Worker’s Compensation and Winter Safety

Posted on Thursday, January 17th, 2019 at 4:45 pm    

Rear view of man holding shovel over his shoulder and preparing for shoveling snow.

North Carolina already had one significant snowfall during December of 2018 and early in 2018, southeast Virginia was struck by a crippling blizzard. Ice, snow, and cold weather can make it extremely difficult to work – especially for construction workers and anyone who works outside. Anyone who walks outside may slip and fall on the ice. Well-known dangers, although rare in our neck of the woods,  include hypothermia and frostbite.

Some examples of outdoor work include:

  • Construction work
  • Snow cleanup crews
  • Police officers
  • Firefighters
  • Sanitation workers
  • Emergency medical technicians
  • Highway maintenance crews
  • Landscapers
  • HVAC Technicians
  • Utility Workers
  • Refuse and Recyclable Collectors
  • Surveyors

Cold weather can be relative. Some climates are known for their cold weather and people there understand what steps are needed to protect roads, pipes from bursting due to freezing, and most of all people. Other climates including southern climates often don’t understand how to respond to cold weather and the city crews with their meager supplies and equipment are quickly overwhelmed when extreme winter weather takes over. It is not their fault; it is simply such a rarity that it is not worth the expenditure to purchase the extra equipment.

The OSHA Cold Stress Guide

As with all worker’s compensation claims, there is no requirement to prove fault. If an accident at work causes the employee to be injured, the employee has a right to demand wage loss benefits and payment for the medical costs to get healthy again. The employer is generally liable even if it did everything it could to prevent the accident.

Employers and employees should both understand the risks of working in cold weather and to how to minimize those risks. The Occupational Safety and Health Administration does have some guidelines on what employers can do to help any worker who works outside in extreme cold or a combination of cold and wet weather.

Still, employers are required to comply with “hazard-specific safety and health standards.” Employers must also “provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm.” Employers should also use standards that are commonplace in their industry.

Risk factors for cold stress

Cold weather includes more than just looking at the temperature. It also requires looking at how wind chill makes it feel colder.

In addition to wind, the following factors can make cold weather more difficult to manage, according to OSHA:

  • Wet and damp weather
  • Employee fatigue
  • Not being properly dressed for winter. Workers should wear layered clothing and have protection for their hands, fingers, feet, toes and face.
  • Workers who are in poor health or who have certain risk factors such as diabetes, hypertension, and hypothyroidism should stay inside.

Cold weather places stress on the body by shifting blood flow, over time, away from the extremities to the body’s internal organs, the chest, and the abdomen. This shift plus any exposure of the extremities increases the body’s risk for hypothermia, frostbite, and trench foot.

What is hypothermia?

Hypothermia is a dangerous condition which happens “when body heat is lost faster than it can be replaced.” Another factor is that the body’s temperature drops to below 95 degrees F instead of its normal temperature of 98.6 degrees F. Hypothermia normally occurs at very cold temperatures. It can, however, happen even at temperatures above 40 degrees F if other elements exist. These elements include exposure to rain, sweating, or being submersed in cold water such as falling into a lake or pond.

Hypothermia symptoms. Mild symptoms include shivering and stomping one’s feet to try to get the blood circulating. More serious conditions include a falling body temperature. The worker will stop shivering and may become confused and disoriented. He/she may show signs of losing coordination. Workers may not be able to stand. Their pupils become dilated. Their pulse and breathing slow. Workers with hypothermia may lose consciousness. In tragic cases, they may if they don’t get immediate help.

Treatment for hypothermia. Any worker, supervisor, or helper should call 911 or seek immediate medical help. Some of the many common steps OSHA recommends include:

  • Moving the worker to a dry, warm location
  • Taking off any wet clothes and putting on dry clothes.
  • Covering the whole body including the head and neck with blankets – and with “a vapor barrier.” The face should not be covered.
  • If medical help is over 30 minutes away, the worker should
    • Be given warm sweet drinks (but no alcoholic drinks) which can help raise the worker’s body temperature. If the person isn’t conscious, then he/she should not be given a drink.
    • Placing “warm bottles or hot packs in the armpits, the sides of the chest, and the groin. Call 911 for additional rewarming instructions.

If the worker isn’t breathing or doesn’t have a pulse, a call to 911 for emergency help should be made immediately. Additionally, OSHA recommends:

  • That the general instructions above, other than being given fluids, should be followed
  • The worker should be checked again for signs of breathing and for a pulse. The check should be for 60 seconds.
  • A 911 operator or emergency medical service worker should start chest compressions – or direct someone at the site on how to perform chest compressions. OSHA’s cold weather guidelines provide that “Chest compressions are recommended only if the patient will not receive medical care within 3 hours.”

 

The dangers of frostbite?

Frostbite occurs when the skin freezes and the tissue beneath the skin is affected. The lower the temperature, the greater the risk of frostbite. The hands and face are normally the parts of the body affected. In severe cases, amputation may be required.

Frostbite symptoms include red skin with gray and white patches. There’s numbness in the body part affected. There can be a feeling of hardness in the hand, foot, or body part. In severe cases, there may be blisters.

Treatment for frostbite. Generally, the treatments for hypothermia should also be used to treat frostbite. Additional treatment considerations include:

  • Do loosely cover the affected body part and try to protect that part.
  • Do give the worker warm sweetened drinks – if they are alert but not if they are unconscious. Don’t give the worker any alcohol.
  • Don’t do the following:
    • Don’t rub the frostbitten party of the body. This can cause more harm.
    • Don’t apply water or snow.
    • Don’t break the blisters
    • Don’t try to rewarm the frostbitten area yourself such as by placing the hand or foot in warm water. This can cause tissue damage. Instead, be sure to get medical help. Medical professionals should understand the right way to warm the affected part.

Attorney Joe Miller Esq. fights for injured workers in North Carolina and Virginia. He’s been helping workers get just recoveries for 30 years. Attorney Miller works with your doctors and independent doctors to fully understand your medical needs. To make an appointment, call 1-(888) 667-8295 or fill out my contact form.

Don’t Get A Side Job While Receiving Comp Checks!

Posted on Wednesday, January 9th, 2019 at 5:01 pm    

In this video, Attorney Joe Miller explains why you should NEVER obtain a side job or other “under the table” job while receiving workers’ compensation benefits:

Frequently Asked Questions – Part Three

Posted on Wednesday, January 9th, 2019 at 4:56 pm    

Here’s our third series in common questions and answers about North Carolina and Virginia worker’s compensation.

What is a Nurse Case Manager? (NCM)

Employers have the right to appoint a nurse case manager to help injured and ill workers with their medical needs. Employers will say that the nurse case manager is just trying to help the worker get healthy. That’s not always the case, in fact it is mostly not the case. While a nurse case manager can help coordinate your appointments and help get workers to their treatment or therapy sessions; nurse case manager’s main goal is to show that you are ready to return to work. They are agents of the insurance company and one of the defense professionals usually hired to do the insurance company’s dirty work.

What is that “dirty work.” The insurance company’s interest is to get you back to work as soon as possible. In Virginia, if you are not yet under an Award, and you get released to light duty— that means ANY light duty—even with a one lbs lifting restriction—then the insurance company does not have to pay you a penny, even if your employer does not accommodate your restrictions.

