Workers’ Compensation and Cold Weather

Posted on Tuesday, December 8th, 2020 at 1:32 pm    

We’ve written before about some of the types of accidents workers have when the weather gets cold – Worker’s Compensation and Winter Safety | Joe Miller Law, Ltd. (joemillerinjurylaw.com). Some of the major types of cold-weather accidents and injuries for workers include. Probably the most common type of injury is a slip and fall due to ice, melting water, and slippery surfaces. Cold weather cause potholes and pavement cracks which can also make falls likely.

Common cold weather injuries include frostbite, hypothermia, and back injuries. People who work outside such as construction workers, agricultural workers, and roadway maintenance crews are most at risk of suffering from the cold. 

Unfortunately, the notion of a worker’s compensation claim for injury such as frostbite or hypothermia is not as easy as a normal type of “accident” such as a slip or fall. This is because usually, frostbite and injuries like it occur over a span of time, sometimes days, and not in a particular moment. Generally, with very few exceptions, workers compensation law in both Virginia and North Carolina do not permit recovery for repetitive trauma injuries. In other words, if you cannot pin down your injury to a very specific period of time as well as conditions and assignments, you will have no case. 

A review of the case law tends to indicate that in, for instance, a frostbite situation, if the frostbite is brought on over several days or months in the cold weather, it may be difficult to bring a workers’ compensation claim for an injury by accident. If, however, the frostbite occurs as a result of a very limited, say, four or five hour uninterrupted exposure to extreme cold due to a set of tasks that the injured worker is required to perform, that may satisfy the requirement that the injury occur during a specific, identifiable period of time. Of course, this must be backed up with a qualified physician’s opinion. 

All that being said, there may be another option that is revealed by a review of the case law. Frostbite, hypothermia and other such cold-induced conditions could also be considered to be an occupational disease. To bring such a case, one would have to show, through clear and convincing evidence, that the unique conditions of work brought about the injury. Again, one needs to be prepared with a very clear physicians’ opinion that the specific injuries were a result of exposure to extreme cold at work. 

Best cold-weather practices for employers and employees

Many cold weather injuries are preventable with proper planning, training, and safety protocols. Some of these common strategies include:

  • Being prepared for cleaning snow and ice when it occurs
  • Having backup generators, heaters, and other equipment so workers can do their jobs and stay warm when the temperature drops
  • Having plans for stopping work when it gets too windy. For example, ladders and scaffolds are especially dangerous when the winds are too high.
  • Having the proper clothing and work gear for workers so they can work outside if it’s too cold. This includes protective equipment so that cold and rain doesn’t get in the worker’s eyes. Proper clothing should also include footwear to provide better traction and to prevent the worker’s feet and toes from getting too cold. Workers should have gloves, hats, thermal wear, and other protective clothing.
  • Hiring and using maintenance crews to inspect outside areas and entrances to inside areas for wet, cold, and slippery surfaces. Until the repairs can be done, the employer should place warning signs around all the dangerous sites.
  • Being vigilant about salting and de-icing any means of ingress and egress into work buildings. 

What steps should a worker take if a cold-related injury is suspected?

Workers have two priorities if a cold-weather injury such as frostbite or hypothermia is suspected: The first is to get immediate help. If the employer has in-house health care, they can help there. Otherwise, it’s advisable to call 911 or contact your emergency room. Workers may be in shock. The worker may not be aware of the extent of their injuries. Emergency medical personnel should be able to advise the worker and a supervisor whether the worker can be moved safely to the hospital or if emergency on-site care is needed.

The second priority is that workers who are physically able to need to notify their employer (usually a supervisor or manager) that they can’t work anymore due to the cold. If you can’t tell your employer immediately, you should inform your employer as soon as possible after you receive emergency medical treatment.

As mentioned above, unless one suffered an accident such as slipping on ice, workers who suffer injuries due to cold weather conditions such as frostbite or hypothermia may find it more difficult to prove their claim. If they cannot prove that the frostbite or hypothermia was a result of a very defined and specific period of time of no more than a few hours of exposure to extreme cold, the only other option would be to attempt to prove their case through the means of occupational disease, which is more difficult. 

Assuming the injured worker could prove his or her claim, the worker would have the right to file for workers’ compensation. Many injuries can take weeks or months to heal. During the time period where the worker is unable to work, the worker is entitled to:

  • Payment of all reasonable and necessary medical expenses
  • A percentage (about 2/3rds) of the workers pre-accident average weekly wages for the time they can’t do their job

General winter tips for workers

Workers and employers should also advise and prepare their workers for cold weather by:

  • Making sure they stay properly hydrated. Hydration can help manage dry skin and the itching and irritation dry skin causes
  • Making sure to focus on keeping the extremities warm – ears, finger, and toes
  • Eating plenty of fruits and vegetables to balance all Holiday carbohydrate treats
  • Getting some sun and fresh air when possible. Even before the pandemic, it was and still is important to spend some side outside
  • Keeping in shape. Get plenty of exercise.
  • Minimizing contact. As we all know now, shaking hands and close contact spreads germs and the flu. 
  • Washing your hands regularly
  • Knowing the signs of frostbite and hypothermia

Some ways to keep warm (and things to avoid) include:

  • Making sure your smoke detectors are working
  • Being extra careful when using candles
  • Turning off any portable heat-soured device when you go to sleep and when you leave home

A few winter driving safety tips

Many workers such as truck workers and delivery workers are entitled to workers’ compensation benefits if they are injured as a result of an accident while making deliveries. Salespeople and other workers may be entitled to work injury benefits too – if they have a vehicle accident AND if the accident occurs during the scope of their employment. With some exceptions, commuting back and forth to work is not considered within the scope of employment.

