workers lose a limb due to being crushed or pinned by workplace machinery or equipment. Our office has represented a number of clients who are amputees, and obtained settlements for them for their workers compensation cases. We recently posted another article which discussed the workers compensation benefits that an injured worker who suffers an amputation may be entitled to.
Here, we will focus more on the medical aspects of amputations. The recovery process often includes the need for a surgical amputation or re-work of an already-amputated limb. In the best cases, the worker can be fitted for a prosthetic device. Most workers who lose a limb or appendage need to treat with multiple doctors. Some workers are able to return to work. Many workers are disabled due to the workplace accident – and they can never work again.
According to John Hopkins Medicine, an amputation is a condition that results in the loss of a limb – usually due to injury or disease. When amputations are due to trauma, in 70% of the cases, the upper limbs are the body parts that are lost. According to the National Limb Loss Information Center, about 185,000 amputation surgeries are performed each year.
A loss of an arm, leg, foot, hand, or other body part often affects the worker’ self-esteem, his/her ability to provide self-care, the ability to move, and the loss or decrease of other functions. Generally, amputees require extensive rehabilitation. The success and length of the rehab depends on:
Each worker’s and each amputee’s rehabilitation is different. The main goal is to help the worker gain as much function and independence as follows, “while improving the overall quality of life — physically, emotionally, and socially.”
Rehabilitation includes some or all of the following:
Workers who lose the loss of a limb often need to treat with some or all of the following doctors, health providers, and counselors. Some patients require treatment for months or years. Many workers require some type of lifelong assistance. The types of care required depends on how acute the amputation is and the availability of out-patient services.
Other doctors and rehabilitation team staff include the following health providers and professionals:
A determination needs to be made to decide if a worker/patient who has a limb that is at risk from “infection, bone loss, soft-tissue compromise related to trauma, tumor reconstruction, or peripheral vascular disease” requires limb salvage surgery or amputation reconstruction surgery.”
Limb-salvage surgery generally includes bone grafts, tissue transplantation, and implanting internal devices. Limb reattachment may also be a possibility.
According to Pharmacy Times, there are two types of amputation categories:
“Prior to surgery, most patients are measured for their prostheses and receive counseling on living with an artificial limb. Prosthetic choice is individualized, ranging from externally fitted devices to patient-controlled motion robotics. “
Post-operative care for an amputation surgery generally ranges from 5 to 14 days. Most wounds heal in a month or two. Complications, according to Pharmacy Times, can include: “edema, hemorrhage, hematoma, site infections, sepsis, soft-tissue debridement, necrosis of the skin flaps, and pneumonia.”
Many workers whose limb or appendage has been amputated suffer “phantom pain, “– the experience of pain in the limb even though the limb is no longer there.
“Along with phantom pain, 76% of patients experience phantom limb sensations, generally in the form of tingling, burning, or itching. Once thought to be psychological, phantom sensations appear to result from brain nerve-circuitry changes. Over time, phantom pain tends to decrease or disappear altogether, but when phantom pain persists longer than 6 months, prognosis for total pain relief is poor.”
The Workers Compensation Aspects of Amputation Cases
In a recently-posted article, we discussed the Workers Compensation Benefits that may occur in the case of an amputation on the job. The Workers Compensation aspects of an amputation case are generally broken down into three different types of cases.
One-Limb Amputation-Unable to Return to Job. First, there are the cases where there are one or more limbs lost, and the injured worker is unable to return to pre-injury work due to the injuries. In these cases, a settlement is usually achieved based on the remainder of weeks in the Award. If there is an amputation to one limb, the injured worker would be entitled to no more than 500 weeks of compensation, and settlement may be achieved on that basis; however, due to the high cost of prosthetic replacement, which must typically occur every five years, the medical portion of the claim often remains open and unresolved because the settlement value would be more than the workers compensation carrier is willing to pay at once, in a lump sum. Sometimes, when the injured worker is older, assuming the injured worker regularly takes advantage of the medical benefits available through workers compensation, a full settlement of the medical benefits may be examined and the worker and his or her attorney approached for settlement.
