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.
Posted on Thursday, September 19th, 2019 at 11:06 am
Workers who are injured on the job can take months or even years before their injuries are properly healed. Many employees with severe injuries such as spinal cord damage, lost vision, or traumatic brain damage never fully heal.
In workplace injury cases, the initial medical goals are to treat any emergency conditions, make a proper diagnosis of the worker’s injuries, and develop a treatment plan. The physicians should also explain to the patient the long-term prognosis for their medical condition. The employer’s insurance carrier (unless the employer is self-insured) is required to pay for all necessary medical care to help the worker improve physically and emotionally – as much as possible.
A major medical and legal determination and milestone in an injured worker’s case is when he or she finds out if the worker can return to his or her job. Another important determination connected with this is whether the worker has reached maxim medical improvement (MMI).
MMI is the point where additional medical care is not reasonably likely to improve the health of the worker. Additional surgeries aren’t likely to help and additional therapies aren’t likely to help. MMI does not automatically mean the end of medical care because some injured workers still need physical and other types of therapy such as pain management so their condition doesn’t worsen or they can achieve ongoing pain relief.
MMI does not mean the worker is as healthy as he/she was before the accident. It just means that additional medical care won’t make a major difference. When a worker has reached MMI, then he/she should work with an experienced North Carolina workers’ compensation lawyer to review the following issues:
Workers who have reached maximum medical improvement could also consider settling their overall claim. Workers generally can’t settle their claim if there’s the reasonable probability that continued medical care of a substantial nature would improve their condition. This does not mean medical care such as pain management or the ongoing taking of medication. MMI is typically not declared by the treating physician if additional, major procedures such as surgery are upcoming.
On the other hand, if the worker has been declared to have reached MMI, then what usually happens is the treating physician will refer the worker for a Functional Capacity Exam (FCE) to determine their permanent physical restrictions.
After receiving the results of the FCE results, that is usually a good point to think about seeking a lump-sum settlement based on the worker’s average weekly pay, the standard 2/3rds adjustment of the pay, the number of weeks they can still receive pay, (which is usually the remainder of 500 weeks if they are under an Award or under an Accepted Claim) their likely future medical bills, and other factors.
In North Carolina, a settlement agreement in a workers’ compensation case is called a Clincher Agreement. In Virginia, it’s simply called a Full and Final Settlement. Once you accept the lump sum payment as a settlement, upon entry of the Settlement Order by the Workers Comp or Industrial Commission, your rights to income payments due to a temporary total or temporary partial disability generally stop, as do your medical benefits.
There are a lot of pros and cons to settling your case once you’ve achieved MMI:
Additionally, as noted above, the worker can seek an impairment rating which can result in income payments based on the type of injury the worker has the severity of the injury. The severity of the injury is based on an impairment rating typically expressed as a percentage, and that rating is then translated into a number of weeks of payments, all set forth in the statute books. Typically, the treating doctor will assign an impairment rating based on the workers condition and standard medical guidelines such as those of the American Medical Association or the North Carolina Industrial Commission.
A common misconception is that the permanency ratings are very important in valuing a worker’s comp settlement. 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 really 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.
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 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.
Reaching your MMI does not mean your disability benefits end. They continue as long as the law allows, meaning unless you settle your claim or return to a job paying the same or higher wages as you had before you were hurt.
Covered injuries are assigned a number of weeks. For example, the loss of an arm is assigned 240 weeks. If you can still use your arm but not as much as before the accident, the treating doctor will assign an impairment rating to reflect the degree of loss. If the impairment rating is 20% that would equate to 240 x .20, or 48 weeks. Then if your average weekly income was $1,000 a week – then your comp payments are $666.67 per week. So you would be entitled to 666.67 x 48 weeks, or $32,000.16.
Workers in North Carolina have the right to challenge the impairment rating of the treating doctors by getting a second opinion which is paid for by the employer’s insurance carrier. If the ratings differ, then the North Carolina Industrial Commission may be required to decided which rating to use. No such right exists in Virginia.