A few common safety tips for cold weather driving include:

  • Keeping longer distances between you and other drivers especially the driver in front of you
  • Being prepared to leave the road if the snow, sleet, hail, wind, or rain gets too intense to make driving safe
  • Allowing for much longer stopping distances
  • Allowing for more time to achieve your tasks
  • Having weather-related tools in your vehicle such as shovels and salt to help melt the ice
  • Making extra sure your windshield wipers work, your mirrors are clear, and your window defrosters work
  • Making extra sure your headlights are in good working order

According to Business Insurance:

  • Businesses may consider less formal dress codes – so people are encouraged to wear boots and stay warm.
  • Installing signs to warn people of cold-weather dangers
  • Making sure to inspect the property more often for uneven or slippery surfaces
  • Having more dry mats for people to wipe their feet

“Construction and utility, postal carriers, delivery personnel and employees in other similar positions may be negatively affected by improper protective clothing and training in the bitter cold, which could lead to hypothermia and/or frostbite, noted Ms. Roth.”

Employers who fail to take necessary precautions may be subject to OSHA violations.

Speak with an experienced North Carolina and Virginia workers’ compensation lawyer today

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. understands the many reasons why workplace accidents occur. It is not necessary to prove your employer was at fault in order to receive workers’ compensation benefits. The focus on considering safety measures in cold weather or any weather is to try to avoid the accident from happening. For help with any work injury claim, contact a seasoned North Carolina and Virginia workers’ compensation attorney. You can reach attorney Joe Miller, Esq., at 888-667-8295. or fill out my online contact form to schedule an appointment. You can use complete our New Electronic Case Review. It’s a new way we’re offering workers to contact us remotely, particularly if they are awake after normal business hours. 

Carpal Tunnel Syndrome and Workers Compensation – Part Two

Posted on Friday, October 30th, 2020 at 8:52 am    

Carpal tunnel syndrome is painful and is likely to cause workers to lose time from their job. If your median nerve isn’t working you’ll have a lot of complications such as:

  • Not being able to use your thumb effectively
  • Not having the right feeling in your fingers
  • Not being able to hold objects well
  • Not being able to distinguish between hot and cold – on touch

How does your doctor diagnose carpal tunnel syndrome? 

According to the Mayo Clinic, your physician will conduct a series of tests and questions to determine if you have carpal tunnel syndrome. These tests and questions include:

  • Asking you about your symptoms. The doctor will take an oral history of the problems you’re having such as asking when the pain occurs and under what conditions it occurs.
  • Physically examining you.  The doctor will examine how well you feel with your fingers and how strong your hand muscles are. He/she will bend the wrist, touch on the median nerve, and/or press on the nerve to see if these efforts trigger pain.
  • Taking X-rays. Generally, X-Rays can’t diagnose carpal tunnel syndrome. X-rays can rule out other problems such as fractures.
  • Giving you an electromyography. This test measures the tiny electrical discharges produced in muscles. During this test, your doctor inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify damage to the muscles controlled by the median nerve, and also may rule out other conditions.”
  • Taking a nerve conduction study. Here, two electrodes are taped to your skin. Then a small shock is directed through the median nerve – “to see if electrical impulses are slowed in the carpal tunnel.” The test can help diagnose carpal tunnel syndrome and also helps rule out other medical conditions.
  • Giving you a Tinel test. This test is a physical test to see if you develop a tingling sensation or if you are numb in certain areas of the wrist and hand. 

Imaging tests may also eliminate other problems such as diabetes.

What are the initial treatments for carpal tunnel syndrome?

It’s best to start treatments of carpal tunnel syndrome as quickly as possible. Early self-help treatments include:

  • Taking more frequent rest breaks
  • Avoiding any actions that make your symptoms worse
  • Using cold packs to help reduce any swelling

In milder cases, where your condition is less than 10 months old, splinting may help. If, however, your hands feel numb, you should treat with a doctor as soon as possible. As a general rule, you should see a doctor, even if you have a mild case, so he/she can diagnose the condition and recommend initial therapy.

Splinting the wrist helps keep the wrist still while you sleep. Patients use the wrist splint at night though it can help with daytime aches and pains.

Some stretching exercises may help. Some patients seek chiropractic care and/or acupuncture

What nonsurgical treatments may help?

Some nonsurgical therapy treatments include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications may help reduce carpal tunnel syndrome pain. NSAIDs include Advil, Motrin IB, and other medications. Generally, NSAIDs don’t improve your disorder. The aim of these drugs is to hopefully reduce the level of pain.
  • Corticosteroids. These are injections designed to help reduce pain. Sometimes your doctor uses an ultrasound to guide these injections.” “Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.”

What types of surgery are used for treating carpal tunnel syndrome?

The Mayo Clinic indicates that there are two types of carpal tunnel syndrome surgery:

  • Endoscopic surgery. “Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist. Some surgeons may use ultrasound instead of a telescope to guide the tool that cuts the ligament.” This type of surgery, during the first few recovery weeks, may be less painful than open surgery.
  • Open surgery. “Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.”

There are risks to surgery that your surgeon should explain to you before any operation. These risks include:

  • “Incomplete release of the ligament
  • Wound infections
  • Scar formation
  • Injuries to the nerves or blood vessels”

The healing process, after surgery usually takes a few months. During this time, “the ligament tissues gradually grow back together while allowing more room for the nerve.” Employees, who are entitled workers’ compensation, should receive temporary disability during the healing process. The employer’s insurance carrier should pay for the surgery.

In some cases, your symptoms may not completely disappear after surgery.

Are you entitled to workers’ compensation if you have carpal tunnel syndrome?

Often, employees can show that they developed carpal tunnel syndrome due to their work. Still, that doesn’t mean you’re automatically qualified for workers’ compensation in either North Carolina or Virginia. Generally, injuries must either be due to a workplace accident or an occupational illness or disease.

In Virginia, Carpal Tunnel Syndrome is specifically not recognized as a statutory occupational disease the same way as something like asbestosis; however, it is probably the most commonly claimed “ordinary disease of life” that injured workers claim is due to have occurred due to exposure to specific work conditions. 

It is definitely not a given that a claim for carpal tunnel will be found compensable. In Virginia, any “ordinary disease of life” much meet the higher standard of “clear and convincing” evidence. This means that there must be very clear proof that the unique work conditions are such that they have caused the CTS, and also that the CTS is not due to factors outside of work. It must be “characteristic of the employment and was caused by conditions peculiar to such employment.”

Employers will typically argue that your carpal tunnel syndrome is due to other conditions – such as a second job or activities you do at home. They’ll also argue that you had a pre-existing carpal tunnel condition caused by other activities or conditions that pre-dated your work history with the employer.