Two-Limb Amputation or impairment—Unable to Return to Job. In those circumstances where there is tragically a loss of more than one limb, or even where one limb is not amputated, but clearly is damaged to the point of having significant permanent impairment in the limb, then the injured worker would not be limited to the 500-weeks of benefits, but would be eligible for lifetime compensation benefits. This is because the “loss” of two limbs is considered a permanent and total disability. This would obviously entail a much higher potential settlement value than a settlement that is limited to 500 weeks. Again, though, due to the high cost of prosthetic replacement, which must typically occur every five years, the medical portion of the claim often remains open and unresolved because the settlement value would be immense—and more than the insurance carrier is willing to pay at this point. That does not mean a medical settlement may never occur. The insurance carrier may want to wait until the injured worker is much older to consider closing out the medical portion of the claim.
Return to Work and One-Limb Amputation. If the injured worker is able to return to work at an equal or greater wage than before the accident, despite the amputation– as is often the case in younger workers– there is still the potential value due the injured worker for the permanent partial impairment rating of the amputated limb. This would not be a final settlement, but would be a number of weeks of compensation paid to the injured worker based on the percentage of impairment assigned by his or her doctor. In some cases, such as an above-the-knee amputation, that would obviously be 100%, but in others, such as a below-the-knee amputations, it may be less.
Virginia and North Carolina Workers’ Compensation Attorney Joe Miller Esq. understands the short-term and long-term needs of workers who lose a limb, whether it be a hand, foot, arm or leg – due to a workplace accident. He works with your doctors to understand what treatments you’ll need and for how long. He’s helped thousands of employees get the workers’ compensation recoveries they deserve. To schedule an appointment, call lawyer Joe Miller at 888-667-8295. or fill out my contact form.
Posted on Friday, November 22nd, 2019 at 1:31 pm
Workers who lose a limb due to any type of accident are entitled to unique workers’ compensation benefits because of their injuries. The benefits may be unique because the medical needs are different than most other injuries and because many workers may be entitled to scheduled pay benefits for a specific number of weeks – based on the specific body part(s) that were amputated. Whether the claim for those benefits becomes a significant part of the claim really depends on whether the injured worker is able to return to work at the same or greater pay than pre-injury.
Injured employees who suffer a workplace accident are entitled to have their medical bills paid. This includes the initial surgery to try to save as much as the limb or body part as possible, to leave the surrounding body parts as healthy as possible, and to help the worker be able to have a good fitting prosthetic.
For most amputees (those who lose an arm or a leg), being fit for a prosthetic device and learning how to use the device requires a lot of medical treatments and care. Many victims may need to have their prosthetic device replaced every few years. Newer better devices may be available with time. The cost of a prosthetic device can run $5,000 to $50,000 according to Hospital for Special Surgery. The insurance company for the employer should pay all the reasonable costs so that you can regain as much function as possible.
Workers who lose a limb or a body part usually require physical therapy, occupational therapy, and other help so that they can return to their job or be in a position to learn a new job. Many workers who suffer an amputation also need psychological counseling to help them adjust to living a life without an arm, leg, hand, foot, or other body part. In addition, many workers need pain management treatment. They may need addition medical help if infections occur.
In addition to prosthetics, there are new develops such as artificial joints and computerized anatomy that may help a worker restore function to a limb or body part that was severed.
Joe Miller and the Work Injury Center have represented, and continue to represent injured workers who have suffered an amputation injury.
Like other workers, employees who have a part of their anatomy amputated, are entitled to 2/3rds \ of their pre-injury average weekly wage during the healing process and so long as they are unable to return to work.
Once a worker has reached the point of maximum medical improvement (no further medical treatment will improve their overall health), an evaluation is made as to the type of disability they have – a total or partial disability.
North Carolina and Virginia Workers’ Compensation Lawyer Joe Miller Esq. has earned the high respect of former clients and the legal community for his ability to win and settle work injury cases. He understands how to counter many of the arguments defense lawyers assert to try to minimize your claim. He works with orthopedists, neurosurgeons, pain management doctors, and other medical professionals to assess and document the severity of your amputation. For help now, contact attorney Joe Miller at 888-667-8295 or fill out my contact form to make an appointment.