Employees should review with their worker’s compensation lawyer exactly what the nurse case manager can and cannot do. Nurse case managers do have the right to know about your appointments. They do have the right to go the doctor’s office or therapy office. They do have the right to obtain bills and reports from the health provider’s office. They do have the right to discuss your medical condition (including the diagnosis, necessary treatments, and prognosis) with the health professional. They can help you get transportation to the medical office.

They don’t have the right to be in the examination room with you the entire time, if you do not want them in there.  At least some portion of your examination with your doctor should be private so you’re comfortable explaining exactly why you’re hurting. Your doctor should know you can’t lift objects or that it hurts when you move. You also have the right to be present when the nurse case manager discusses your case with the physician. The nurse case manager and the doctor are supposed to be there to help you – not bow to the insurance company’s desires. They do not have the right to “manage” your medical care by deciding where or with whom you will treat. Those decisions belong to the authorized treating physician.

For the most part, the nurse case manager’s access to your physician will be dependent on how open your physician is to dealing with the nurse case manager. Some are more open to allowing the NCM into the examination room, while others are less open to it. Our interpretation of the law is that their only obligation is to provide the records to the NCM. Beyond that, your physician is under no legal obligation to talk to the NCM. The issue is that many physicians realize that if they completely “shut out” the NCM, it is less likely that the physician is going to get any further referrals from the insurance company. In other words, it’s bad for business. Most patient advocate type physicians will walk a fine line of communicating with the NCM, but maintaining their own independent medical judgement, despite the pleas of the NCM to return you to work before you are ready.

What is an independent medical examination?

Sometimes, the employer or your own lawyer will request an independent medical examination (IME). An IME is a physical and oral examination of your current health condition. It is performed by a physician who is not one of your treating doctors. In North Carolina, you are entitled to an IME with a physician of your choice respect to your permanent impairment rating if you do not like your treating physician’s opinion in that regard, at the defendant’s expense. In North Carolina, you are also entitled to an IME at the defendant’s expense for general issues as well; however, there must either be an agreement by both sides as to who will perform the general IME, or the Industrial Commission will have to order who will perform the IME via a motion filed by the attorney.

In Virginia, you have no right to obtain an IME at the defendant’s expense; however, you are entitled to see any doctor you like at any time at your own expense. In North Carolina, it is not advisable to do this, as the IC will generally ignore unauthorized examinations and opinions.

On the other side, the employer’s insurance company also has the right to request an IME at any time in both Virginia and North Carolina. The defense may request an IME to try to show you are ready to go back to work, or when there is a question as to whether a procedure or surgery recommended by your physician is medically necessary. The doctor is hired by the employer’s insurance company which means he/she is not your friend. The employer physician normally only sees you one time at the IME. He or she will take an oral history and then conduct the physical exam.

You and your lawyer have the right to challenge any report the IME doctor makes that suggests you can return to work or that you can go back to work with some restrictions. Your lawyer will normally seek to have one of your own doctors review the IME doctor’s report – and explain where the report is not accurate.  Your treating doctors can show what the IME doctor misses because he/she only sees you one time and why any conclusions about your ability to work are not true.

Should I seek vocational rehabilitation?

Some workers can’t return to the type of job they did before their accident. For example, construction workers who needed to be able to lift 50-100 pounds or more to do their job may now not be able to lift much more than a few pounds.  Going back to work with restrictions may not be an option – either because there are no suitable restrictions (you just can’t do physical labor any more) or because the employer doesn’t have a job that matches your abilities.

Since you can’t do the job you’ve been trained for, you may be eligible to be retrained to do a new type of job. The new job is often more clerical and administrative if you were a physical laborer. Your North Carolina or Virginia work injury lawyer should then explain that you may be eligible to go back to school or to attend a training program so that you can be qualified to do more work.

That being said, the process of vocational rehabilitation, unless it is a simple payment for school tuition (rarely the case), is generally not what it sounds like. In our experience, it is generally an unpleasant and difficult process designed to strip you of your benefits. It is generally not designed to find you suitable employment but trip you up and find you out of compliance and hence no longer entitled to your workers comp benefits.  

While engaged in vocational rehabilitation, you still have the right to be paid your compensation checks (generally 2/3rds of your average weekly wages) and treat with you doctors. The insurance company is supposed to pay for your tuition or course costs, your books and training materials in connection with any vocational rehabilitation, but in our experience, they will typically take the cheapest road and enroll you in free courses if any re-training is required. If you need help getting to the course programs or school, vocational rehabilitation is supposed to either help or reimburse you for your transportation costs as well.

What does a vocational professional do?

This is someone who is trained to say what type of work a person can and can’t do based on the worker’s education, past job experience, current skills, and current physical and emotional abilities. Employers sometimes employ a vocational professional to say that – while you can’t do your current job – you should be able to find suitable work in the area where you live. These professionals usually review Department of Labor standards and other guidelines to help make their determination.

They will typically start with an initial session which goes through your entire work history to determine your current transferrable skills. They will also review any FCE’s and your doctor’s records to determine your current work restrictions. After that, the vocational rehab professional will often meet with you on a weekly basis to provide job leads for you to apply to. These job leads are supposed to be pre-screened, meaning they job must be within your physical restrictions, within your skills, and also at least some significant portion of your pre-injury wages. In other words, if you were earning $1500.00 per week pre-injury, having you apply for a minimum wage job would not be suitable employment.

Experienced work injury lawyers understand how to question vocational professionals. They also understand that most of the time, their job is not to find you suitable employment, but to trip you up so that you are stripped of your workers compensation benefits. They work to make sure the vocational rehabilitation counselor follows the rules and guidelines which govern what they can and cannot do.  In some cases, they may consult with another vocational professional who has a different opinion about the work you can and cannot do.

Attorney Joe Miller Esq. has been a strong advocate for injured and ill workers for more than 30 years. He’s helped thousands of North Carolina and Virginia employees get just recoveries when they’re hurt on the job or suffer an occupational illness. To speak with a lawyer who fights for injured workers, please call 1-(888) 667-8295 or fill out my contact form.

Additional Frequently Asked Questions regarding North Carolina or Virginia Workers Compensation Benefits

Posted on Friday, January 4th, 2019 at 12:41 pm    

Some more answers to commonly asked questions when workers are injured in North Carolina or Virginia include the following:

How long can I receive worker’s compensation benefits?

The maximum insofar as the weekly checks are concerned is generally up to 500 weeks, but other than the most severely injured workers, most will stop receiving benefits long before the end of the 500 weeks.

When a worker reaches maximum medical improvement, then an analysis is made of the worker’s physical health. Maximum medical improvement is the time when additional medical treatment isn’t expected to improve the worker’s health or physical capacities any further.

During the analysis, referred to as a Functional Capacity Exam (FCE) a judgment will be made whether the worker has a permanent disability of any kind such as hearing loss or the loss of a body part and whether the worker is suffering from permanent physical restrictions.  If a worker has a partial permanent disability, the worker may be entitled to additional wage loss benefits, even if he or she is able to return to work.

Workers can receive medical benefits for as long as they need medical help. Even if they have reached maximum medical improvement, they can still treat with doctors so their health doesn’t get any worse. Many injured workers who hurt their back, for example, may benefit from continual physical therapy or pain management.

Do other claims/benefits affect my worker’s compensation benefits?

Workers may be entitled to a pension, to social security, or to a personal injury accident settlement or award.  If you are undergoing ongoing treatment and disability, you should NEVER settle your personal injury case before your workers compensation claim is fully settled and resolved. Doing so will essentially end your workers compensation case because of very harsh setoff rules.