North Carolina is similar in its proof requirements. CTS would fall under the “catch all” occupational disease claim found at N.C.G.S. 97-53(13)  which does generally allow a carpal tunnel syndrome claim to be filed if it is due to a repetitive stress injury – if it can be shown that the CTS is proven “to be due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation or employment, but excluding all ordinary diseases of life to which the general public is equally exposed outside of the employment.”

If you are able to prove your claim, while you’re out of work due to the CTS, you should be entitled to temporary disability benefits at 2/3rds of your average weekly wage and of course coverage for any and all treatment related to your CTS. If your hand doesn’t completely recover, and you end up with some kind of permanent impairment, you may be entitled to permanent partial disability (PPD) benefits.

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq has helped thousands of injured workers obtain just recoveries. He understands the unique coverage and treatment issues involved with carpal tunnel syndrome claims. To talk with a seasoned work injury lawyer, call North Carolina and Virginia attorney Joe Miller, Esq., at 888-667-8295. or use my online contact form or our new online case evaluation form to find out if you may have a claim. 

Carpal Tunnel Syndrome and Workers Compensation – Part One

Posted on Wednesday, October 28th, 2020 at 8:50 am    

Carpal tunnel syndrome is an injury due to stress. It happens when pressure on the median nerve and tendons that travel through the carpal tunnel (a passage in your arm). You feel the injury as you flex your fingers. The carpal tunnel can cause pain, numbness and tingling,  even with minor swelling.

What are the symptoms of carpal tunnel syndrome?

According to the Mayo Clinic, symptoms include:

  • Tingling or numbness. If you have carpal tunnel syndrome, you may notice numbness and tingling in your hand or fingers. The most affected fingers are the thumb and index, the ring fingers, and the middle fingers- but not your little finger. The sensation may even feel like an electric shock.

The feeling may extend from your wrist up your arm. The symptoms can appear while you’re driving or just reading a publication. They may cause you to wake from your sleep. Many people try to shake out the feelings. The numbness feeling may last a long time.

  • Weakness. You may not be able to grasp or hold onto objects – due to numbness or weakness. The inability to hold objects may also be due to the pinching muscles of the thumb.

What causes carpal tunnel syndrome?

Pressure on the median nerve causes carpal tunnel syndrome. The median nerve “provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).”

Carpal tunnel syndrome can be due to anything that irritates or squeezes the median nerve. A fractured wrist can also cause the carpal tunnel to narrow. Rheumatoid arthritis is another cause of carpal tunnel syndrome. Often, there is no one singular cause. A combination of factors may cause he disorder.

What are the risk factors for carpal tunnel syndrome?

Many factors increase the risk of carpal tunnel syndrome though they may not cause the disorder. These risk factors include:

  • Anatomical factors. Examples include a fractured wrist, a dislocation of the wrist, or arthritis. These conditions can change the space within the carpal tunnel or place pressure on the median nerve.
  • If you have a smaller carpal tunnel than others, you’re more likely to have carpal tunnel syndrome.
  • Gender. Women are more likely to develop carpal tunnel syndrome than men. 
  • Nerve-damaging conditions. “Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.”
  • Inflammation. Inflammation, due to rheumatoid arthritis or other causes can place pressure on the median nerve and affect the tendon linings around the wrist
  • Medications. “Some studies have shown a link between carpal tunnel syndrome and the use of anastrozole (Arimidex), a drug used to treat breast cancer.”
  • Obesity. Being overweight is a risk factor
  • Changes in bodily fluids. Fluid retention can irritate the median nerve and “increase the pressure within your carpal tunnel.” Bodily fluid changes often occur during menopause and pregnancy. The good news is that once the delivery is complete, the mother usually feels better.
  • Other medical disorders. Examples include kidney failure, lymphedema, thyroid disorders, and menopause. Some diseases such as a tumor or diabetes can also increase the risk of carpal tunnel syndrome.

Of particular note, is that workplace conditions are a known risk factor. Examples include:

  • Working with tools that vibrate
  • Working on an assembly line which requires repetitive wrist flexing or prolonged wrist flexing – which can place pressure on the median nerve or affect existing nerve damage.
  • Age. Older people are more likely to develop carpal tunnel syndrome than younger people
  • Trauma. An injury increases the risk of carpal tunnel syndrome.

“Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. Some evidence suggests that it is mouse use, and not the use of a keyboard, that may be the problem. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.”

Are there ways to prevent or reduce the risk of carpal tunnel syndrome?

Some of the ways to reduce stress on your wrists and hands include:

  • Use a relaxed grip. Reduce your force. If, for example, you use a computer or a cash register – try to hit the keys or numbers a little softer. If you write with a pen,, try using a large pen that has a large soft grip adapter – and ink that flows freely.
  • Take more breaks. During breaks – stretch and bend your hands and wrists. Try to alternate tasks – especially if you use equipment that vibrates like a jackhammer. A few minutes’ break every hour can make a large difference.
  • Watch your form. Try not to bend your wrist – all the way up or down. Use a relaxed position where possible. “Keep your keyboard at elbow height or slightly lower.”
  • Improve your posture. “Incorrect posture rolls shoulders forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers and hands, and can cause neck pain.”
  • Make sure you have a comfortable computer mouse.

You should also avoid working where it’s cold. If you can’t control the cold/heat, try using fingerless gloves. They may help.

What types of jobs are most at risk for carpal tunnel syndrome?

Some that we’ve mentioned include computer work or keyboard work, assembly line work, and using a cash register. Other risky jobs include:

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. has helped thousands of injured workers obtain their full work injury benefits. He’ll fight to show your carpal tunnel syndrome is compensable under state workers’ compensation laws. He’ll work to show how much medical care and time off you need.To speak with an experienced work injury attorney, call North Carolina and Virginia lawyer Joe Miller, Esq., at 888-667-8295. or fill out my online contact form to make an appointment or feel free to utilize our new online case evaluation form.