Posted on Thursday, November 21st, 2019 at 1:31 pm
Amputation injuries at work can happen for many reasons such as a vehicle accident, being caught or trapped in machinery or equipment, a fall from a high height. The loss of an arm, leg, hand, foot, finger or toe is life-altering for anyone. Many workers who suffer an amputation need surgery to help limit the physical damage. Victims sometimes suffer pain for the rest of their lives. Many workers who suffer an amputation need psychological counseling and therapy. Most require prosthetics to be able to walk or regain some function in the area of the missing limb. These prosthetics, as well as the supplies that enable them to function properly, entail ongoing costs that the employer and workers compensation insurance carrier will be responsible for.
According to Amputation Coalition, a doctor supported nonprofit, the Occupational Safety and Health Administration (OSHA) data has found that most “workplace amputations occur because of unguarded machinery, lack of adequate training and appropriate practices and procedures to safeguard employees.”
Their findings also show that 1 out of every 20,000 workers suffers a workplace amputation. The incidence rate for amputations in certain professions is higher:
Employers should work with OSHA to help implement safety protocols. Regular inspections should be conducted. The following hazards should be reviewed:
According to OSHA, some of the machines that cause amputations include:
Amputations also occur when workers work with forklifts, trash-compactors, and various types of hand tools.
The injuries can occur during cleaning, lubricating, preparing, threading, and maintaining the machines and equipment.
The following types of mechanical components are considered the most dangerous:
While all mechanical motion is considered dangerous, some of the most common hazards include:
OSHA provides standards that employers should follow to address the danger of amputations at work:
Other OSHA regulations cover maritime work
Some of the key ways to safeguard machines that OSHA recommends are:
New machines should come with safeguards already installed. The employer can also buy safeguards or install them before use.
Workers under 18 are banned from operating certain types of machines due to their inherit dangers. The bans include “operating band saws, circular saws, guillotine shears, punching and shearing machines, meatpacking or meat-processing machines, paper products machines, woodworking machines, metal forming machines, and meat slicers.”
In addition to filing a North Carolina or Virginia workers’ compensation claims, workers have additional rights according to OSHA. The best course of action is to prevent the amputation in the first place. If amputation injuries do occur, then experienced work injury lawyers can help the amputee get all the medical help, wage benefits, and other benefits that law allows. Our team at the Work Injury Center has represented, and continues to represent several clients with amputation injuries.
These additional workers’ rights include:
Virginia and North Carolina Workers’ Compensation Attorney Joe Miller Esq. knows how traumatic the loss of an arm, leg, or any body part is. For over 30 years, we’ve helped thousands of injured workers get the full compensation they deserve. We work with your doctors and other health care providers to understand whether prosthetics or other medical advances are an option. We fight to get your full wage loss and medical benefits. When appropriate, we also seek payment for disfigurement and loss of function. To speak with an experienced North Carolina and Virginia workers’ compensation lawyer, call lawyer Joe Miller at 888-667-8295. or fill out my contact form to schedule an appointment.
Posted on Tuesday, November 5th, 2019 at 10:22 am
It’s tempting for many North Carolina and Virginia workers to think that their employer and the employer’s insurance company are on their side – especially when they’re paying you 2/3rds of your lost wages and paying for your medical bills. While this may seem nice, it can hurt your case in many ways. The best course of action is to consult with an experienced work injury lawyer who will protect your rights by filing a formal workers’ compensation claim on your behalf. The bottom line is that if you are not under an Award in Virginia or you do not have an Accepted Claim in North Carolina, your benefits are in serious jeopardy.
Some of the reasons workers need to file a formal claim, instead of relying on the informal kindness of their employer are:
A Form 60 is Filed by the Carrier if they are accepting the claim.
A Form 63 is filed by the Carrier is they are conditionally accepting the claim (i.e. they need to investigate a few things first)
A Form 61 is filed by the Carrier if they are denying the claim.