Virginia and North Workers’ Compensation Attorney Joe Miller Esq. has been helping injured workers for more than 25 years. He’ll review and explain your options once you’ve reached maximum medical improvement. He’ll work with your doctors and you so that you make the right choices for your physical and economic needs. To review your case now, call lawyer Joe Miller at 888-667-8295. or use my contact form to make an appointment.
Posted on Friday, September 6th, 2019 at 3:11 pm
Repetitive stress injuries, according to Medical News Today, can affect most every movable part of your body. They are generally associated with repeating the same task over and over again, vibrations, and forceful exertions. Some of the other names for repetitive stress injury (RSI) are repetitive motion disorder, cumulative motion disorder, repetitive motion injury, occupational overuse syndrome, and regional musculoskeletal disorder.
Generally, in both North Carolina and Virginia, repetitive stress injuries do not constitute valid claims. If one claims, for instance, that due to years of heavy lifting one’s back has started to hurt, that claim will be denied by the insurance company as well as by both the Virginia Workers Comp Commission or the North Carolina Industrial Commission.
There are, however, a couple of sets of exceptions carved out in the law.
The first is if the repetitive stress injury is suddenly aggravated by a traumatic event. In Virginia, as long as the doctor can say that the traumatic event caused a “sudden mechanical change” in the injured body part, then this would be a valid injury. Similarly, in North Carolina, a slip, trip or fall that aggravates a repetitive injury would be compensable.
The second set of exceptions relate to some specific injuries that are very common and generally accepted as either occupational diseases or ordinary diseases of life caused by repetitive work trauma.
Carpal tunnel syndrome is perhaps the best- known form of RSI. It is treated as an ordinary disease of life that is an occupational disease. It is a condition, according to Orthoinfo, that occurs when a major nerve to the hand (the median nerve) “is squeezed or compressed as it travels through the wrist.” It can be quite painful and generally gets worse over time unless it is treated. For some patients, surgery may be required to take pressure off the median nerve.
CTS is very common in machinist occupations and electrical occupations where repetitive use of the hands is required.
Symptoms often vary depending on the part of the body that is affected.
Many workers don’t’ realize they have an RSI until the damage to their body is significant. By the time they do feel the pain, they need to stop working and get medical help.
Some of the general causes of repetitive stress injuries include:
Psychological stress can worsen RSI.
Some of the causes of RSI that cause workers to lose time off from work and file a workers’ compensation claim include:
Other jobs that are known to cause RSIs include delivery work, plumbing, agricultural work, firefighting, stocking shelves, janitors, maid services, and food processors. Professional athletes and professional musicians also do a lot or work that involves repetitive motions.
The earlier workers begin treatment for an RSI, the better. Doctors will conduct a range of tests depending on the body part that hurts and other factors. These tests include:
Treatments for an RSI include:
The recovery process for surgical and non-surgical treatments can take months or even up to a year.
Unfortunately, other than Carpal Tunnel Syndrome (CTS), or aggravation of pre-existing RTS injuries by a single traumatic event, Virginia does not recognize any other repetitive stress injuries as valid, compensable injuries or an occupational disease.
In North Carolina, the legislature has carved out a few specific, repetitive stress injuries that are recognized as specific, valid, occupational diseases.
In addition, in North Carolina, (not in Virginia) repetitive stress injuries can sometimes be classified as occupational diseases and be compensable IF they are proven to be caused by things that are characteristic and peculiar to the employment of the injured person and excluding ordinary diseases of life to which the public is equally exposed. An example is a cameraman who develops a rotator cuff injury over time. His job requires him to carry the heavy camera on his shoulder every day, and if the doctor supports it, this would be an example of a compensable RTS injury in North Carolina.
One should proceed with caution, however. These types of North Carolina “ordinary disease of life” cases are notoriously difficult to prove. The doctor must not only say that the work caused the issue, but that it was NOT caused by exposure to repetitive stress outside of work. For some jobs, such as daily work with a jackhammer, the proof may be clear. For other jobs, such as computer work, an insurance company may argue that your off-duty typing or exposure to other, off duty activities caused the RSI.
There are, however, some RTS diseases in North Carolina that are specifically listed by the legislature as an occupational disease.