Pre-Existing Medical Conditions and Workers’ Compensation Claims

Posted on Thursday, October 22nd, 2020 at 1:28 pm    

Workers’ compensation claimants have the right to demand that their employer pay for all medical bills for injuries related to a workplace accident or an occupational illness. The insurance carrier for the employer is also required to pay temporary benefits (2/3rds of your average weekly wages – with some adjustments) until you can return to work or alternate, light duty work is found for you. Once you’ve reached maximum medical improvement (MMI), you may be evaluated to determine if you have a permanent impairment as well as permanent work restrictions due to your workplace injury. This evaluation includes a permanency rating which details the type of disability you have in your injured body part(s) and the severity of the disability as it relates to the types of work you will be able to do, and not do, going forward. Additional work loss payments are paid depending on the impairment rating and whether you are capable of returning to your pre-injury job.

Insurance companies for the employers are always looking for a way to limit how much they have to pay. One classic strategy that employers use is to argue that your injuries and inability to work are due to a pre-existing condition. If the employer can show you have a pre-existing condition:

  • Your right to benefits could be denied;
  • Your right to medical treatments (and payment for those treatments) could be reduced or denied;
  • Your right to temporary wage loss benefits could be reduced or denied;
  • Your right to permanent disability benefits could be reduced or denied.

Whether these rights are denied or reduced depends on the relationship between any prior condition and your current medical condition.

If the pre-existing condition dose not relate to your current medication condition (for example, your knee now hurts when the pre-existing condition was a broken arm), then your right to new benefits should not be affected. Likewise, if he pre-existing condition fully healed before your current accident, then your right to benefits should not be denied.

What is a pre-existing condition?

A pre-existing condition in the context of an injury case is a form of injury for which a worker has previously received medical treatment or for which a diagnosis of an injury has been made in his or her current work injury case. It used to be the case that if you had a pre-existing medical condition, your own health insurance wouldn’t pay for treatment for that condition – unless a sufficient length of time had passed since the last treatment. Due to the Affordable Care Act, insurance companies are now prohibited from denying payment for any necessary treatments – even if you have a pre-existing condition.

While the ACA helps with medical bills, it doesn’t pay any wage compensation. In addition, if you use your own health insurance, you have to pay the deductible and copays. Workers compensation doesn’t require deductibles or copays. If your claim is accepted or ruled compensable, the workers compensation insurance company must pay all reasonable and related costs in connection with your work injury. 

Pre-existing conditions vary from worker to worker and patient to patient. They include conditions due to injury such as broken bones and arthritis due to surgeries. Pre-existing conditions also include diseases such as heart disease and cancer. Whether your pre-existing condition will negatively affect your workers comp claim depends on a variety of factors, not the least of which is where your case is pending. 

Is your current medical condition related to your pre-existing condition?

In most cases, your physicians will make the initial determination about whether you have a pre-existing condition. This determination is based on a number of factors including:

  • A thorough review of your prior medical records. Previous doctor reports should document any treatments you had. They’ll document any diagnostic tests, such as x-rays, MRI’s or CT scans– if you had diagnostics. If you never received any treatment for your prior injury, then your current doctor is less likely to be aware of you pre-existing condition.
  • A physical examination. A scar from a prior surgery, for example, is an immediate clue that you had a prior injury. On the other hand, if your prior injury has completely healed, then a physical exam is less likely to show the prior injury.
  • An oral examination. Your physician will likely ask you about any pre-existing conditions. You need to be as candid and forthcoming as possible. Never, never try to lie or hide any pre-existing condition. The Insurance companies have a vast network of computer surveillance and of course, the power to subpoena records. If your doctor and your attorney know about any relevant pre-existing conditions, they can be dealt with. A surprise piece of information that is dug up by the defense and thrust into your doctor’s face is less likely to be effectively dealt with and may cause your doctor to be hostile towards you. 

It is important that you speak with your North Carolina or Virginia workers’ compensation lawyer as soon as possible. Often, your employer will go on a fishing expedition to try to show you have a pre-existing condition. There are limits to what employers and even physicians can ask about your prior medical history. Your lawyer can explain these limits. But we will say this repeatedly—the worst thing you can do is try to hide a pre-existing condition. This will destroy your credibility, not only with the Workers Compensation Commission, but with your doctors as well. 

Is the pre-existing condition related to your current injury or illness?

Whether the injury is “related” to a pre-existing condition is a legal question. The main issue is one of determining how much the new accident caused your injury and how much the prior condition is contributing to your need for medical benefits and work loss payments. Factors that need to be considered include:

  • Were you still treating for prior medical condition?
  • Did the current injury worsen your prior medical condition?
  • Is the current injury different than the new one? For example, if your prior injury was a torn meniscus and your new injury is a torn ligament, then the injuries (even though both may be to the same knee) are fairly different.
  • Was the pre-existing condition due to another workplace accident, to a personal injury accident, to old age, or to some other cause?
  • The type of injury. Some injuries like a broken arm should fully heal within a few months. Other injuries, like a bad back can be chronic and last for a lifetime.
  • The severity and trauma of the current injury. If you had a pre-existing, active condition, and the trauma associated with the new injury was very slight, it may be harder to prove that you have a new injury. 

Jurisdiction Matters. A lot really depends on what jurisdiction you are proceeding under. In Virginia, believe it or not, the law relating to medical causation is actually fairly liberal. First, as with any work injury, you just show that you suffered an injury by accident, which means that you suffered a sudden mechanical change in your body as a result of a trauma. 

Then, once you can prove that, if ANY part of your current disability or need for treatment comes from the new injury by accident—even if it’s only 1%— then the entirety of the claim is compensable.  So yes, the law on this is very helpful for injured workers in Virginia. 

Let’s take an example. Say you had a pre-existing herniated disc in your back. You may have even had surgery, but the surgery was about a year before the current accident, and you’ve done fairly well. In fact, you’ve resumed your full duties at work for the last three months. 

But then your co-worker drops his end of a heavy object which pulls you down and causes you to have a “pop” and then horrific pain in your back. Your left leg goes, and stays completely numb with shooting pins and needles down your left thigh and leg. Your Neurosurgeon says it’s a re-aggravation of your previous injury, takes you 100% out of work, and also says you will now require a more extensive fusion surgery on your lumbar spine. 