Insofar as Social Security Disability, there are sometimes when it is advisable to make a claim, such as when your comp claim is denied and it may take a long time to get you money. In either event, a workers compensation attorney who knows what he or she is doing can make sure you’re your settlement will only minimally effect your rights to file and still obtain Social Security Disability benefits.  Your North Carolina or Virginia worker’s compensation benefits lawyer can explain if any of these benefits affect your worker’s compensation case.

Are worker’s compensation benefits taxable?

Generally, worker’s compensation benefits are not taxable. If you receive Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) or Social Security Disability (SSDI) and worker’s compensation, then some tax issues may arise depending on the amount of the combined income.

What happens if the accident happened away from the employer’s main site?

The main requirement is that the accident occur during the scope of your employment. This can be complicated sometimes. If you are commuting to work, you may not be eligible unless you were doing a work chore for the employer or you are picked up by a supervisor and transported to the job site.  If you are a sales representative, then it’s pretty much a given that you won’t be at the company site during work hours and you would still be covered. You are generally covered if you are on the employer’s premises, even if you take a brief break from work and your employer agrees to such breaks. There are many just reasons for a worker to be away from the main job site and still be considered working on the job, such as being sent on an errand for the employer.

What is an impairment or permanency rating?

This is an analysis of the worker’s loss of ability to function. It can apply to any part of the worker’s body. Doctors generally use impairment guidelines created by the American Medical Association to determine the percentage (impairment rating) loss of function. Workers with a permanent disability are generally entitled to additional work loss benefits if they lose function. The impairment rating adjusts the entitled amount by the percentage loss. For example, if a work loses the ability to hear, then the worker is entitled to an additional number of weeks benefits. If the impairment rating (the loss of hearing) is 10%, then the benefit amount may be just 10% of the total additional weeks of pay, as set forth in the statute books.

What are the different types of disability?

Generally, work injury disability falls in the following categories:

  • Temporary total disability.  (TTD) These benefits are paid while the worker is injured and unable to return to work, and receiving medical treatment to get better for a maximum of 500 weeks. Workers are normally paid 2/3rds of the average weekly wages while out of work, or sometimes even on light duty, if the employer is unable or unwilling to accommodate the employee’s light duty restrictions.  
  • Temporary partial disability (TPD) These benefits are paid when the worker’s physical restrictions prevent him or her from returning to pre-injury employment, but the worker or the vocational rehabilitation counselor finds the worker a lesser-paying job that accommodates the worker’s restrictions. In those cases, the worker is entitled to 2/3rds of the difference between the light duty job pay and the pre-injury job pay.
  • Permanent & total disability. These are additional weekly benefits payable at the 2/3rds rate beyond the 500-week limit, to potentially lifetime TTD benefits, if a worker can never return to any type of work because of his or her work injuries Workers may be entitled to lifetime payments based on the type of disability they have – if they have an special loss or disfigurement of two or more ratable body parts, a serious brain injury, are paralyzed, or have suffered extremely severe burns. In Virginia, one must suffer an injury in one of those categories to be considered permanently and totally disabled. In North Carolina, those categories also qualify for permanent and total benefits.
  • North Carolina “Extended Compensation.” In North Carolina (not in Virginia) there is an additional category known as “extended compensation.”  An injured worker may qualify for extended benefits beyond the 500-week limit, and proof may be offered to receive such benefits once the worker has reached 425 weeks of TTD benefits.  At that point, a motion may be made for the worker to be declared entitled to extended benefits beyond the 500-week limit, but the worker must show that he or she has suffered a total loss of wage-earning capacity. The big difference with extended benefits vs permanent and total benefits is that any serious injury may qualify—it does not have to belong to one of the permanent and total categories; however, the ongoing extended compensation may be challenged by the insurance company at any time, if the insurance company and employer can show that the employee no longer has a total loss of wage earning capacity.
  • Permanent partial disability or impairment. (PPI) These are the ratings benefits that a worker may be entitled to, based on injury to a ratable body part. In Virginia, this generally refers to the extremities, but does not include injuries to the spine. In North Carolina, these DO include injuries to the spine and the extremities as well. The physician typically rates an injury through the use of a Functional Capacity Exam (FCE) and comes up with a percentage rating of impairment. Then one looks at the statute to determine how many weeks of TTD payments the worker is entitled to based on that percentage rating. Generally, ratings are only important in two instances. One is where the worker has returned to work. This is because in any event, the maximum once can receive is usually 500 weeks. The 500 weeks cannot be increased through the use of ratings.

The other circumstance where ratings are important is if a worker has a rating to two or more ratable body parts. That could qualify the injured worker for permanent and total disability.  

Do I need a workers’ compensation attorney?

Yes. While employees can file their own claim, there are many reasons why it’s wise to hire an experienced North Carolina or Virginia work injury lawyer. Skilled work injury lawyers help with following:

  • They make sure you process your claim correctly
  • They understand how to verify your employee status if it is challenged by the employer
  • They work to show the accident or illness was work-related
  • Skilled lawyers help you get better assistance from your doctors when company doctors aren’t helping
  • They present your case before a hearing office if it is contested
  • They work with your physicians to verify your inability to work and why you still need medical care
  • They contest efforts by the employer or employer insurance company to force you to return to work when it is not medically feasible
  • They explain what a nurse case manager does and what the manger can’t do and prevent them from managing your care against the advice of your treating physicians
  • They help verify what type of disability you have and make sure you are paid accordingly
  • They work with vocational professionals when necessary to make sure they are doing their job in accordance with guidelines established by the Workers Compensation Commission.

Experienced attorneys guide you through each stage of the litigation process. They also explain when you can make a long-term settlement and what the terms of that settlement should be.

Experienced work injury lawyers understand how to question and cross-examine witnesses.

In most cases, a skilled worker’s compensation helps the client get a just recovery – one that is much better and stronger than the recovery the client would obtain on his or her own.

What is discovery?

The injured worker and the employer both have the right to certain types of information in order to prepare their case for trial. The lawyers for each side can request:

  • That the other side answer written questions called interrogatories.
  • That the parties answer oral questions called depositions. These questions and answers usually take place before a Court Reporter or stenographer who transcribes the oral Q and A into a written document.
  • That each side produce certain types of records such as wage-earning records and medical bills and reports through something called requests for production
  • To Subpoena certain documents if necessary from health care providers or other third parties whose information is needed to proceed with the claim.

Attorney Joe Miller Esq. has the experienced and resources to help injured workers get justice. He anticipates many of the arguments insurance adjustors and defense lawyers make. He’ll fight to help you get the wage loss benefits, medical bill payments, and other benefits you deserve. To make an appointment or have your claim evaluated in our 7-step elite and easy case evaluation process, please call 1-(888) 667-8295 or fill out my contact form.

Common Questions about Worker’s Compensation

Posted on Wednesday, December 26th, 2018 at 9:21 am    

Injured workers have many questions about whether they can file a claim, how to file a claim, and what benefits they’re entitled to. Claimants worry about which doctors they can treat with. They wonder what actions the employer’s insurance company can take to force the worker back to work or to terminate his/her benefits.

For the best advice, make an appointment with an experienced North Carolina or Virginia work injury lawyer. Here are some of the many questions workers often ask and some of the answers to those questions:

What exactly is worker’s compensation insurance?

Decades ago, the states agreed to a compromise in how work accident claims are handled. Injured workers used to have to prove the employer was at fault – that they caused the worker’s injuries. If a worker could prove fault, the worker would be entitled to lost wages, medical bills, and pain and suffering damages.