The RTS diseases that are specifically listed in North Carolina General Statute Sec. 97-53 as compensable occupational diseases are:
Examples of repetitive stress injuries that might be compensable in North Carolina, (but not in Virginia) depending on the proof of facts, are:
If you have a workers’ compensation claim because of a repetitive stress injury, Virginia and North Workers’ Compensation Attorney Joe Miller Esq., will explain your legal rights. In most cases, unless you fall into one of the exceptions listed above, there is a good chance you may not have a case. But if you have a valid work injury claim, he’ll work with your doctors to determine your full health condition. In some cases, he may recommend that you see other doctors who are approved by the state workers’ compensation organizations. To learn if you have a claim, call attorney Joe Miller at 888-667-8295. or fill out my contact form to schedule an appointment. Joe Miller has been fighting for injured workers for more than 31 years.
Posted on Wednesday, September 4th, 2019 at 3:11 pm
According to the Occupational Health and Safety Administration (OSHA), there are numerous reasons why back injuries are a major cause of lost work days. Back disorders generally occur in one of two ways:
A single traumatic event or a combination of a single traumatic event that aggravates an accumulated problem both generally constitute compensable, valid injuries under workers compensation law in both Virginia and North Carolina; however, cumulative injuries by themselves are generally not compensable and do not constitute a valid workers compensation claim.
Also, while usually in North Carolina, a “slip, trip, or fall” is required to prove an injury by accident, an exception is carved out in the law with respect to back injuries. Evidence of a single, traumatic event is usually sufficient to prove a back injury in North Carolina.
Virginia also only requires a single, traumatic event, but there must also be a “risk of employment” associated with the accident. This means that if one is simply injured suddenly in the course of performing one’s duties in Virginia, unless there is something that is a “risk” posed by the employment, i.e. a very heavy weight being lifted, a defective piece of equipment, or a weight suddenly shifting, simply feeling sudden back pain will not rise to the level of a valid injury in Virginia. In North Carolina, with respect only to back injuries, it would, so long as the injured worker can point to a specific moment when the pain started during the performance of work duties.
Often, workers and employers fail to treat back problems which accumulate over time – until the symptoms become very so severe, so acute – that the cause a disabling injury. Some of the causes of back injuries include improper lifting techniques or lifting loads that are just too heavy for the worker’s body.
Often, the single traumatic event is really due to “years of weakening of the musculoskeletal support mechanism by repetitive micro-trauma. Injuries can arise in muscle, ligament, vertebrae, and discs, either singly or in combination.”
Once again, unfortunately, these types of back injuries, if not precipitated or aggravated by a single traumatic event that the injured worker can point to, will not give rise to a valid workers compensation claim.
OSHA states that back injuries from working aren’t known to cause fatalities. They do, however, cause a lot of pain and suffering and lost productivity. Back injuries affect nearly 600,000 employees on a yearly basis at a cot of nearly $50 billion annually. As the average age of employees increases, the cost to treat and pay disabled workers is likely to rise.
Some of the workplace activities that cause deterioration of muscles, discs, joints, and ligaments – which in turn cause back injuries – include:
Some loads are much harder to lift or move than other loads. Generally, any load that is more than 50 pounds should be moved or lifted by using some of the following equipment or strategies:
OSHA states the employers and employees can help each other in the following ways:
“Principal variables in evaluating manual lifting tasks to determine how heavy a load can be lifted are:
Other manual lifting variables include examining space constraints, the size of the load, and the stability of the load.
Once all these variables are known, The National Institute for Occupational Safety and Health (NIOSH) of the US CDC – has a formula for determining whether a lift is safe or not.
OSHA further recommends the following safety tips for manually handling objects to help avoid the risk of bank injuries:
Virginia and North Workers’ Compensation Attorney Joe Miller Esq. understands back pain injuries. He workers with your doctors and independent doctors, when necessary, to diagnose your pain and prepare a full prognosis for your recovery. He’s helped thousands of injured workers get just recoveries. For help with your work injury claim, due to a back injury or for any reasons, call lawyer Joe Miller at 888-667-8295. or fill out my contact form to make an appointment.