In Virginia, unless your Neurosurgeon or Orthopedic can say that the new accident had NOTHING to do with your current inability to work, then you should have no problem moving forward with a new claim on your back. 

How is this determined? In Virginia, we typically will write your doctor and ask him to answer a few questions in the form of an Opinion Letter which sets forth

  1. Whether you suffered a sudden mechanical change as a result of the new injury; and 
  2. Whether the new injury contributes—even in the slightest degree—to your current disability and need for treatment. 

So long as the answer to both of those questions is “yes,” from your authorized treating doctor, you should be fine and the entirety of your new claim should be compensable. 

North Carolina Workers Compensation Pre-Existing Injury Law—Not Quite as Liberal

Unfortunately, North Carolina Workers Compensation Law is not quite as liberal as Virginia in relation to the law on pre-existing injuries. 

First of all, except with respect to back injuries, North Carolina requires that you show some type of actual “slip, trip, or fall,” when attempting to prove that you suffered an “injury by accident.”  Accordingly, a “leg giving way” or a twisting of the knee, without a fall to the ground or slip, would not be considered an “accident” under North Carolina Law, where it might in Virginia. That being said, North Carolina has carved out an exception for back injuries. All that need be shown is a “sudden traumatic event” if you’ve suffered a back injury.  This could be something as simple as feeling a sudden “pop” in one’s back as one is lifting something heavy at work. 

But of course, as in Virginia, once you have established that you have suffered an accident, what happens if you have a pre-existing condition in a North Carolina Workers Compensation Case? Unfortunately, things are not quite as easy as in Virginia. 

Let’s use the example we used in Virginia—you suffered a pre-existing back injury and surgery, and you’ve done fairly well and returned to full duty.  

Now you’ve re-injured the same back in a new North Carolina Workers’ Comp Case, and your doctor pulls you 100% out of work and says that you will require a more extensive back surgery. What will you have to prove to show that this is separate from the old injury? 

 North Carolina Law is similar, but not quite as liberal, as Virginia on this issue. The law in North Carolina is that where a nondisabling condition is aggravated or accelerated by an accidental injury from employment, so that the worker is now disabled, then the employer must compensate the employer for the entire resulting disability. In other words, just because the injured worker had some underlying condition that made the current injury worse, there is no “apportioning” done as between what was there before and what is wrong with the employee now. The entirety of the current disability is compensable. 

That being said, North Carolina has the extra requirement that the employee prove that the work-related accident “contributed in some reasonable degree” to the plaintiff’s disability.  The injured worker must prove that it is more likely than not that the accident was a “causal factor resulting in the disability.” 

So that standard is a little higher than Virginia’s causation standard, which sets forth that ANY contribution by the new injury to disability is enough to make the entire claim compensable. North Carolina requires a little more than that—a “reasonable degree” of contribution. 

How does one prove this? Again, as in Virginia, an opinion as to whether an aggravation of a pre-existing condition rests entirely with the authorized treating physician. If the physician is able to state that more likely than not, the new injury contributes in some reasonable degree to the current disability, then the entire claim is compensable. 

Unfortunately, unlike Virginia, the North Carolina Industrial Commission does not accept medical opinion letters as testimony or evidence, without sworn testimony. Accordingly, if a matter is proceeding to Hearing in North Carolina, the deposition of the doctor must be scheduled to elicit his or her testimony for hearing. 

That being said, oftentimes the production of a favorable opinion letter well in advance of any deposition of the doctor will give a clear indication of the way the physician intends to testify and may result in an agreement by the defense to accept the claim. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. is a seasoned workers’ compensation attorney. He’s helped thousands of injured workers, including many with pre-existing conditions, obtain a just recovery. He’ll fight to show the prior condition isn’t related to your new medical condition. To speak with an experienced work injury lawyer, call North Carolina and Virginia attorney Joe Miller, Esq., at 888-667-8295. or fill out our online contact form  or our new online case evaluation form to streamline the process of having Mr. Miller review your case. 

COVID-19 Can Kill Your VA Workers Comp Case

Posted on Thursday, September 17th, 2020 at 2:27 pm    

In this video Workers Compensation Lawyer Joe Miller explains how your contraction of COVID-19 illness could completely “kill” or derail a perfectly good workers compensation case in Virginia, even if you are under an Award. As a matter of fact, if you become unable to work as a result of ANY condition that is not related to your work injury, and your workers comp doctor has you on light duty, you can expect your benefits to be immediately cut off.

Why? Because you have been removed from the labor market for an unrelated condition, and therefore, your inability to work has nothing to do with your work injury, but with an unrelated condition. Yes, it is very, very unfair and no, it was not your fault that you got sick. But the workers compensation insurance company does not care about that, nor does the Virginia Workers Compensation Commission. The bottom line is if you are under an Award, and you’re on light duty, you had better avoid getting COVID-at all costs. Even if you only test positive and have no symptoms, we know that positive result would prevent you from working anywhere and therefore, you can expect your benefits to be cut off.

Common Mistakes that Can damage Your North Carolina or Virginia Workers’ Compensation Case

Posted on Wednesday, July 22nd, 2020 at 9:53 am    

Workers have the right to file for workers’ compensation if they are an employee, if they are hurt on the job, and if the injuries they suffer stop them from working. Workers may also be entitled to work injury benefits if they suffer an occupational illness due to their job. There is no requirement to prove the employer was at fault. The claims process is normally easier than in a personal injury case. Still, there are many mistakes employees can make that can hurt their case. Just one key mistake can affect your entire claim or your ability to get all the compensation you deserve. (more…)

Will I Lose my Comp Checks if I’m Laid Off due to the Coronavirus?

Posted on Thursday, March 26th, 2020 at 11:10 am    

Clearly many folks are concerned right now about the effect on their weekly compensation checks of any potential layoff of themselves and their fellow employees at work or company closures due to the severe economic downturn and mandatory closures related to the Coronavirus. 

This is a very important question right now and also this particular question regarding layoffs happens to be an evolving and very active area of VA Workers Comp law.