Employees should understand that there is no expense to file a claim but, as mentioned, there are time limits – generally one day less than two years from the date of the accident. These limits can be extended in some cases if the employee is receiving benefits, but a competent worker’s comp attorney should be consulted to see if you are being protected appropriately. When in doubt, FILE.
Virginia and North Workers’ Compensation Attorney Joe Miller Esq. has the experience and skills to help you get your full benefits and help you fight attempts by the employer to terminate or reduce your benefits. He has helped thousands of workers get strong recoveries and has been representing injured and ill workers for more than a quarter of a century. To speak with a persuasive workers’ compensation attorney, call lawyer Joe Miller at 888-667-8295. or use my contact form to schedule an appointment.
Posted on Saturday, November 2nd, 2019 at 10:20 am
Injured works and ill workers in North Carolina and Virginia are entitled to have all their reasonable and necessary medical expenses paid. This includes more than just paying hospitals for surgeries and hospital visits, doctors for their reviews and treatments, and therapists for their continual care. It includes more than the cost for medical devices and prescriptions.
Workers also have the right to have the insurance company for the employer pay for the cost to get to the hospitals and their doctors. This is especially fair because the employer chooses the doctors patients can treat with and the choice is what’s best for the employer, not what’s best or convenient for the employee.
In both North Carolina and Virginia, the mileage and transportation costs include the cost to pay for cabs and rideshare services, public transportation, parking lot fees, and tolls. For employees who drive their car to the medical provider’s offices, they are entitled to a mileage allowance.
Reimbursement costs don’t include the cost of gasoline to get to these medical offices and they don’t cover trips to the pharmacy. Pharmacy costs generally aren’t covered because many workers and doctors can use mail pharmacy services.
According to the North Carolina Industrial Commission rules, mileage reimbursement is allowed for trips 20 miles or more (round trip – so 10 miles each way) as follows:
In North Carolina, this is done through a Form 25T. If employees travel 20 miles or more round trip for medical treatment in workers’ compensation cases, they are entitled to collect for mileage at the rate of 25 cents a mile for travel prior to June 1, 2000;
The IRS sets the reimbursement rates so the amount workers can be reimbursed is the same in Virginia as it is for North Carolina. As of this writing, it is .555 cents per mile. In Virginia, there is no prescribed form to recover mileage, but it should be done clearly and legibly, with each date of service listed as well as the mileage roundtrip for each date.
In addition to transportation expenses, in North Carolina: “Employees are entitled to lodging and meal expenses, at the rate established for state employees by the North Carolina Director of Budget, when it is medically necessary that the employee stay overnight at a location away from the employee’s usual place of residence.”
Your North Carolina and Virginia workers’ compensation lawyer will help you obtain and fill out the correct reimbursement forms. It’s critical that you document all your travel expenses. This means getting receipts where you can and keeping a travel and mileage journal.
Posted on Wednesday, October 30th, 2019 at 10:19 am
Many older workers who are injured on the job or suffer an occupational illness are entitled to both Medicare and Worker’s Compensation benefits.
There are two general issues involving Medicare. The first involves the regular medical submissions from doctors and other health providers while the employee is getting treatments so they can return to work – or know if they can’t return to work. These payments are paid until the worker reaches maximum medial improvement – the point at which future medical treatments won’t help the worker’s health improve.
The second issue involves the settlement of the claim after the worker has reached maximum medical improvement. In a settlement, funds need to be allocated ahead of time, often before the worker is eligible for Medicare, to account for what Medicare will pay and what workers’ compensation will pay. This is discussed in several places on this website and is known as a Medicare Set-Aside (MSA).
Workers’ compensation is managed by the state where you work. Medicare is a federal program. Generally, the bills for work injuries are submitted to the insurance company for your employer. If they refuse to the pay the bill with 120 days, then Medicare should pay the bill – conditionally. This means Medicare pays the bill – but reserves the right to be reimbursed if it is agreed that the workers’ comp carrier should have paid the bill or there is a ruling that they should have paid the bill.