Posted on Thursday, August 1st, 2019 at 3:23 pm
For many workers, once it becomes clear that they have reached maximum medical improvement (MMI) (that no further treatments will improve their health), it makes sense to start thinking about their long-term position. Some of the reasons workers consider lump-sum payments are:
The amount you receive will be discounted to reflect the idea that the lump sum can earn interest over the time you normally would have waited to get your payments.
If, as we’ve pointed out before, you are receiving any unemployment compensation pay, you will lose the right to claim those benefits.
The answer depends on your type of injuries. The basic types of injury categories in North Carolina are:
If all these criteria are met, you will be entitled to checks of 2/3rds of your average weekly wage for the remainder of your life.
It is typically not advisable for a worker to settle his or her workers’ compensation claim if the worker has not reached maximum medical improvement. Additional surgeries, treatments, and therapies may improve your condition. They can be quite expensive. You shouldn’t forfeit the right to get as healthy as you can by having the employer and insurance company pay for that treatment. Then again, each and every case is different.
You may feel, for instance, that your skill set will enable you to obtain an alternate job where you can find health insurance which will likely cover future costs, in which case, it may make sense for you to examine settlement.
Once workers have achieved their maximum health, some may not need additional medical care – for example, if they broke a bone and the bone has healed. Many workers, however, will need continuing health care to prevent their condition from getting worse. This is especially critical for workers with occupational diseases which often worsen with time. Workers with chronic injuries or other physical injuries may need constant help. If a worker needs a prosthetic, the prosthetic may wear out with time. The cost of medications must be part of the overall clincher settlement agreement.
There is always some risk in settling your case if you need more medical care. An experienced workers comp attorney can help you make an estimate as to what your future medical bills will be.
In any event, once it is determined that a full and final settlement of your case may be advantageous, your attorney will help calculate your future medical costs related to your injury by first estimating our life expectancy. This can be done by relying on certain statutes in North Carolina that actually provide the average life expectancies for both males and females each year across the State.
One complicated problem is how your Medicare benefits and Social Security benefits are figured since many workers may be eligible for both Medicare and workers’ compensation benefits if they have a lifetime disability or were older when they first applied for work injury benefits. This is typically handled through something called a Medicare Set-Aside Arrangement or MSA. Basically, if you are a current Medicare recipient or if you are on Social Security Disability, you cannot settle your workers compensation claim without taking into account Medicare’s interests.
Also, if you’re going through a divorce, you’ll need to review your marital rights with a family lawyer.
North Carolina Workers’ Compensation Attorney Joe Miller Esq. has been fighting for injured workers in North Carolina and Virginia for more than 30 years. He is highly respected by his legal peers and former clients. He’ll fight to get you every dollar you deserve. He’ll contest any effort by the employer to terminate or reduce your benefits. Call attorney Joe Miller today at 888-667-8295. or use my contact form to schedule an appointment.
Posted on Monday, July 29th, 2019 at 3:22 pm
In our continuing series of answers to frequently asked questions about work injury claims in North Carolina, here are more questions and answers. As with all workers’ compensation cases, the best course of action is to contact an experienced work injury attorney. Each state has different rules. All answers have some exceptions which depend on the facts of your case.
Mediation-also known as “alternative dispute resolution,” is an informal process where the parties to a case attempt to resolve the case, usually via negotiation of a full and final settlement. In North Carolina, the reaching of such an agreement has traditionally been known as a “clincher” agreement.
In North Carolina, about 70% of cases are resolved at a mediation conference which helps to save time and can save costs. If the case can’t be resolved, then the case is heard before a Deputy Commissioner of the Industrial Commission. Normally, your lawyer and the employer’s insurance carrier will choose a mediator from a list approved by the North Carolina Industrial Commission. If the two sides can’t agree on a mediator, then the North Carolina Industrial Commission will appoint one. Each side shares the cost of the mediator. As the NCIC says on its website, the employer’s insurance company will usually have a lawyer, so it’s in your best interest to have a lawyer fighting for you.
