Impairment Ratings and North Carolina Workers’ Compensation Claims

Posted on Tuesday, May 14th, 2019 at 11:11 am    

Even if an injured worker has returned to work, he or she may qualify for additional weeks of workers’ compensation pay if they lose function of a key body part. The benefits will be adjusted according to the injury impairment rating. The rating is given as a percentage rating by the injured worker’s authorized treating doctor.

There are different classifications of work injury disability in North Carolina. The main four are:

  • Temporary total disability. (TTD) Many workers are able to return to work after treatment with the doctors, therapists, and other health providers, but for now, are either held out of work completely by their doctors, or can prove that they are unable to find work within their physical restrictions;  
  • Total and permanent disability. Some workers are never able to return work at all on a permanent basis due to their injuries and are entitled to ongoing compensation for life.
  • Temporary partial disability. (TPD) In the middle, are the workers who can return to work with restrictions at a lower-paying job. They get 2/3rds of the difference between the lower-paying and pre-injury job
  • Extended compensation. A new category passed in 2011, once an injured worker reaches 425 weeks of compensation, if he or she can prove that the employee has sustained a total loss of wage-earning capacity, the employee may receive compensation beyond the 500-week limit; however, this Award can be challenged if the worker if the defendants can prove the worker is no longer disabled.

North Carolina generally pays these workers 2/3rds of their average weekly wage during the time they aren’t working. When workers return to their job with restrictions, they are paid a portion of their average weekly wages which is apportioned based on how much money they are earning at the lower- paying job.

There is one more type of condition that can result in additional wage loss payments (generally 2/3rds of the average weekly wage), even if the injured worker has returned to work. This condition is called a permanent partial impairment. Also called PPI or PPD payments.

The North Carolina Industrial Commission defines this category as follows: “Permanent disability is not a purely medical condition. A patient is ‘permanently disabled’ if ‘under a permanent disability’ when his actual or presumed ability to engage in gainful activity is reduced or absent because of ‘impairment’ and no fundamental or marked change in the future can be expected.”

Essentially, a doctor reviews the various parts of the worker’s body to see if there are any parts (such as the motion of an ankle) that the worker can’t use. The doctor then determines what percentage of that bodily function has been damaged and assigns a percentage (called an impairment rating) to the damage part of the body.

For example, if worker’s foot motion is limited due to the workplace injury, the doctor will assign the following percentages:

Limitation of motion of ankle

  • Motion between 90 degrees and 120 degrees = 10%
  • Motion between 100 degrees and 115 degrees = 25%
  • Motion between 105 degrees and 110 degrees = 50%

The impairment rating evaluation by the doctor is not made until the employee has reached what is called – Maximum Medical Improvement (MMI). Workers do have the right to treat with all physicians and therapists to try to get healthy enough to return to work. There comes a time, though, when additional medical treatment won’t improve the worker’s condition. While the worker may still be entitled to medical benefits if the treatments prevent his/her condition from worsening, the worker’s right to additional wage loss benefits is re-evaluated. The re-evaluation requires a physical examination by a physician who typically refers the injured worker for an extensive workup with a physical therapist facility.

As mentioned, the physician reviews which body part or medically related part is not functioning. The physician than assigns a rating. Generally, today, physicians no longer perform the impairment rating. Rather, specialized physical therapists perform detailed testing on the injured body parts during an extensive test called a Functional Capacity Exam, or FCE.  These physical therapists do the impairment rating use guidelines established by the American Medical Association.  After the testing is performed, the results will be sent to the doctor and the doctor will decide if he or she is willing to sign off on the testing results. Most of the time, they do.

That being said, FCE’s and the AMA guidelines are just that – guidelines. The doctor can assign the impairment rating on his/her own – based on “the examining doctor’s independent opinion based on his own knowledge, experience and clinical examination.”

Usually, the employer’s insurance company will choose the FCE facility that does the initial impairment rating/FCE Testing. The employee, in North Carolina, does have the right to get a second opinion on the rating at an doctor of his or her choosing– paid for by the employer, not the employee.