The medical bill should be something that Medicare covers. Complicating matters is that Medicare normally only pays 80% of hospital and physician services. Supplemental insurance pays the other 20% if the worker has supplemental insurance. The issues get more complex if the worker has reached the age of Medicare eligibility before he/she has reached maximum medical improvement.
A Workers’ Compensation Medicare Set-Aside Agreement is used to pay future bills in a settlement. Typically, before any long-term settlement is reached, the lawyer for the employer will contact a company who specializes in estimating the future medical costs of the injured worker in relation to their work injuries. That company will usually then prepare a detailed Medicare Set-Aside report which sets forth, in great detail, the estimated amounts of the injured worker’s future treatment for his or her work injuries.
If the injured worker is a current Medicare recipient, the employer’s attorney must then submit that report to Medicare’s CMS Office to get approval for any funds that are set aside to pay Medicare in the future. This is money that is set aside is first used to pay the future medical expenses in relation to the employee’s work injuries. Once approved by CMS, the settlement can then proceed.
Only when the set-aside amount is used up can the worker request that Medicare pay for any other future medical bills. To ensure that Medicare isn’t paying more than it should, if the worker is a current Medicare recipient, he or she must obtain the OK from Medicare for set-aside amount. Sometimes the set-Aside arrangement will be lump sum, other times it will be an initial seed amount, followed by yearly payments for a set number of years to the worker. In addition, sometimes the Medicare money is “self-administered” by the employee, and other times, it is administered by a Medical Management Company.
If the injured worker is not a current Medicare recipient, but the settlement is over a certain amount and the worker has applied for Social Security Disability (SSDI), it is recommended that a Medicare Set Aside be done privately by the employee as part of settlement, and that the amounts set aside be recited in the settlement agreement. This is to make sure Medicare’s interests are protected, because a worker who is deemed disabled by the Social Security Administration will automatically qualify for Medicare at 24 months from his or her date of disability. Although such arrangements for non-Medicare recipients do not have to be reviewed in advance by Medicare, they are advisable to avoid any problems down the road.
The bottom line is that the law wants to prevent “double-dipping.” Medicare does not want to see a worker receiving a settlement which includes money for future medicals for his or her injuries, and then see that same worker turn around and hit up Medicare for those same bills.
Experienced workers’ compensation lawyers know how to review Medicare-Set Aside plans to help determine what your future medical needs such as continued therapy, medication, or diagnostic procedures a will be. Once a settlement is made, the employee can’t go back and ask for more. That being said, the beauty of a formal Medicare Set-Aside is that once the money is used up, the worker can then turn to Medicare to cover his or her treatment related to the work injuries.
Virginia and North Workers’ Compensation Attorney Joe Miller Esq. knows his way around the rules pertaining to authorized physicians as well as Medicare. He’ll help you come up with legitimate strategies to find a solution if the company doctors are more interested in rushing you back to work than in treating your injuries or illnesses. He’s helped thousands of employees get the full workers’ compensation awards and settlements they deserve. For help now, call lawyer Joe Miller at 888-667-8295. or fill out my contact form to make an appointment.
Posted on Wednesday, October 30th, 2019 at 10:08 am
In Virginia, workers are generally required to treat with a doctor chosen from a list of doctors provided by the employer. This list is known as a “panel” of doctors. Panels must be provided for each individual specialty required. Oftentimes, there is no time to choose from a panel because the injured worker has been transported by ambulance to the emergency room and/or undergone surgery by a physician such as an orthopedic surgeon, who will typically continue to treat the injured worker. If the injuries are severe, there is often an extended hospital stay where the injured worker may see several specialists while in the hospital. In those circumstances, panels are not usually required, as the doctors who treat the injured worker in the hospital will typically become the authorized treating physicians by virtue of their visits with the patient and their familiarity with his or her injuries and treatment over time.
Workers in Virginia should be wary of companies who shuffle workers off to a “company doctor” as the sole means of treating an injury. This is not in accordance with the law. The injured worker in Virginia is entitled to choose from a panel of three doctors which the employer/comp carrier must provide. Note that all of the doctors on the panel must be from different practices. The employer cannot simply list three doctors within the same practice and ask the injured worker to choose one.