The mediation is held at a mutually agreeable location, which may be at either attorney’s office, the mediator’s office, or a third party’s office if all of those are inconvenient. Mediation is a relatively informal process. The mediator, usually an attorney familiar with workers comp, will begin by explaining the process, and what his or her role is.
Each side then gives a presentation, outlining what evidence they will present if the matter proceeds to hearing. The plaintiff does not have to testify and there are usually no witnesses.
Once those presentations are made, the parties usually then separate into two separate rooms and the process of negotiation begins. Depending on the size of the case and the willingness of the parties to resolve the claim, the mediation process can last from a half hour to an entire day. Your attorney may occasionally pull out pieces of evidence or medical records for the other side to review that might “loosen the purse strings” at various stages of the discussion, but other than that, the process is a bit like buying a car. A lot of back and forth on the numbers.
At the end of the negotiation, one of two things will occur. Either the mediator will prepare a mediation agreement, or he or she will declare an impasse. If an impasse is declared, that means the parties were unable to reach an agreement, and the matter will proceed to hearing at an upcoming date.
The Mediation Agreement.
The Mediation agreement is a short summary of what the parties agreed on at the mediation. It is drawn up by the mediator and signed by all parties before anyone leaves the location of the mediation. It is not the final agreement; however, what is advantageous about a mediation agreement is that in North Carolina, it is recognized as a legal document. In other words, should something happen to you, the agreement obligates the defendant to pay your estate as set forth in the agreement. If also puts into place an obligation of the defendants to send a completed clincher agreement for your attorneys’ review within 30 days. This is one of the reasons we like mediation in North Carolina. If the parties can resolve the claim, you leave the proceeding with a tangible, enforceable, legal document, not just a “promise.”
A clincher agreement is an overall settlement of a worker’s claims – past, present, and future. Once a clincher agreement is completed and signed, there’s no do-over. It is the document that the defense lawyer will send to your attorney if the mediation or other negotiation reached a successful conclusion.
The fundamental basics of a clincher agreement are:
The NICI will review the agreement to make sure it complies with Rule 502 which provides that approval requires that:
If the employee hasn’t returned to a job at the same or greater wage (as prior to the workplace accident or occupational illness), the clincher agreement should state whether the employee “has, or has not, returned to some other job or position, and, if so, the description of the particular job or position, the name of the employer and the average weekly wage earned.”
The clincher agreement should then also “summarize the employee’s age, educational level, past vocational training, past work experience, and any impairment, emotional, mental or physical, which predates the current injury or occupational disease. The parties will be relieved of this duty only upon a showing that providing such information creates an unreasonable burden upon them.”
“This subsection (the part about returning a job or new position) of the Rule shall not apply where the employee is represented by counsel or, even if the employee is not represented by counsel, where the employee certifies that partial wage loss due to an injury or occupational disease is not being claimed.”
The proposed clincher agreement is typically drafted by the defense attorney in North Carolina, and emailed to your lawyer.
A skilled North Carolina work injury lawyer will explain all of the items set forth in the clincher agreement and also make sure that certain language is included to protect you—for instance, if you wish to file for Social Security Disability, certain language must be in the clincher agreement or you could be prevented from obtaining your SSDI benefits for a very long time.
Once your attorney says it’s ok, he will review the agreement with you and have you sign it. After that, the signed agreement is returned to the defense attorney for filing with the NCIC, along with your attorney fee agreement with your lawyer.
If the clincher/settlement agreement is approved by the NCIC, they will issue and typically fax to both parties a settlement Order, setting forth the amount agreed upon and the attorneys’ fees.
After that, the worker’s comp carrier has up to 47 days to mail out your settlement check to you. A separate check is made out for your portion and the portion representing attorneys’ fees.
Attorney Joe Miller understands that you may be anxious to settle all your claims at once. He’ll guide through the settlement/clincher process if you have reached your maximum medical improvement. He’ll review your past and future medical expenses and your past and future wage loss issues. For help filing and resolving your workers’ compensation case, call attorney Joe Miller at 1-(888) 667-8295 or use my contact form to schedule an appointment.