The amount of pay due a worker with an impairment is based on the following three factors:

  • The number of weeks the state has preset as a maximum for that specific type of injury. These numbers are set forth in Section 97-31 of the North Carolina Workers’ Compensation Act.
  • That number is multiplied by the impairment rating percentage
  • The resulting number is then multiplied by the workers average weekly wage figure (adjusted by 2/3rds)

In the reduced range of motion of the ankle example:

  • Workers who lose the entire use of their ankle/foot are entitled to work loss benefits for up to 144 weeks.
  • If a worker’s impairment rating is 25%, then the number of weeks is cut to 25% of 144 weeks = 36 weeks.
  • The worker then receives 2/3rds of his/her average weekly wage for 36 weeks. So– if the average weekly wage were $1000.00, then 2/3rds of that figure would be $666.67. That is the compensation rate of $666.67 x 36 weeks, which gives us a payment to the injured worker of $24,000.00 for his or her permanent partial impairment to that body part.

Note that these payments ARE NOT in addition to the maximum of 500 weeks of benefits and one cannot receive these payments for. Unless the worker has been determined to be totally disabled per the rules or entitled to extended compensation, 500 weeks is the limit.

The permanent partial impairment benefit therefore really only becomes important where the injured worker has returned to work at the same pay as pre-injury. Then, with the help of an experienced North Carolina workers’ compensation lawyer, the worker may be entitled to a lump sum payment instead of having to wait the 24 weeks to get his/her physical impairment benefit.

Section 97-31 covers the loss of hearing or the loss of vision (one eye or both) in addition to the loss of use or the amputation of any limbs, hands, feet, finger or toes. Additional payments can also be made for disfigurement or scarring. The loss of use of important bodily organs is also covered.

Workers need to be careful. They should review their disability payment rights and overall workers’ compensation rights with an experienced lawyer.   Once the worker accepts a permanent partial disability, they can continue to receive medical benefits – provided the medical benefits are helping the worker. This could further form the basis of a potential settlement with the insurance company—even if the injured worker has returned to work.

Joe Miller Esq., understands when workers should claim the impairment disability benefits. We work to verify the injury and the impairment rating. We recommend settlement when it is in the worker’s best interest. We’ve been fighting for injured workers for over 31 years. For help with all phases of your workers’ compensation claim, call attorney Joe Miller at 1-(888) 667-8295 or complete my contact form to schedule an appointment.

New Workers’ Compensation Trends

Posted on Wednesday, May 1st, 2019 at 3:08 pm    

Sometimes, we like to look at the broad trends in the workers’ compensation arena. These trends can help anticipate new changes to the North Carolina and Virginia worker’s compensation laws. They can help us understand what limits and expansions of benefits might apply – particularly for medical and vocational benefits. Trends help understand why workers get injured, what can be done to reduce the risk of injury, and what medical benefits may help the worker. Trends can also address the administrative end so that claims are filed faster and decisions are made on a quicker basis.

According to Managed OutSource Solutions Medical Record Review, these are some of the new trends and concerns for 2019:

  • Many states have adopted Medicaid Expansion. Medicaid expansion may help low-wage workers get medical treatment when workers’ compensation is untimely or when an accident isn’t covered by state workers’ compensation insurance.
  • As prescription drug costs continue to increase, new strategies are being developed to address the high cost of these drugs.
  • With each new election cycle, state administrations may change power. There may be changes in Governorships, state House seats, and state Senator seats. These officials help decide who the next workers’ compensation Commissioners will be. We saw this not long ago in North Carolina, which has turned decidedly Republican. As a result, the workers compensation system in North Carolina as well as the personal injury laws underwent a massive change toward less rights for injured workers in 2011. And in 2019, the Industrial Commission, as a result of republican appointments, has become far more conservative and company-oriented than in previous years.  But there are sometimes benefits to change. Many states, including Virginia, now have statutes to help first responders (police, firefighters, and emergency medical technicians) get their workers’ compensation benefits faster and to cover injuries such as post-traumatic stress disorder and heart disease. Some states are making payments to the spouses of first responders a priority in the case of the tragic death of a first responder.
  • A possible new trend is to focus more on the emotional and psychological scars of any workplace injury. New treatment plans may be compensable. Doctors may be encouraged to help workers get evaluations and treatments for this side of their pain. Workers may be more encouraged to seek treatment with psychologists and mental health professionals.
  • There will be more reviews of the American Medical Association (AMA) impairment guidelines. Doctors use these AMA guidelines to determine a worker’s level of physical impairment in a specific body part. The relationship between physical impairment and loss of earning capacity due to that impairment might become part of the analysis of an employee’s work injury claim and his/her permanent partial impairment rating, especially if there is a permanent and total disability.
  • Another trend will focus on such issues as safe housing, transportation access and other socioeconomic factors. For example, the review states that “Many insurers are already addressing these concerns by providing meal replacement delivery services after surgery and also caregiver services for food preparation and companionship.”
  • The use of telemedicine as a way of improving the patient’s health and providing access to more physician service will be explored. Telemedicine may be especially useful for workers who can’t get a ride to see their physicians. Telemedicine also gives employees a chance to speak with specialists who aren’t local to where the worker lives.
  • As claims adjusters are retiring, new claims adjusters will need be trained
  • Employers are now offering more leave of absence programs and more enticements for workers as the economy begins to rebound. Employers, according to the Review, claim that leave of absence programs are more than just an enticement. They help companies keep employees.
  • Newer workers are more likely to be injured because they don’t have the training and experience to handle complex tools, machines, and business requirements.

Insurance industry trends

Heffernan Insurance Brokers provides the following trend review for California. Some of their trends should be taken with a grain of salt as insurance companies favor the employers who hire them. Insurance companies are not the worker’s friend when there are disputes.

Many of these trends may become trends for North Carolina and Virginia:

  • “Evidence based-medicine” is helping workers get improved treatments, better medications, and better access to doctors
  • Some companies, such as Starbucks, are using self-reporting system that let employees self-report when they first have an accident rather than going through the company manager. The process involves more technology including a workers’ compensation call center, direct-deposit of workers’ pay, and other benefits.
  • Employers are recognizing they can help their employees through early intervention. Musculoskeletal ailments, according to the Bureau of Labor Statistics account for nearly 13% of all worker injury and illness claims. These disorders include back injuries, muscle strains, tendinitis, and carpal tunnel syndrome. Early medical care can help the worker get the care he/she needs and return to work sooner.
  • Like the Managed Outsource Solution study, Heffernan believes that telemedicine will be a major workers’ health trend. In addition to providing physical care, telemedicine is being used to provide psychological care. Workers with mental health problems find that speaking with a counselor or doctor directly through the Internet is more comfortable than driving to an office, seeing other patients, and having to work with office personnel. Telemedicine is available for desktops and smartphones.
  • Onsite triage programs. One California company uses an onsite triage program to make a quick diagnosis of a worker’s injuries and then arranges for a ride-hailing service to get the worker to the hospital as quickly as possible.
  • Robotics. Robotics are helping workers’ compensation insurance companies and doctors reduce costs while providing physical therapy, clerical help, and other services to the worker

 

Workers’ compensation lawyer Joe Miller Esq. has been fighting for injured workers for more than 30 years. We’ve helped thousands of injured workers get the wage loss benefits and medical compensation they deserve. We work to keep abreast of industry trends so we can better understand how workplace accidents happen and what medical options are possible. At the core, we are strong advocates for anyone who is injured at work for any reason. To speak with a strong experienced advocate, please  call attorney Joe Miller at 1-(888) 667-8295 or fill out my contact form to make an appointment. Initial consultations are free.

 

Types of Small Reimbursements in Workers’ Compensation Cases

Posted on Friday, April 5th, 2019 at 3:06 pm    

The bulk of the payments in a North Carolina or Virginia workers’ compensation claim are the wage loss benefits and the medical expenses. Wage loss benefits are generally paid at the rate of 2/3rds of the worker’s average weekly wages (prior to the accident) – up to preset maximums. The wages are paid until the employee can return to work. Additional payments may be made if the worker has a full or partial permanent disability.  Adjustments to the pay are usually made if the employee can return to work but at a lower paying salary.