The short answer is if you are currently under an ongoing, finalized Award for benefits, meaning an Award for weekly checks for either Temporary Total or Temporary Partial Disability, then NO, you will not lose your benefits; however, if you are NOT under an Award yet and your position is permanently eliminated or the layoffs are clearly permanent with no chance of re-hiring, then you will likely have a very difficult time of trying to obtain comp check benefits from the date of such layoff forward. You may only be able to claim benefits up until the date of the layoff.  It’s not impossible to prove ongoing benefits in a permanent layoff situation, but you will be required to rise to a very high level of proof to show that your inability to obtain a job is due to your disability and not just to your job being eliminated permanently. 

That being said, if the layoff is only temporary—as many will likely be in our current situation—then if you are not under an Award and on light duty, you would still be able to claim benefits; however, you would need to engage in active marketing of your residual capacity to work in order to prove your inability to find a job.  And of course, you will likely end up at a Workers Comp Commission Hearing to prove you engaged in adequate marketing. 

Of course, those held out of work 100% by their doctors due to their work injuries and have the physician’s work notes to prove it would not need to prove marketing.  

If this all seems confusing, I encourage you to first see my video on the importance of being under an Open or Ongoing Award for benefits in Virginia. It’s important to understand what an Award accomplishes for you in Virginia.  

So why is someone under an ongoing or Open Award in a better position compared to someone who is not in a layoff situation?  

It’s because when you’re under an ongoing Award, that Award is a proclamation or Order by the Virginia Workers Compensation Commission that you are entitled to the weekly benefits stated in that Order on an ongoing basis, until proven otherwise by the defense.  In other words, you have met your burden and you have won your case. Many times, the Award occurs due to an Award agreement, but the result is the same—once that Award has been entered by the Commission and the 30 day appeal period has passed, the Order is Final and you have won. 

When you have an ongoing or Open Award for weekly benefits, it becomes the defense’s burden to prove you’ve been returned to full duty and that you are capable of performing your pre-injury work if they want to get out of paying you those weekly benefits.  There are a few other ways for them to stop the Award, such as failure to comply with medical treatment or vocational rehabilitation, but they’re not relevant to our discussion right now. 

If the defense cannot prove you are capable of a return to full duty, then you are going to remain under your ongoing Award and they still have to pay you your ongoing, weekly benefits  even during the layoff and even if the layoff is permanent.  

Now what about folks who are not under an Award yet, but are trying to prove one?  

The case law is clear that for folks who are not yet under an Award, the difficulty of proving you are entitled to benefits really depends on whether the layoff is temporary or permanent. 

This is because an injured worker who is not yet under an Award has no Order from the Commission regarding anything. Nothing has yet been proven, so the burden of proof remains on the injured worker to show he or she is entitled to benefits. 

In a temporary layoff situation, if you are on light duty, assuming your employer does not accept you back at light duty status, so long as you are able to prove sufficient marketing of your residual capacity to work (i.e. looking for work elsewhere within your physical restrictions) during the temporary layoff, you should be able to prove you’re entitled to benefits. Of course, you will likely have to go to Hearing to prove that. 

Again, if you are in a temporary layoff, and your authorized treating physician has you out 100% due to your injuries, then since you currently have no residual capacity to work per your doctor, you do not have to market or look for work.  You would only need to prove your total incapacity with your doctor’s work notes and office notes. 

Unfortunately, for those of you whose positions are eliminated and are fully and permanently laid off along with your coworkers, if you are on light duty and not yet under an Award, you will  unfortunately find it much more difficult to be able to claim ongoing weekly workers comp benefits. The case law in such circumstance requires a higher level of proof to show that your economic loss is due to your injury and not the elimination of your job.     

The Commissioners and Judges have reasoned in the case law that since you don’t yet have an Award, and your job has been eliminated, the burden is on you to prove economic loss due to your work injuries. And since the burden is on you for proof and since the reason you don’t have a job is because your job was permanently eliminated, then you need to prove your economic loss is actually related to your work injuries and not just the fact that your job does not exist any longer. In such cases, just doing the marketing/looking for light duty work as usual is probably not enough. There needs to be proof that not only can you not find a job, but the reason you cannot find a job is because of your work restrictions as set forth by your treating doctor. If you don’t have such proof, then the Commission will find that the loss is not related to your work injury. They will find that it is related to the fact that your job no longer exists. 

Such proof may be through the hiring of an expert such as a vocational rehabilitation expert, and/or through some kind of testimony or other evidence from one or more of the potential employers where you applied that you could not be hired because your work restrictions could not be accommodated. 

We think that the decision by the Court of Appeals back in 2016 which raised the standard of proof for permanently laid off employees was wrong and a harsh result, and in fact there were strong dissents by Judges on the case, but unfortunately those Judges were outvoted and that is the law in Virginia. 

The only good news is that in many of the Full Commission decisions that have followed this 2016 Court of Appeals Case, the Commission has gone to great lengths to say it does not apply to the situation at hand. Clearly, the Full Commission also feels the Court of Appeals went too far and takes every opportunity to try to limit the harsh effects of that decision. 

Also, just to be 100% clear, it is very important to distinguish between an Open or Ongoing Award and a Closed Award. A Closed Award is for some past period of weekly payments that has now ended because you have returned to work. Although such an Award contains a lifetime medical benefit and is also evidence that your claim is compensable (meaning there is no longer a defense that you did not have a legitimate, on-the-job injury) in terms of attempting to get your checks started again because you have been laid off, it’s almost like have no Award at all.  In other words, if you’re on light duty, you would have to prove it’s a temporary layoff and you would have to prove marketing just like the folks with no Award at all. And just like those folks, you would not be able to prove any entitlement to ongoing checks if your layoff became permanent. 

We hope this article has been helpful. 

From all of us here at Joe Miller Law/The Work Injury Center, please stay safe, please follow the CDC COVID-19 Guidelines for prevention,  and God Willing we will all get through this safely together. 

Attorney Joe Miller has been representing injured workers in Virginia and North Carolina for over 32 years. If you have any questions about a worker’s compensation injury incurred by you or a loved one, please do not hesitate to reach out to us at 888-694-1671 or fill out our online contact form

Please do not wait to contact us, as there are time deadlines for filing your claim. If you fail to meet those deadlines, your right to benefits will be forever lost. 