The compromise method helps workers get compensation quicker and helps employers avoid large jury awards. The compromise is that workers don’t have to prove the accident was the employer’s fault. They just have to show an accident happened at work. In return for waiving the liability duty, employees only get about 2/3rds of their wages instead of 100%. They also can’t make a claim for pain and suffering against the employer. Workers are entitled to have the costs for all their medical bills covered as a result of the accident—for life. This includes surgeries, doctor visits, long-term therapy, and other types of medical services. It also includes the cost of medications and any prescribed medical equipment. Workers may also be entitled to vocational retraining benefits if they can’t work at their prior job.

Are there time limits for notifying the employer?

Generally, workers should notify their employer or a supervisor as soon as possible – verbally and in writing. In North Carolina and Virginia, workers are required to provide written notice within 30 days of the accident. This is usually done in the form of an Accident report.

Is there a time limit for filing a claim?

Yes. North Carolina and Virginia both have a statute of limitations for when claims can be filed. You generally have two years to file your claim from the date of the accident. DO NOT BELIEVE your employer if they say they have “filed everything for you.” There is NO SUCH THING. Only YOU or your workers compensation attorney can file the appropriate paperwork to insure your rights are protected.  If you were hurt at work, you should make the call to a work injury lawyer as soon as possible.

When does a worker become eligible for state worker’s compensation benefits?

Workers aren’t entitled to compensation for the first seven (days) unless their disability is more than 21 days. If the worker is out of work for less than three weeks, then the worker isn’t entitled to lost wages for those first seven days.

Who is entitled to worker’s compensation?

As a general rule, the worker must be an employee – not an independent contractor. Some exceptions may apply. Often, an experienced work injury lawyer will fight to show that someone who the employer labeled as an independent contractor is really an employee. Whether someone is an employee or independent contractor basically depends on how much control the employer had over their worker’s job duties. Signs of control include saying when and where the worker must work, how the worker is paid, what tools the worker uses, and other factors. Some employers think they can get around this by having the employee sign some silly agreement that says the worker understands that he or she is an independent contractor and not an employee. Those agreements are WORTHLESS. The Commission will look at the facts on the ground. The employer cannot “contract away” their obligations under the law.

What are the standard wage loss benefits?

In general, workers are entitled to 2/3rds of their average weekly wages as long as he or she can demonstrate disability from work. The average weekly wage is determined by the worker’s salary in the 52 weeks prior to the time of the accident. Workers are entitled to the 2/3rds benefits up to the time they return to work. They may also be entitled to additional wage loss benefits if they have a permanent partial disability to a ratable body part.  North Carolina and Virginia both generally limit the maximum number of weeks obtainable in comp payments to 500 weeks. The exception is if one can show permanent and total disability or in North Carolina, an entitlement to extended compensation. Then one could be entitled to lifetime compensation benefits.

Does it cost money to hire a worker’s compensation lawyer?

No. Worker’s compensation lawyers, if they decide to take your case, are paid their attorney’s fees on a continency fee basis. This means they are paid only if your claim is successful. On successful claims, they are paid a percentage of the worker’s compensation award. If the case is not successful, then you don’t owe the lawyer for his/her time. Occasionally, on successful claims, there may be applications for small fees that come out of ongoing checks even before settlement, but these are small amounts of money, usually in the hundreds of dollars.

Are employers required to carry work injury insurance?

Most North Carolina and Virginia employers are required to have worker’s compensation for their workers. Alternatively, they may be allowed to self-insure – to pay any award from the company funds if they meet certain requirements. In order to be required to have comp insurance, there must be a minimum of three employees routinely engaged and required to perform the employer’s business.

Which doctors can I see?

Typically, injured workers in Virginia will be given a list or panel of 3 doctors to choose from– from their employer’s panel of doctors. This applies to general physicians, pain management doctors, orthopedists, and many other types of doctors. In North Carolina, the law is more strict. An employer and insurance carrier get to choose who the authorized doctor will be.

In Virginia, if a worker is dissatisfied with the workers compensation doctor, one can always see whomever they wish and pay out-of-pocket; however, only authorized treating physicians are required to be paid by the workers compensation insurance carrier. In North Carolina, it is not advisable to seek one’s own doctor unless the Industrial Commission approves that choice. Unapproved doctors in North Carolina are generally ignored by the Commission and will not help your case.  

An experienced North Carolina and Virginia lawyer will explain when you can switch doctors. He’ll work to get approval from the NC Industrial Commission or Virginia Workers Compensation Commission.

Can I get workers’ compensation if the accident was your fault?

Generally, yes but there are exceptions.  As long as the injury wasn’t deliberate such as if you started a fight, and as long as you did not willfully violate a safety rule or you were not willfully intoxicated,  workers are entitled to work injury benefits even if they were careless or sloppy.

In North Carolina, violation of a safety rule merely works to diminish recovery of benefits by 10%, whereas in Virginia it can operate to completely prevent a claim.

Workers often trip over objects, slip and fall, drop merchandise, or make other mistakes that can hurt themselves. Worker’s compensation will still pay benefits for this type of accident.

 

At the Virginia Law and North Carolina Firm of Joe Miller Law, we’ve helped thousands of injured workers get just recoveries. We’ve been helping injured workers for more than 30 years. To speak with a tough advocate, please call 1-(888) 667-8295 or complete my contact form to schedule an appointment.

Common Workers Compensation Definitions and Acronyms (I-W)

Posted on Monday, December 10th, 2018 at 9:27 am    

This is the second part of a summary of common medical acronyms and terms. These definitions apply to many aspects of an employee’s workers compensation case:

  • IME. Independent medical examination. This is an evaluation performed by a non-treating doctor. It is usually requested by the employer to evaluate whether a worker is ready to return to work. Often, the IME doctor is hired by the employer and works to show the employee is ready to return to work, or that a treatment recommended by your authorized treating doctor is not medically necessary. It is essential that an injured worker prepare for the IME exam beforehand with an experienced North Carolina or Virginia work injury lawyer. The attorney can explain what takes place at the exam and what the employee is required to tell the IME doctor. The lawyer will usually contest the IME doctor’s report through the worker’s own treating physicians. In North Carolina, An IME can also be requested by an employee to show the current doctors aren’t helping the worker – and that the worker should have the right to switch to a new physician.  
  • Indemnity benefits. These are generally the non-medical payments – including temporary total disability pay, permanent partial disability benefits, permanent total disability benefits and death benefits.
  • IR. Impairment rating. Also known as PPI or permanent impairment rating. Workers are entitled to treat with physicians, therapists, and other health providers as long as they are helping the worker get better. At a certain point, most workers reach the level of maximum medical improvement. This is the point where additional medical care won’t help improve the employee’s medical condition. At this point, the worker will be examined by the treating physician to analyze if he/she has a permanent disability. The seriousness/level of the disability is then given a percentage impairment rating.
  • For example, the doctor may say the ability to hear is only 40% of what it was prior to the accident or the impairment rating of the ability to use a left leg is 30% of what it once was. In Virginia, for instance, a 30% impairment rating of the leg would equate to 52.5 weeks of comp checks. So, if the worker had a weekly comp rate of $500.00, that would be $26,250.00.
  • But it should be noted that no matter how high the rating is, sometimes the impairment rating is really not significant in terms of the value of the claim. For instance, if the worker is unable to return to his or her job due to his injuries, and he or she is still receiving comp payments each week, then he or she can in any event usually only receive a maximum of 500 weeks of benefits. The additional weeks provided by an impairment rating are not allowed to increase the 500 weeks. In addition, under Virginia Law, one cannot receive temporary total disability (TTD or comp payment) benefits at the same time as permanent impairment benefits.
  • So, in our example of the 30% leg rating of a person who remained out of work, could not return, and was still receiving his TTD benefits, the 30% rating would not matter, because we’d really be looking at the 500 weeks and that’s it. On the other hand, if the worker had returned to either full duty or a job paying the same as the pre-injury wage, or even a lesser-paying job, then the he or she would be entitled to receive the impairment rating.
  • The other reason an impairment rating can be important is if the injured worker has received a rating to two or more ratable body parts. If that is the case, and the ratings interfere with the worker’s ability to work, then it is possible that a permanent and total finding may be made by the Commission, which could entitle the employee to lifetime benefits, not just the 500-week benefits. For instance,
  • LE. Life expectancy. This is the number of years the worker is expected to live based on his/her age, gender, and physical condition. It is used when lump sum payments are being considered. Essentially, a worker’s yearly wage loss and yearly medical bills are multiplied by his/her life expectancy to get the cost of future benefits. These numbers are set by statute in both Virginia in North Carolina.
  • MMI. Maximum medical improvement. This determination is made by a physician. It essentially is the time when additional medical treatment won’t help the patient get any better. When a worker reaches MMI, the impairment ratings of any permanent impairments are typically analyzed and oftentimes, the treating physician may order a functional capacity exam (FCE) to determine the worker’s permanent physical restrictions. MMI does not end medical benefits. Injured or ill workers may still need regular checkups, treatments and therapies so a condition doesn’t worsen, and medical devices and prescriptions. The employer’s insurance carrier should pay for these long-term medical costs.
  • MSA. Medicare Set-Aside Agreement. MSAs are usually considered when a worker wants to enter into a lump-sum settlement and is a currently-qualified Medicare recipient. In the workers compensation context, these are usually folks who have been determined to be disabled by Social Security for more than 24 months. Those people automatically qualify for Medicare coverage after the 24 months elapses. The gist of the concept of an MSA is that the worker may not “double-dip”. One cannot receive a sum of money for future medical care from the carrier in settlement and then turn around and utilize their Medicare to cover the same injuries. The worker is required to protect Medicare’s interests. The employer’s insurance company will generally obtain a Medicare-Set Aside Report. That report is then sent off to CMS, the review office for Medicare, and they will either approve the suggested set-aside amount, or suggest a different amount. The MSA essentially sets aside the sums that the settlement will use for medical bills so the Medicare isn’t required to pay those expenses. The MSA is usually funded by an annuity purchased by the workers comp carrier, which annuity will pay out a seed amount in the first year and then a set amount each year thereafter for the worker’s life expectancy to cover the injury-related medical expenses that Medicare would normally cover.
  • NCM. Nurse Case Manager These people work for the insurance company. On the surface, they are trying to help workers schedule their medical appointments and get to their appointments on time. On the surface, they are available to answer questions workers have about their medical care and prescriptions. The reality is that they are working to get you back to work as soon as possible. They often look for workers to miss appointments or fail to take medical advance – and then help their employer try to terminate your benefits. Workers should review with skilled work injury lawyers exactly what case managers can and can’t do. For example, while CMs can help you get to your appointment, they do not have the right to be in the room when you are being treated by a physician.

 

 

 

    • PTD: Permanent and total disability. Some workers can never return to work. Workers who lose both eyes, hands, arms, legs, or feet (or a combination of two) can claim permanent total disability benefits. Also severely brain-injured workers and workers with severe burns may qualify for permanent and total disability. These benefits cannot be claimed until the worker approaches the end of his or her 500 weeks. Then the Commission makes the assessment as to whether or not the work injury qualifies for permanent and total to go beyond the 500 weeks into lifetime benefits.  In North Carolina, in addition to the categories of injuries mentioned above, after an injured worker reaches 425 weeks of TTD benefits, he or she may make an application for extended benefits beyond the 500 weeks by showing a “total loss of wage earning capacity” due to his or her work injuries. That being said, once the worker on extended TTD starts receiving Social Security Retirement benefits, there is a “set off” of 100% of the retirement benefits.
    • PT. Physical therapy. Workers often need many different types of therapy so they can get better. Physical therapy focuses on helping the patient with physical injuries such as a sore back or rotator cuff injury to the shoulder. Other types of therapy include occupational therapy, speech therapy, and vocational therapy.
    • RSI. Repetitive stress injury. This is an injury that develops over months or years due to constant repeat pressure or motions. Carpal tunnel syndrome is a well-known RSI. It may be possible to claim worker’s compensation for an RSI though the employer will argue that it wasn’t due to an accident and isn’t an occupational illness. That being said, most other forms of repetitive stress injuries are not compensable under workers compensation law. A skilled work injury can explain when and how a claim for an RSI injury can be made.
    • SOL. Statute of limitations. All work injury claims must be brought within specific time periods or the claim will be forever barred. It’s important to see an experienced worker’s compensation lawyer as soon as possible so you meet this crucial deadline. Typically, one must file a claim within two years of the accident or one is forever barred from recovery.
    • TPD: Temporary partial disability. This term applies to workers who can return to some sort of modified or light duty work, but for less money than their pre-injury wage. The amount received is 2/3rds of the difference of their pre-injury and post-injury, light duty wage, for up to 500 weeks.

 

  • TTD. Temporary total disability. This is the term applied to the typical “workers comp check” benefit received by the injured worker each week. This term applies to an employee who can’t return to work at any level based on their doctor’s note, and it is typically 2/3rd’s of the injured worker’s average weekly wage, for up to 500 weeks.

 

    • Vocational benefits. Some workers may not be able to return to work at any job – but may be able to obtain new work if they are retrained. Vocational benefits pay for the cost of retraining this type of injured worker. Vocational benefits can include tuition, books, the cost to get to the training, and other related expenses.

 

  • Vocational Rehabilitation Counselor or VRC. This professional is knowledgeable about what work is available for specific skills in the region where the worker lives. The expert evaluates if work is available and what type of training is needed to that type of work. The vocational expert also reviews if the worker is capable of being retrained. Be forewarned that these experts are on the dole of the workers compensation insurance company. Their goal is often not to find you a job, but to make you “jump through hoops” in order to trip you up so that your benefits can be cut off. Going through vocational rehabilitation is usually a very annoying and frustrating experience. Sometimes, it is used to put pressure on the injured worker to settle their claim for a lesser amount. We usually advise our clients to simply endure the “game,” and play it, until we can get their case in a good position for settlement.

 

  • Workers’ compensation rate. This is the amount the worker is actually paid if the claim is approved. The starting point is 2/3 of the worker’s average weekly wage or .66667 of the pre-injury average weekly wage.

Don’t wait. Call the North Carolina and Virginia Law office of Joe Miller Esq., today. We have the experience and resources to help you get justice. You may have a large recovery coming your way. help now, phone 1-(888) 667-8295 or complete my contact form to discuss you work injury claim.