Medical payments cover surgeries, doctor visits, psychological counseling, and a variety of different therapies. The payments are made by the employer’s insurance company as long as the treatments are helping the worker get better. Even when an employee has reached maximum medical improvement (no additional medical care will improve his/her condition), the worker is still entitled to have the medical bills paid so that the condition doesn’t worsen. In other words, the worker is entitled to medical coverage to maintain his/her health.

Vocational rehabilitation

Some workers may not be able to return to their prior work because of the severity of their injuries. North Carolina and Virginia allow these workers to explore the option of vocational retraining. The employer may be required to pay the cost of training the worker or helping the worker get an education – up to certain limitations. Helping workers acquire new schools often means they can work in new jobs at somewhat similar pay. Speak with a skilled North Carolina or Virginia workers’ compensation lawyer to learn if you are entitled to vocational rehabilitation expenses.

Mileage reimbursement to the doctors

Workers often need to treat with many different doctors. Additionally, they may be required to see a doctor or health provider multiple times. Many workers, for example, can see their physical therapist several times a week for months at a time.

The cost to get these doctors can add up quickly. In North Carolina and Virginia, workers are entitled to be reimbursed for the cost to see their own doctors, to travel to an independent medical examination when requested, and for vocational rehabilitation support and schooling. The mileage reimbursement expenses continue for health care even if the worker has returned to the job – provided the worker needs the medical treatments to stay healthy.

The mileage expenses are calculated as follows:

In North Carolina, workers can claim mileage reimbursement if the round trip to the doctor or therapist is 20 miles or more. The amount the worker will receive is generally set by the North Carolina Industrial Commission. The NCIC, in turn, sets its rates based on the Standard Mileage Rate that is annually prepared by the IRS.

According to the NCIC, the mileage reimbursement rates are as follows:

“If employees travel 20 miles or more round-trip for medical treatment in workers’ compensation cases, they are entitled to collect for mileage at the rate of 25 cents a mile for travel prior to June 1, 2000;

  • 31 cents a mile for travel between June 1, 2000 and January 17, 2006;
  • 44.5 cents a mile for travel between January 18 and December 31, 2006;
  • 48.5 cents a mile for travel between January 1 and December 31, 2007;
  • 50.5 cents a mile for travel between January 1 and June 30, 2008;
  • 58.5 cents a mile for travel between July 1 and December 31, 2008;
  • 55 cents a mile for travel during 2009;
  • 50 cents a mile for travel during 2010; 51 cents a mile for travel between January 1 and June 30, 2011;
  • 55.5 cents a mile for travel between July 1, 2011 and December 31, 2012;
  • 56.5 cents a mile for travel between January 1 and December 31, 2013;
  • 56 cents a mile for travel between January 1 and December 31, 2014;
  • 57.5 cents a mile for travel between January 1 and December 31, 2015;
  • 54 cents a mile for travel on or after January 1, 2016.”

According to the IRS, the rates for 2017 are 53.5 cents per mile and for 2018, the reimbursement rate is 54.5 cents per mile.

The costs are meant to cover expenses for gasoline as well as wear and tear on the vehicle.

“The Industrial Commission has given the self-insurers and insurance carriers permission to pay drug and travel expenses directly to the employee without approval from the Commission.” This means that, normally, the worker will keep a record of the mileage and then submit the record to the employer’s insurance company. The record should include the date of the visit to the health provider, the identity and location of the healthcare provided, and the total distance traveled. North Carolina actually provides a form, called a Form 25T, upon which the worker should submit his or her mileage information to the employer.  It’s generally a good idea to mark down the odometer amount before the trip starts and at the end of the return home. The distance from your home to the health care provider can also be tracked by using Google Maps.