The Details Behind the JLARC study on Virginia Firefighters and Presumptions

Posted on Saturday, March 21st, 2020 at 2:18 pm    

The JLARC’s review of Virginia’s workers’ compensation laws focused on a variety of issues including the relationship between firefighting and 10 different types of cancer to determine what presumptions should apply. They study was performed by epidemiologists at Johns Hopkins University’s Bloomberg School of Public Health

We discussed some of these issues in a previous article. The general findings of the study were as follows:

  • Current presumptions. 40 states have presumptions for firefighting and cancer. 34 states have presumptions for firefighting and heart disease. 15 states have presumptions for law enforcement and heart disease.
  • Virginia’s current presumptions for first responders:
    • Cancer. There are presumptions for breast, leukemia, ovarian, pancreatic, prostate, rectal, and throat cancer
    • There are proposed exemptions, as of 2019, for brain cancer, colon cancer, and testicular cancer
    • There was another proposed exemption for post-traumatic stress syndrome (PTSD)
    • Cardiovascular disease
    • Respiratory disease. Workers generally don’t’ seek to establish this presumption.
    • Infectious disease. Workers generally don’t seek to establish this presumption.

83 studies on cancer, heart disease, respiratory disease, and PTSD among firefighters and police officers were analyzed and evaluated for quality and bias.

The findings of the John Hopkins University study

The epidemiologists made the following findings regarding the validity of Virginia’s current and proposed cancer presumptions:

Johns Hopkins University epidemiologists determined that the best available evidence provides some support for most of Virginia’s current and proposed cancer presumptions.

  • Firefighters are exposed to carcinogens. Firefighters can’t fully avoid exposure to these carcinogens – even when they are wearing protective gear.
  • Every type of fire releases toxic and carcinogenic substance
  • To what extent firefighters are exposed to these carcinogens depends on many factors. The main exposure routes are inhaling these toxins and skin absorption of the carcinogens.

The study found that the firefighters had an increased risk of the following types of cancer:

  • Prostate cancer
  • Throat cancer
  • Brain cancer (proposed in 2019)
  • Leukemia
  • Rectal cancer
  • Testicular cancer (proposed in 2019)

The Johns Hopkins study did not have enough evidence on the following cancer types:

  • Colon cancer (proposed in 2019)
  • Pancreatic cancer
  • Breast cancer

No research was done on ovarian cancer. This is interesting, since pancreatic cancer and breast cancer are specifically listed in VA Code 65.2-402 ( C ) among those cancers to be presumed to be an occupational disease. As mentioned in a previous article on this subject, the mention of pancreatic cancer is inherently contradictory since it is really impossible to know what caused any pancreatic cancer based on our current state of scientific knowledge. 

Cancers which should be added to the firefighter presumption lists

The JLARC report, based on the John Hopkins study, recommended that worker’s compensation laws in Virginia create presumptions for the following cancer types:

  • Brain cancer
  • Testicular cancer

The reports added that colon cancer could be added to the list though the evidence for adding it wasn’t as strong as the other two cancer types.

Recommendations by the JLARC regarding current cancer presumptions for firefighters

Current cancer presumptions which should be maintained or could be subject to a sunset provision depended on the following:

  • “Better data on firefighting-cancer associations will be available after new National Firefighter Registry is fully implemented.”
  • “The General Assembly could maintain all current cancer presumptions in statute, including those with less scientific evidence, but add a sunset provision. Cancers with weaker scientific evidence to support occupation-disease associations could be removed if new scientific evidence does not increase support for including them.”

Costs for adding the three extra cancer presumptions – brain cancer, testicular cancer, and colon cancer

Enactment of Virginia House bill 1804 (which adds several cancer presumptions) for firefighter should result in just about six new compensable workers’ compensation claims yearly – though the five year total is expected to be high.

  • Insurance premiums for workers’ compensation for firefighters are expected to rise $269 in the first year.
  • The insurance premium for the Line of Duty Act (LODA) are expected to rise $61 “per FTE in the first year.”

“Some additional liability would be created for firefighters no longer working with an employer and still within statute of limitations.”

Additional JLARC firefighting presumptions

The JLARC also found that the “requirements to establish cancer presumptions for firefighters are unreasonably burdensome and appear counter to the purpose of the presumption.” This is the same comment I had made in my previous article on this subject

Most disputed claims by firefighters for Virginia workers’ compensation benefits – between 2019 to 2018 – found that the firefighter would not be entitled to benefits – in large part because of the failure to prove exposure to the right substance.

Of the 20 firefighter/cancer cases heard during that timeframe:

  • 13 (65%) did not prove toxic exposure or a disability resulting from the cancer and denied benefits
  • 4 (20%) were denied benefits for other reasons
  • 4 (20%) did meet the occupational illness requirements and were awarded benefits

The “presumption covers firefighters who have had “contact with toxic substance encountered in line of duty.” A big part of the reason for these denials was that firefighters were required to “prove exposure to specific carcinogen suspected to cause their particular type of cancer.”  “Of 16 cases heard by VWC in which firefighters did not meet all requirements, the firefighter did not meet the toxic exposure requirement in seven.”

The Johns Hopkins scientists found that:

  • “Documenting exposure to carcinogens is extremely difficult and costly. Virginia firefighters are not equipped with technology to measure exposure” because the technology is expensive and requires expertise.
  • The strict requirements are “counter to the purpose of presumption, which is to relieve firefighters of need to prove work caused their disease.”

The study found that it would be sufficient if firefighters were required to show exposure to hazardous conditions that, in turn, exposed them to carcinogens.

Another finding by the JLARC study was that Virginia’s requirement for 12 years of continuous service was not supported by scientific evidence (studies have shown that less service time could cause cancer) and was the highest in the country (the next highest was 20 years). In fact, there is case law that says that assuming there is sufficient proof that a firefighter has a type of cancer caused by exposure to known cancer-causing toxins that match up to that cancer, he or she need only prove ONE SINGLE EXPOSURE to a fire to prove there was sufficient exposure.  In that context, the 12 continuous years of service makes little sense. 