Common Workers Compensation Definitions and Acronyms (A-F)

Posted on Friday, November 30th, 2018 at 11:21 am    

North Carolina and Virginia use a lot of confusing terms in worker’s compensation cases. An experienced work injury term understands these definitions. He knows how they affect your claims for lost income, payment of medical bills, and other aspects of your case. A few of the more common worker’s compensation terms are these:

  • Accident. In both North Carolina and Virginia, work injury claims are brought based on two criteria. The first is that an employee suffers an accident at work. The second is that the worker suffers an injury.  To prove an accident, there is no requirement to show the employer was negligent or failed to exercise proper care. There’s no need to assert or prove negligence or fault on the part of the employer. In North Carolina, except for back injuries, an “accident” is harder to prove than in Virginia. In North Carolina, there must generally be some kind of “slip, trip or fall,” that led to the injury. In Virginia, this is not necessary. For instance, in Virginia, if your job required that you pick up a 100 lbs item, and during that process, you felt a sudden “pop” in your shoulder which caused injury, then this would qualify as an “accident.” In North Carolina, that would not qualify as an “accident,” because there was no “slip, trip or fall.”
  • AWW. Average Weekly Wage. This is the calculation of the amount the worker earned on weekly basis prior to the accident. This is the gross amount, prior to deductions for taxes or other items. For workers who worked for more than a year, it is generally the average of the worker’s earnings in the 52 weeks prior to the accident. Workers are generally entitled to 2/3rds of their AWW for the time they can’t work – up to preset maximums. If that calculation is not fair for whatever reason—for instance, if the employee received a significant promotion and wage increase during the prior 52 weeks, then adjustments can be made.
  • Compromise and release. This is basically an overall settlement agreement so that workers can be paid in a lump sum instead of being paid on a weekly or monthly basis. It is usually used  when the worker has reached his/her maximum medical improvement – the time when additional further treatment will not improve his/her condition. Experienced work injury lawyers work to get the right lump settlement based on many factors. Some of these factors including reasonable understandings of the patient’s future medical needs and expenses, his/her life expectancy, and other factors. In North Carolina this is often referred to as a “clincher.” In Virginia, it is simply referred to as a “full and final settlement.”
  • Dependent. This term is used when a worker tragically dies due to a workplace accident or occupational illness. Generally, a surviving spouse and dependent children are presumed to be entitled to some worker’s compensation benefits on behalf of the deceased workers. Dependents include children under 18 and handicapped children 18 and over. Dependents can also include grandchildren and siblings. Even dependent parents and grandparents may be eligible if it can be shown they were financially dependent on the worker who died.
  • FROI. First report of injury. This is essentially the notice/report that the worker gives the employer when he/she is injured. In addition to placing the employer on notice. Generally, the notice must be given to the employer within 30 days and should be preferably in writing. We have seen cases get denied when suddenly the folks you reported the accident to verbally are no longer around, or worse, deny that you reported the accident to them.  This is also the terminology used to refer to the requirement that the employer report your injury to the Virginia Workers Compensation Commission or the North Carolina Industrial Commission, as the case may be. Note that the employer will often be heard to tell the employer “Don’t worry, we have filed your claim for you.” What the employer is usually referring to when they way that is the FROI. It has zero legal effect on your claim and you need to know that your employer cannot file your workers compensation claim for you. The report of injury is not a filing of your claim and does not provide you with any rights at all. The filing of your claim must be done by you or your attorney. In Virginia, that begins with a Claim for Benefits and in North Carolina, it begins with a Form 18. The filing of these forms makes clear to the insurance company and the Worker’s Compensation Commissions that you are demanding your wages, medical bills, and any other benefits.
  • FCE. Functional capacity evaluation. This is an evaluation usually performed by a physical therapist or occupational therapist. It typically lasts for four or more hours and it is conducted to determine which of your job tasks you can and can’t do. The FCE professional will examine physical abilities such as how much you can lift or carry, how long you can stand without having to sit, your ability to reach, whether you can hold items with your hands, how well you can speak, and other functional abilities. After the examination, you will be rated on a continuum of physical ability, which goes from the lowest, meaning sedentary, to the highest, which his very heavy. These examinations are also often used to provide a permanency rating with regard to your injured body part (s). After the evaluation, a report will be drawn up and you will typically have a scheduled visit to review the results with your authorized treating physician, who will usually then sign off on the FCE, or make modifications.
  • Future medical bills. It’s easy to calculate past due medical bills. Employees should understand that in worker’s compensation cases, the employer or the employer’s insurance company is required to pay all your future medical bills in relation to your work injury as well. Generally, workers seek medical help until they reach their state of maximum medical improvement. After that stage, many patients still need to continue seeing therapists and other health providers so their condition doesn’t worsen, or to decrease ongoing pain. Future medical bills also include the cost of medications, prosthetics, and medical equipment that you’ll need for the rest of your life. The insurance carrier should pay your medical bills as they become due. Additionally, your lawyer will work with your doctors to calculate the likely future medical bills if you want to enter into a lump sum settlement.

At the North Carolina and Virginia Law office of Joe Miller Esq., we answer your questions and guide you through each phase of your work injury case. We’ve been fighting for injured workers more than 30 years. To speak with a strong advocate, call 1-(888) 667-8295 or complete my contact form to schedule an appointment.

Your Workers’ Compensation Rights in Virginia and North Carolina

Posted on Thursday, November 1st, 2018 at 3:06 pm    

Anyone injured in a workplace accident or who becomes ill due to an occupational illness has the right to request that the employer pay workers’ compensation benefits. There is no requirement that the employee prove fault. Injured workers must report their injury to their employer or a supervisor.

Once the injury is reported (sometimes after emergency medical care is obtained), the worker can seek medical help. Virginia and North Carolina workers’ compensation will normally pay for all your medical bills.

Worker’s compensation should pay all your medical bills to get better and to stay better. That includes:

  • The cost of emergency room care, ambulances, and other care you need immediately after an accident
  • Any surgeries that are require and the cost of any hospital stay
  • Checkups with your authorized treating physician and the work your that doctor does to coordinate all your other care
  • Treatment with psychiatrists, psychologists, and health care counselors for any behavior health, anxiety, depression, or other emotional issues if properly referred by the authorized doctor;
  • Treatment with pain management doctors, neurologists, and other specialists if properly referred by the authorized treating doctor;
  • The care you need from a broad range of therapists. This can include, occupational therapy, physical therapy, speech therapy, work hardening, and many other types of therapy.

The time you need to spend with chiropractors is generally covered too, within limits.

In Virginia, unless you have already established a course of care with someone, you are able to choose from a list of 3 doctors (called a “panel”) provided by your employer. This applies for each type of specialist and care. If the doctors aren’t helping you or your employer doesn’t work with the medical providers you need, an experienced work injury lawyer may be able to help get authorization to see doctors of your own choosing.

In North Carolina, there is unfortunately no provision for a panel of three doctors. You must usually go to whomever you are directed by the workers comp insurance company; however, unlike Virginia, there are other provisions for a second opinion in the event you disagree with the findings of your authorized treating doctor.

If you need prosthetics, a wheelchair, braces, or other medical equipment; the cost of those devices is normally covered, too. Additionally, workers’ compensation should cover all your prescriptions and medications too.

Vocational rehabilitation

In some cases, workers need to be retrained because they’ll never be able to return to the type of work they did before the accident or illness. Skilled work injury lawyers help you get the funds you need to be to be retrained or reeducated if you need vocational help.

Disability Benefits (Your Workers Compensation Weekly Checks)

Employees, in general, are entitled to a percentage (66 and 2/3rds, or .66667) of their average weekly wages while they can’t work. The percentage is a compromise that ensures workers get a good part of their pay. Workers don’t get 100% because the compromise in the law that was agreed upon long ago was and is that the worker doesn’t have to prove the employer was at fault for the accident. There are some limitations such as that there is a one week waiting period and there is a maximum rate on how much a worker can be paid for work injuries. There is also a minimum amount, if your wage exceeds the minimum amount.