Generally, workers should be reimbursed within a few weeks from the time they submit their form but unfortunately there is no rule that sets for the time frame by which the employer/insurance carrier are required to reimburse the employee. Unfortunately, some carriers are delinquent in this regard and we sometimes have to file a motion with the Commission if an unreasonable amount of time has passed before payment has been received by the injured worker.  Depending on the amount of medical and/or vocational travel you are engaging in, it’s a good idea to submit mileage reimbursement requests on a monthly basis

Workers who take public transportation are generally allowed to be reimbursed for the cost of the public transportation. Workers who use their car to see their health care provider should also add in the cost of parking – if there is any.

The mileage reimbursement rates in Virginia are based on the same principles.  Virginia likes workers to:

  • Indicate the dates traveled and the addresses (the workers and the health care providers)
  • Attach a MapQuest or Google Maps printout of the directions and mileage
  • List any parking, bridge tolls, or public transportation costs. This can include the cost of a taxi.
  • In Virginia, mileage is reimbursed at 55.5 cents per mile.

 

Reimbursement includes the mileage reimbursement and the other miscellaneous costs – tolls, public transportation, and taxi. Workers should also include a statement from the healthcare provider to confirm they were at the appointment on the scheduled dates. Virginia does not have the 20-mile round requirement that North Carolina does.

At the North Carolina and Virginia Law office of Joe Miller Esq., we’ve been fighting for injured workers for more than 25 years. We fight to get our clients every amount they deserve – large and small. We’ll fight to get you approved for worker’s compensation benefits and explain which forms you need to complete to get paid. To speak with an experienced work injury lawyer, phone 1-(888) 694-7994 or fill out my contact form to schedule a free appointment.

The Settlement Process In A Virginia Workers’ Comp Case

Posted on Monday, February 18th, 2019 at 5:41 pm    

Here Virginia Workers Comp Attorney Joe Miller reviews the Settlement Process in a Virginia Workers Compensation Case. Although he is addressing his clients, if you are looking at settling your case, you can benefit from this “inside baseball” view of settlements as well.

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.

Do Not Quit Your Job

Posted on Thursday, August 2nd, 2018 at 12:30 pm    

Lately, we have been coming across cases where we haven’t been able to help an injured worker because they have quit their job after being hurt.

We understand how frustrating it is when an employer or insurance company will not cooperate, or you are sent to a company doctor who will not listen to you. You are hurt and the doctor is sending you back to work when you know you are really in severe pain and you have no business working. So in frustration, you just quit your job and hope for the best.

But injured workers need to understand that just because they are hearing the job numbers in the U.S. are up and there is low unemployment, that does not mean the worker can “have his cake and eat it too,” by simply quitting his job after a serious injury. When the injured worker quits, he does irreparable damage to his chances of obtaining a fair recovery for his workers compensation claim.

You simply cannot quit the job you were hurt on and then expect to have a decent workers compensation claim.

In this video, workers compensation attorney Joe Miller explains why you should NEVER quit your job after an on-the-job injury.

If you or a loved one were hurt on the job in either Virginia or North Carolina, please call us at 888-694-1671 or use our online form.

Issues to Consider If Your Employer Wants you to Return to Work

Posted on Thursday, July 26th, 2018 at 8:29 am    

Many injured workers can never return to work. A traumatic brain injury, spinal cord injury, paralysis, or other disorder may make the worker permanently disabled. Some workers can return to work but with medical restrictions. Many employees need to be retrained so they can learn a new job.

Employees should work with their doctor and their workers’ compensation lawyer so that they understand their medical needs and legal rights. Employers often try to force workers back to their job or a job before the worker is really ready.

Most workers are happy to return to work if they can do the job. Workers’ compensation generally just pays about 2/3rds of the worker’s wages. It’s nice to get 100% of your pay. With work comes the reward of helping your company and your community. Workers who can’t return to work shouldn’t be rushed. You do have the right to contest efforts to make you return to a job before you’re physically ready.