Virginia workers’ compensation lawyer Joe Miller Esq. has been fighting aggressively for injured workers and workers who suffer occupational illnesses – for more than 31 years. He understands how dangerous firefighting, policing work, and other types of first response work are. For help with any illness claim based on your work, please phone Joe Miller, Esq., at 888-694-1671 or use my online contact form to speak with a strong advocate.

What Happens if I get the Corona Virus Because of my Job?

Posted on Thursday, March 19th, 2020 at 2:24 pm    

Virginia and North Carolina Workers Compensation Attorney Joe Miller here explains why with some possible exceptions, it is unlikely that you would be able to pursue a compensable claim based on your contraction of the COVID-19 or Coronavirus at work. The possible exception might be someone whose sole job is to treat patients who are known to be infected with the virus, or test people for infection with the Coronavirus. Even then, it would be challenging.

More JLRAC Recommendations and More on Presumptive Diseases

Posted on Thursday, March 19th, 2020 at 2:16 pm    

This is the third in a series of recommendations by the Joint Legislative Audit and Review Commission (JLARC) for how to improve the Virginia Workers’ Compensation system. Earlier articles discussed executive recommendations and legislative recommendations. This article is a continuation of the legislative recommendations.

Legislative recommendations

Recommendations 21. The JLARC recommends that the Virginia General Assembly consider changing the Virginia Workers’ Compensation laws to address amending the criteria for establishing presumptions with respect to certain occupational diseases of first responders as follows:

  • Total or partial disability – can be shown through wage loss, lost work time, or medical evidence
  • Workers who seek only medical benefits should for a total or partial disability should only be required to submit medical evidence

Recommendation 22. The JLARC recommends that the state legislature consider amending the state workers’ compensation laws for certain occupations diseases of first responders to reduce the “years of service requirements from 12 years.” Right now, they must show continuous service of 12 years to be eligible for the disease presumptions. 

Recommendation 23. The Virginia General Assembly should consider amending the current work injury laws so that the word “continuous” is removed from the years of service requirement part of § 65.2-402.c for first responders. 

Option recommendations

The JLARC also recommends that the following options be considered by the Virginia General Assembly regarding amending § 65.2-402 of the Code of Virginia (the state’s workers’ compensation law):

  • Option 1. “To add brain and testicular cancers to the list of cancers that are presumed to have been caused by firefighting.”
  • Option 2. “To add colon cancer to the list of cancers that are presumed to have been caused by firefighting.”
  • Option 3. “To specify that the presumptions for breast, colon, ovarian, and pancreatic cancers covered by the statute shall not apply to workers’ compensation claims submitted after June 30, 2030.” Prior to June 30, 2030, the state legislature could direct that there be a study of the latest national research to determine if there is an “association between firefighting and these cancers.”
  • Option 4. “To require that workers’ compensation claimants have completed a minimum number of years of service as a firefighter or police officer, including any time spent in required training, to claim the cardiovascular disease presumption.”

Presumptive diseases and workers’ compensation

Presumptive disease laws, according to Business Insurance, have been in place in many states to help protect firefighters, police officers, and other first responders such as EMT personnel. The presumptions are used in occupational illness cases. Anyone who is hurt in a workplace accident has the general right to file a workers’ compensation claim provided that the accident caused their injuries, but occupational disease cases do not require a specific accident to have occurred.  

Occupational disease claims are based on the premise that some workers are exposed to unique hazards at work that are beyond those to which the general public is exposed.  Normally, workers have the burden of proof to show:

  • That the occupational illness/disease was caused by conditions that are unique to the worker’s type of employment
  • That the occupational illness was not a disease that a worker would generally develop in the same way the general public would develop the disease.

Unless the disease is one that is typically recognized in the case law and statutory law as an occupational disease, proving these two elements can be quite difficult. The presumption that a disease is occupational shifts the burden to the employer to show that the disease uniqueness and causation factors do not explain the worker’s illness. Otherwise, the disease is considered an “ordinary disease of life” and to be compensable, the injured worker must meet a standard of “clear and convincing evidence.” 

Presumption laws in many states already help emergency personnel and other first responders by allowing for presumptions for heart and lung disease. Business Insiders says that there is push in many states to apply the presumption of compensability to other disorders such as:

  • Mental health disorders such as post-traumatic stress disorder
  • Many different types of cancers

The shift in presumptions is generally a balance argument. Employers argue that shifting the presumptions will increase their employer insurance costs. Opponents of expanding presumptions argue that public safety workers in some states have other types of occupational disease protections or that that emergency responders are trained to handle some of these disorders such as stress situations.

Advocates for firefighters, police officers, and other ER officers argue that the shift is only fair because these brave workers put their lives on the line every day. Opponents to expanding the presumptions argue that, “There’s greater scientific knowledge, but that doesn’t mean that it’s all attributable to the workplace, and municipalities are very vigorous in their opposition of expanding the costs of workers compensation.” 

According to the International Association of Fire Fighters, over 40 states have some type of presumption allocation for public employees in the areas of heart and lung disease, cancer, infectious diseases, or mental health diseases.

“A 2013 study by the National Institute for Occupational Safety and Health found that firefighters have increased rates of cancer. That data has led to an influx of proposed cancer presumptions, said Jim Brinkley, Washington-based director of occupational health and safety at the International Association of Fire Fighters. Opponents argue that the scientific connections showing links between the workplace conditions and diseases are not strong enough yet.

As discussed in a previous article, although Virginia does have such presumptions in place for certain cancers amongst firefighters, Virginia has made the standards of proof difficult to meet in the event a firefighter should contract cancer, even listed cancers such as pancreatic cancer, since we have no idea what causes pancreatic cancer.  That is why the JLARC has recommended a loosening of those standards for our first responders. 

Virginia work injury attorney Joe Miller Esq. understands Virginia workers’ compensation law and keeps current with any changes. He understands that while many workers file claims based on workplace injuries, workers who spend a lot of time with an employer and become ill due to the type of work they do should also be able to demand workers’ compensation. For help with all workers’ compensation claims in Virginia, call Joe Miller, Esq., at 888-694-1671 or complete my online contact form to schedule an appointment. Cases are handled on a contingency fee basis.

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