In North Carolina, there are no panels of physicians offered. The workers’ compensation carrier is pretty much given free reign to choose a physician to treat the worker’s injuries. The thinking is that if the employer is footing the bill, they get to choose the doctor. That being said, the same kind of restrictions apply as in Virginia for Emergency treatment: The surgeons or other providers who treated the injured worker in the hospital will typically become the authorized physicians, and the carrier really does not have the right to randomly switch treating physicians just because they do not like the surgeon who performed the surgery in the hospital.
The big difference in North Carolina is that there is a provision for a second opinion exam at the expense of the insurance company if the worker is dissatisfied with the treatment of the authorized treating physician. This must be agreed upon or ordered by the Industrial Commission.
In Virginia, there are unfortunately no such provisions for a second opinion examinations with physicians chosen by the employee; however, workers are free to pay for their own second opinion examinations or treatment with whatever doctor they want to if they so choose, or if they are able to do so under private health insurance. That being said, workers should be cautioned that the VWCC will always give more weight to the opinions of the authorized treating physician than the injured worker’s chosen doctor.
While the pain doctors, orthopedists, and other doctors that treat workers are of primary concern, a secondary concern is which pharmacy the employee uses and the prompt filling of prescriptions. The treating doctor is the physician who fills out the prescription. The nurse or staff for the doctor normally calls in, emails, or mails the prescription to a local pharmacy. It can be extremely frustrating for some patients when the workers compensation insurance company either delays the approval of certain medications or simply does not respond to the pharmacy’s requests for approval in a timely fashion.
Sometimes this is based on the fact that the particular medication prescribed by the treating doctor is simply too expensive.
“According to the Insurance Journal, North Carolina authorized a study (called a drug formulary) of which drugs should be used to treat specific work injury conditions and illnesses in 2015.
“A drug formulary is, very simply, a preferred list of prescription drugs. This list can include both generic and brand name drugs, and is composed to identify drugs that are:
(1) appropriate to treat the compensable injuries and
(2) offer good value.
The drugs included on a formulary are considered to be medically appropriate and also cost-effective when prescribed for certain medical conditions. It is not uncommon for health care payors to maintain lists of pre-identified and pre-approved drugs. Formularies are widely considered an appropriate tool to encourage the safe and affordable use of prescription medicines.”
Supporters of drug formularies claim it saves costs and offers better medical treatments. Opponents argue that the employee may not be getting the correct drug for his/her medical condition.
North Carolina eventually decided not to use a drug formulary. Instead they developed rules for the use of opioids for pain management.
Virginia does not use formularies, either. The authorized treating physician is free to prescribe whatever medications that he or she deems necessary to effect a cure or give relief to the patient.
Generally, while the employee in a North Carolina workers’ compensation case must use the company’s doctors, the employee can decide which pharmacy to use. The employee can also switch pharmacies if one pharmacy isn’t satisfactory.
An alternative to visiting the local pharmacy is to use a mail-order pharmacy. For employees who can’t move about easily (workers’ compensation does not normally pay for the cost of travel to the pharmacy, a mail-order pharmacy offers the convenience of not having to leave home and saves the costs. If the carrier will not pay the costs of the medication outright, the injured worker can make a claim in North Carolina for prescription costs with a Form 25P.
Often workers who have reached the point of maximum medical improvement – where additional treatments with their doctors won’t improve their condition – still need to use medications for the rest of their lives or for a substantial period of time.
Posted on Monday, September 23rd, 2019 at 11:06 am
Workers who were injured while doing construction work, retail work, hospital work, or any type of work have the right to get the best health care available to treat their injuries. Many injured employees need to treat with their doctors for months or longer before they begin to see improvement. Some workers are fortunate to return to their old job. Many workers need to work to work with medical restrictions.
Injured workers have the right to be compensated for their injuries (typically at a 2/3rds rate) until they reach maximum medical improvement – the point where additional medical care won’t improve their health. When they reach MMI, workers have the right to have their treating doctor assign a permanent partial disability rating. The worker is entitled to this rating if they haven’t returned to work – and even if they have returned to work.