Medical issues to consider

First, you do have the right to have your treating doctor evaluate your ability to perform the tasks needed to do your job. You should explain to your doctor all the tasks that are required. This includes

  • How many hours you need to stand
  • Whether you can lift, push, pull, or carry heavy items
  • The type of skills you need to do job
  • The job ratings used to judge your work performance
  • How often you can take breaks
  • The hours you need to work
  • How often you interact with the public
  • Many other requirements needed to do your job

Your doctor will generally make one of the following evaluations

  • You cannot return to work at the current time
  • You can return to work but with work restrictions (light duty)
  • You can return to work without any restrictions (full duty)

Once a medical evaluation has been made, an employee should review these options with an experienced North Carolina or Virginia workers’ compensation attorney. If you think you’re just not physically or mentally ready, the lawyer may seek an independent medical evaluation.

There are differences as to how this is accomplished as between North Carolina and Virginia. North Carolina has a statutory method for obtaining an independent medical evaluation (IME) at the defendants’ expense. Attempting to see a doctor outside of this permissible scenario will likely not accomplish anything, as the treatment or evaluation was not authorized.

Virginia has no such method for an IME; however, in Virginia there are really no restrictions on you seeing a doctor on your own, assuming you can pay for it. It must also be remembered that the Virginia Workers Compensation Commission will generally side with the opinion of the authorized treating doctor as opposed to someone you chose on your own. The exception is if the treating doctor has released you and stated that he or she has nothing more to offer you insofar as treatment is concerned. In those cases, you may be entitled to move for a change in treating physicians.  

Return to work outcomes

Possible return to work scenarios include:

  • Trying to work and succeeding. If there is legitimate reason you can return to work, then most employees are encouraged to give the return a work. Caution should be used. You should review your concerns with your employer. If you can return to work, the employer’s insurance carrier will seek to terminate your wage benefits. You still are entitled to medical care provided the care is helping you improve your medical condition – or is helping you to avoid any regression.
  • Doing different types of work. Some workers can return to the same company but at a less stressful level. Some workers can shift to administrative work instead of manual labor. Workers may even be required to look for work with a different employer if they can’t do their old job or their old job is no longer available. When this happens, we call it “accommodation” of the employee’s work restrictions. Unfortunately, this can be potentially very damaging to your case.
  • Trying to work and failing. If the employer the authorized treating physician both agree that you’re not ready to work on a regular basis, then you should be able to reassert your demand for wage benefits until your medical condition improves. If the employer believes you can work but you think the pain is unbearable, then you must have doctor’s opinion supporting your right to remain out of work, or you could be fired for cause for failing to follow the treating physician’s advice, and then your case would pretty much be over.

 

Working with restrictions.

Often, doctors will say you can return to work with restrictions. Examples of restrictions include:

  • Being allowed regular rest breaks
  • Not lifting in excess of 10 pounds
  • Being allowed to sit/stand as needed. There may be limit such as being allowed to sit after standing for two hours.

The doctor should prepare detailed written restrictions. The restrictions, in turn, should be given to your attorney if you have one, and he will disseminate those restrictions to your employer and/or opposing counsel.  If an employer doesn’t respect these restrictions, you do have the right to complain to your doctor. You should take written notes of every time an employer forces you to work beyond these restrictions and you should make sure you tell your doctor precisely which duties are causing you severe pain.

Employees who work with restrictions whose employers cannot accommodate those restrictions may still be entitled to their temporary total disability checks, assuming the worker has an accepted claim in North Carolina or is under an Award in Virginia. If the worker returns to light duty at a lower wage, then the worker would be entitled to 2/3rds of the difference between the pre-injury wage and the light duty wage. This is called “temporary partial disability”. This category of worker usually earns less money than they earned before the accident or occupational illness.

For example, take John who was making $900 a week before his injury. After his injury, he only earns $600 a week. John is entitled to his $600 pay. He is also entitled to 2/3 of the difference between the pre-injury and light duty pay.  Since the difference is $300, John is entitled to claim a $200-per-week temporary total disability payment on top of the $600 weekly wage.

The worker continues to be entitled to payment for all reasonable medical bills, treatments, medical devices, and medications while working with restrictions. Workers with restrictions often continue to treat with physical therapists. Many take prescription medications.