There are several different types of disability payments depending on the severity and the type of injury or illness:

  • Temporary total disability. Here, the worker can’t work at any type of job at all and is being held completely out of all work by his or her doctor. BUT, if the worker comes under an AWARD, then if he or she is unable to return to the pre-injury job, the worker may still receive ongoing checks. The worker will hopefully though be able to return to work at some time. The worker gets the 2/3rd’s figure until there is a determination he/she can return to work at his or her pre-injury job, or is otherwise released to full duty.

Most workers receive temporary total disability. Their medical bills are covered for life as long as it can be proven that the treatment is related to the work injury, and reasonable and necessary to treat the condition.

  • Temporary partial disability. Some employees can return to work but with restrictions. Examples of restrictions include not being able to stand for more than a half hour or not being to lift more than 20 pounds. Workers who return to work with restrictions or with restricted hours usually receive less pay then before they were injured. These workers, in addition to their lower pay, are entitled to partial wage loss work injury benefits – based on the fact they are losing some pay due to their injuries or illness. The rate is 2/3rds of the difference between the pre-injury and light duty wages.
  • Permanent partial disability or impairment ratings. (PPD or PPI) Some workers can return to their prior job but have to cope with a permanent injury such as the loss of a finger, permanent damage to their legs, arms, hands or feet, loss of hearing, sight, or significant disfigurement due to scarring. The worker who returns to work is therefore still entitled to some extra pay for this permanent partial disability based on the type of injury and the severity of the injury. For example, in North Carolina, a worker who loses a leg is entitled to up to 200 weeks of compensation payments, even if they are able to return to work at a higher paying job after the accident. So what about if the worker has not lost the leg, but there is permanent damage due to surgical intervention? The doctor, in consultation with physical therapists, comes to an opinion on the percentage impairment in the leg. Then that percentage is used to determine how much of the 200 weeks the worker would be entitled to. So for instance, a 20% impairment would yield 40 weeks of comp checks, since that is 20% of 200 weeks. It is usually paid in lump sum. The same is true for all of the body parts eligible for an impairment rating.

It bears noting a very important difference between North Carolina and Virginia in this regard. In NC, the highest ratable body part for impairment is the back, which really includes the entire spine, even the neck. That comes in at up to 300 weeks.

In Virginia, not only is the back on the highest ratable body part, it is not considered a ratable body part at all. In other words, in Virginia, a back or neck injury is not eligible for an impairment rating at all. The spine is not a ratable body part.

  • Permanent total disability. Here, the medical evidence confirms that the worker will never be able to return to his/her prior job or to any other job -even with retraining. This worker is entitled to his/her average weekly wage percentage for the rest of the worker’s life. To qualify in Virginia, the worker generally must have a severe brain injury; severe burns; the loss of both hands, eyes, arms, legs, and/or feet; or paralysis. In North Carolina, after

Death benefits in Virginia and death benefits in North Carolina due to a workplace accident

Tragically, some workers die due to falls, explosions and other causes. As a general rule, states like North Carolina and Virginia pay a significant part of the funeral and burial costs. Additionally, spouses and dependents normally entitled to a percentage of their loved one’s average weekly wages up to 500 weeks. It may be possible to obtain a lump sum payment. An experienced workers’ compensation lawyer can explain if stepchildren, adopted children, and other dependents, parents, and other relatives may qualify.

Contact a respected Virginia or North Carolina workers’ compensation attorney immediately

Delay can absolutely hurt your case. We have had to turn down many, many cases simply because the caller waited too long to contact a lawyer. At the North Carolina and Virginia Law office of Joe Miller Esq., we have the experience and resources to help you get justice for your work injuries or occupational illness. We’ll fight to get you ever dollar you deserve. For help now, call 1-(888) 667-8295 or complete my contact form. He’s been fighting for injured workers for more than 30 years.

The Role of Nurse Case Managers in North Carolina and Virginia Worker’s Compensation Cases

Posted on Friday, October 26th, 2018 at 4:44 pm    

The title sounds good. A nice nurse case manager (NCM) will help you communicate with your doctors. They’ll help you get to your appointments and look out for your best interests. But don’t be fooled. The nurse case manager is hired by the employer’s insurance company to help you return to work – often before you’re really ready.

Nurse case managers help set up appointments with your doctors, psychologists, and therapists. They keep notes on your appointments and progress including if you missed or were late for appointments. They meet with your doctors, sometimes while you are meeting with your doctor, other times after ou have left the appointment.

Nurse case managers report back to the insurance company. They are really the “eyes and ears” of the insurance company insofar as your medical treatment is concerned and is part of what I call the trinity of “defense professionals” that are typically employed to try and derail your case. If the insurer thinks that you aren’t following your doctor’s treatment plan for you, they can seek to terminate your rights to both wage loss benefits and payments for medical treatments.

The better nurse case mangers do help in a lot of ways

  • They help patients make appointments with the right health care providers
  • They usually attend the medical appointment with you
  • They help you get the transportation you need if you can’t drive or get to the medical providers’ office.
  • They will keep track of your diagnosis, prognosis, treatments, and medical issues
  • A good nurse case manager can sometimes even advocate for treatments that your doctor recommends when your insurance company may balk at paying for expensive treatments.

Concerns injured workers should have about nurse case managers

That being said, we have found that that “good” nurse case managers are a rare occurrence. Usually, spurred on by the insurance company, the nurse case manager’s aim is to encourage your doctor to release you to return to work. While employees generally do want to return to work where they can get full pay, enjoy doing a job well, and enjoy the companionship of workers – employees should know they have the right to return to work when they’re healthy and not before.

A nurse case manager means that you will lose some privacy over the way you handle your recovery. For many workers, the pain and anxiety of the recovery process can be unbearable. It’s not comfortable for many workers to have to share intimate and personal information with anyone who is not fighting for them 100 %. Many people are afraid to admit how much they really hurt. With their health providers, they should be more open – but with a nurse case manager, they may not fully say all their complaints – which can hurt their case.

Nurse case managers are informed of your medical history, your disability, what caused the accident, the work restrictions you have, and other personal sensitive information.

Losing your privacy pales in comparison to some of the other things nurses can do to directly affect your benefits.

  • The nurse case manager may try to get your doctor to say you are healthy and don’t need any more medical treatments
  • The nurse case manager may question (and pressure) the doctor about why you still need treatments
  • He or she may pressure the doctor to release you to light duty, meaning some type of work, even something not really viable such as a 2 lbs lifting restriction, which enables the employer to put you into a “dead end” job and on a path to being fired, or gets your benefits cut off if you are not under an Award
  • She/he may question your doctor as to why work restrictions are still needed – why you can’t work at full duty
  • Will seek to get you or the doctor to say you’re not really hurting all that much
  • Leave out important oral and physical details when reporting back to the insurance carrier for the employer

Your rights when a nurse case manager is assigned to your workers’ compensation claim

Employees should always speak with an experienced work injury lawyer as soon as a nurse case manager asks to be involved in your claim. The attorney will explain what the nurse case manager can and can’t do. The attorney will explain that the nurse case manager does NOT have the right to be in the examining room with you the entire time and that you have the right to speak with your physician in private, so you don’t hesitate to say everything that’s wrong with you.