Impairment ratings are authorized by the North Carolina Workers’ Compensation Act. Once the rating is assigned, the worker can request a lump sum payment for lost wages based on the impairment rating. The worker will still be entitled to have the employer’s insurance company pay their medical bills so their health doesn’t get worse – provided they comply with the necessary formalities.
Impairment ratings are set forth in North Carolina Statute 97-31. that most workers are entitled to for up to 500 weeks – provided they are unable to return to work.
A common misconception is that the permanency or impairment ratings are very important in valuing a worker’s comp settlement. Many times, that is not the case. If one is unable to return to his or her occupation due to the work injury, then that is certainly not true. Impairment ratings are only relevant in terms of settlement discussions in cases where the injured worker has RETURNED TO WORK at the same or higher wage as the pre-injury job. This is because in those circumstances, his or her ongoing benefits would have ceased, so that all that remains would be the weeks the worker would be entitled to based on the impairment ratings.
If the injured worker is unable to return to his or her occupation, in most cases, the impairment rating is not relevant to settlement discussions. This is because one cannot get more than 500 weeks of benefits except in rare cases. The ratings cannot ADD to the 500 weeks and one cannot get ratings money at the same time one is getting weekly checks for workers comp.
So, what becomes relevant in a case where a worker cannot return to his or her job is how many weeks remain of the maximum allowable weeks of 500 weeks. Usually, the impairment ratings, unless there are extremely severe injuries to multiple body parts, are not going to come anywhere close to the remainder of the 500 weeks. So that number—the number of remaining weeks of the 500 weeks times the weekly workers comp check—becomes the most relevant number when discussing a settlement of the claim.
The worker should review with an experienced North Carolina work injury lawyer whether his or her case fits into the category of a matter that falls under a ratings-type case or a disability-from-work claim. There are other considerations that the lawyer will review such as the need to look for alternative work if you’ve reached MMI. If you’re not careful, you may even lose your weekly benefits if you don’t follow the correct procedures.
Workers who are likely to return to work soon, or have returned to work at the same or higher watges and don’t anticipate much additional medical care would be more likely to be accepting an impairment rating payout as part of any settlement.
Your treating doctor will review whether you have an injury that is listed in the North Carolina impairment statute. If you do, the physician will then determine the severity of your injuries based on North Carolina Industrial Commission standards or standards established by the American Medical Association. The rating examines whether you have lost the full use of an arm, for example, or whether you some limited ability to use the arm. Ratings today are typically done through Functional Capacity Examinations (FCE’s). The treating doctor merely signs off on those ratings. If the treating doctor’s rating seems wrong, workers can request a second opinion at the employer’s insurance company’s expense.
For example, the loss of hearing is paid at 2/3 rds of your average weekly wages for 70 weeks for the loss of hearing in one ear. The amount rises to 2/3rds of your average weekly wage for 150 weeks for the loss of hearing in both ears.
So, if you were earning $900 a week, your comp rate would be $600.00. If you lost hearing in one ear, the doctor will assess the degree of loss. If the impairment rating is 30% for hearing loss in just one ear, that would be 70 weeks x .30 or 21 weeks. Then your payout would be $600.00 x 21 weeks or $12, 600.
The North Carolina statute assigns the following ratings losses for some injuries. The statute contains the full list:
In cases included by the following schedule the compensation in each case shall be paid for disability during the healing period and in addition the disability shall be deemed to continue for the period specified, and shall be in lieu of all other compensation, including disfigurement, to wit:
Additional injuries covered include:
Other injuries and conditions apply.
Virginia and North Workers’ Compensation Lawyer Joe Miller Esq. has helped thousands of injured workers get the full workers’ compensation benefits they deserves. He works with the treating doctors and independent doctors to properly assess your medical condition. He’ll detail how much money you will get if you continue on disability or if you settle your claim in a lump sum. To speak with an experienced work injury lawyer, call attorney Joe Miller at 888-667-8295. or complete my contact form to make an appointment.