Even if the nurse case manager can directly help, for example  – help you move because you’re not mobile due to leg or feet injuries –  once you are in the doctor’s examining room, you have the right to ask the nurse case manager to sit in the waiting room, assuming the doctor is agreeable.  

Many workers have significant injuries that cause additional problems that are not obviously related to the original injury. For instance, workers with severe spinal injuries may be embarrassed to admit in front of the nurse case manager that they are experiencing incontinence or erectile dysfunction—and the worker may not realize that these issues are directly related to their spinal injuries. The physician needs to understand all your physical pains, issues, and emotional anxieties to treat you properly.

In addition, some workers hate to admit they can’t do their job. They may try to do more than they can to get back to work. Doctors need to conduct a full examination to understand if you can do your prior job. They need to conduct tests to analyze what restrictions (such as not lifting more than 20 pounds) are required. When the nurse case manager is out of the room, the doctor and the patient won’t feel rushed or pressured. They can review each job task that you must do to work.

You have the right to be present when the doctor or health provider and the nurse case manager review your case. The nurse case manager is supposed to be working for you, even though in fact, she is an agent of the insurance company. You have the right to know what is being discussed about your case. If a nurse case manager violates this right, you should inform your lawyer.

You also have the right to challenge any inappropriate activity the nurse case manager engages in.  Despite her name, the nurse case manager MAY NOT manage your medical care. That is the job of your treating physician. For instance, your nurse case manager does not get to decide what kind of treatments you need and where they may take place. An NCM’s attempt to divert you to another facility for additional testing or away from a specific specialist recommended by your doctor is not allowed. Her refrain that such a facility or specialist is “not in our network” holds no weight with the Commission. If your treating doctor recommends a certain facility or specialist, then that is where you are to go and the NCM has no right to interfere.

If such attempts to manage your care become an issue, your lawyer may request that the NCM be removed from your case and another nurse case manager be assigned to your case.

Get help from an experienced North Carolina and Virginia workers’ compensation lawyer today

Attorney Joe Miller has been a strong advocate for North Carolina and Virginia workers for more than 30 years. He’s helped thousands of injured workers get a just recovery. He’ll guide you through every stop of the workers’ compensation process including dealing with a nurse case manager. To make a free appointment, please call 1-(888) 667-8295 or complete my contact form.

Workers’ Compensation for Public Servants – Firefighters, Police Officers, and Medical Emergency Service Workers

Posted on Tuesday, October 2nd, 2018 at 4:49 pm    

Police officers, firefighters, and providers of emergency medical services deserve more than just our thanks and respect. They deserve to be honored for the extremely hard jobs and often dangerous work they do. One way to honor them is to pay them the workers’ compensation benefits they deserve when they are unable to perform their jobs due to workplace injuries or occupational illnesses.

Why the jobs of so many public servants are so dangerous

  • Police officers. Police officers are constantly at risk of being shot or attacked. Just one domestic dispute which gets out of control, one police stop of someone who has a weapon, or one accident while they are trying to direct traffic or help the public – can end in the police officer losing his/her life or suffering long-term injuries. Police work is a tough balance between helping the public and protecting the civil rights of defendants. Police officers also need a proper balance between the emotional stresses of their job and the demanding physical requirements of their job.
  • Firefighters. Any fire can take a firefighter’s life. Even the most skilled firefighters can die or require long-term care if the flames suddenly shift direction or if the smoke overwhelms. Firefighters often must deal with dangerous chemicals and toxins. In some cases, they risk their lives to save a child, spouse, relative, friend, or even a beloved pet from on the onrush of the fire’s flames.
  • EMS employees. EMS workers often fly or speed to help get medical care to someone who has been the victim of an accident, an attack, an illness, or just the events of daily life. EMS workers can be injured in car crashes getting the accident site or going to the emergency room. They can suffer infections or contract diseases from the people they treat. Often, carrying or lifting a patient can result in chronic pain.

Many public servants work long hours, sometimes in the middle of the night. Injuries are a natural part of all three types of public service jobs.

Injuries and illnesses that firefighters, police officers, and EMS workers often need medical care and time off from work for

 

Public servants who exert themselves physically and emotionally and who work with people in distress can easily suffer an accident or attack that leads to one or more of the following injuries/illnesses:

  • Burns. Firefighters and other servants who get burned during a rescue process, putting out a fire, or for other reasons often need multiple skin graft surgeries. Some workers need to have plastic surgery. These workers often need to take months off from work just to deal with the physical recovery. Many workers also require long-term psychological counseling especially if the burns are on their face or arms.
  • Smoke inhalation. When there’s fire, there’s often smoke. Firefighters inhale the chemicals which can be dangerous. Fires use up the oxygen the firefighters need to breathe. Without oxygen, workers can die due to asphyxiation. Survivors can suffer serious lung damage.
  • Overexertion. Police officer, firefighters, and EMS workers often need to carry or lift heavy objects, move people, or push equipment out of the way. Overexertion often caused back pain, neck pain, and other types of aches. Treatments usually requires extensive physical and rehabilitative therapy. There have been some recent cases that appear to carve out a bit of an exception to the typical rule that such injuries are not compensable as workers compensation. If it can be shown that the overexertion or repeated carrying or exertion occurred over a defined period of time, in that it represents one “piece of work” —such as the rescue of a person from a burning building—then this has been held to be compensable in Virginia.
  • Injuries due to blunt force. Firefighters are at risk for beams, roofs, and other objects falling on them. Police officers are at risk for being struck or getting injured while trying to avoid being hit. EMS workers can be struck by objects at the accident site they go to help the accident victims.
  • Broken bones. One misstep can cause a public servant to fall. A police officer who is attacked can suffer broken ribs, a broken limb, or other broken bones. Firefighters who are struck by objects or who fall (on a floor or even through a floor) can break a bone in any part of the body. One slip means an EMS worker injuries himself/herself and possibly the person who’s being helped.
  • Cuts and bruises. Firefighters, EMS workers or police officers, or any public servant can be injured due to broken glass or other sharp objects if they’re in a vehicle accident or for other reasons.
  • Exposures to toxins and dangerous chemicals. Firefighters may be exposed to toxins when they try to put out a fire. Toxins can cause more than they respiratory problems. They can cause cancer.
  • Post Traumatic Stress Disorder (PTSD)-Although to a certain degree, “this is what you signed up for,” even the strongest of individuals can break if the situation is so suddenly shocking or frightening that it is out of the norm of what the public servant would normally be exposed to.

Other typical injuries that cause a public servant to need to file for workers’ compensation include:

  • Traumatic brain injury
  • Spinal cord damage
  • Respiratory disorders and illnesses
  • Amputations
  • Loss of vision or hearing
  • Muscle, ligament, and tissue damage
  • Internal bleeding
  • Depression
  • Anxiety
  • Repetitive stress injuries
  • Heart problems such as angina and high blood pressure
  • Exposure to toxins
  • Radiation exposure

 

Firefighters, police officers, and EMS workers are very prone to develop stress-related disorders and diseases. For this reason, injured public servants should feel confident that these medical conditions will be taken seriously by the North Carolina Industrial Commission or Virginia Workers Compensation Commission.

Get help for your work injury claim today

Joe Miller Esq. has been helping public servants and all types of workers for more than 30 years. At the Work Injury Center, he represents work injury victims in both North Carolina and Virginia. He’s helped thousands of workers get economic justice. To speak with an experienced, caring workers’ compensation lawyer, please call (888) 694-1671 or fill out my contact form.

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