Additional return to work considerations

Just because you return to work, doesn’t mean you reached your maximum medical improvement. Many employees continue with medical treatments while they’re doing light duty work. It is only when the employee reaches MMI that an evaluation can be made as to whether the employee has a permanent disability, a partial permanent disability, or no disability. Long-term settlements in workers’ compensation cases may be possible when maximum medical improvement is achieved.

Workers who can’t return to the same job with or without restrictions may be entitled to vocational training. This training ideally allows the worker to learn new skills so he/she can get a new job. It is sometime used, for example, when a worker who did manual labor is retrained to do clerical work.

But one should be extremely cautious with the vocational rehabilitation counselors. Although they are supposed to help the worker find a job, their real mission is usually to torpedo and sink your case by claiming that you failed to comply with their often ridiculous job search requirements.

Understand your right to return to work only when you’re able to

At the North Carolina and Virginia Law offices of Joe Miller Law and the Work Injury Center, we have been fighting for injured workers for more than 30 years. Joe Miller has helped thousands of injured workers get the workers’ compensation benefits they fully deserve. Joe  Miller works with your doctors to understand you medical problems and when you can competently do your job. For help , please call (888) 694-1671 or complete my contact form.

Valuing a Worker’s Compensation Case Settlement & How Life Expectancy and Present Value are Determined

Posted on Tuesday, March 6th, 2018 at 11:14 am    

If you or someone you love is disabled from a work injury, the disabled worker can receive 2/3rds (.66667) of their average weekly wage loss benefits on a weekly basis for up to 500 weeks. This is called temporary total disability or TTD.  In some very narrow categories of permanent and total disability injuries, that can be extended to lifetime payments, often well beyond the 500 weeks.  

Many employees prefer though, to settle their case rather than continue to receive weekly checks.  As part of the settlement, they will ask for some or all of the future wage losses in a lump sum benefit as well as an estimate of the value of their future medical care, rather than continue to receive their wages and medical care from the workers compensation carrier on a weekly basis. That way, the employee has immediate access to their funds and can also invest the funds and even pass the money on to his or her heirs. If the worker gets another job or dies, then the payment stops and there are no funds to pass on to one’s children or grandchildren. Experienced North Carolina or Virginia worker’s compensation lawyers understand how to properly value your case so that you or your loved one gets all that he/she deserves.

The amount of the lump sum that needs to be calculated as to your future comp payments is essentially 2/3rds of your average weekly wages up to 500 weeks; however, there may be initial discounts to consider if it is anticipated that you will return to work sometime before the end of the 500 weeks. In addition, there is no guarantee that you will live for the entirety of the 500 weeks. You could, in fact, die from unrelated causes and if that happens, or if you return to work at the same or higher wages, then the weekly payments would stop.

Another consideration is that if you get paid in a lump sum, in North Carolina, your calculation as to future payments must be discounted because you can invest your settlement funds into interest bearing accounts. This is called figuring out the PRESENT VALUE of the future amounts.

We typically do not do this in Virginia, because Virginia provides workers under Awards with the right to COLA payment increases whereas North Carolina does not. Do in Virginia, if we simply take out the anticipated future COLA payments when figuring out the future lump sum amounts, then any gains are really offset by inflation, so there is no discount rate needed.

North Carolina, on the other hand, does not provide COLA as part of its compensation scheme, so you give nothing up when figuring up future lump sums. So you must therefore reduce to present value.

Present Value and the Discount rate.

The discount rate is a way of figuring what the present value of your future income should be in North Carolina. For example, if your Average Weekly Wage (AWW) is $900.00, your compensation rate is 2/3rds of that, or $600.00. If you elect to be paid weekly over 500 weeks, you will ultimately receive $600.00 x 500 weeks= $300,000.

If the interest rate is calculated at three 3 %, the present value of your money is approximately $260,500.00. In other words, if you invest $260,500.00 at 3 percent yearly interest, you will generate $300,000 in money in 500 weeks. In this example, your $300,000 in income is being discounted about 13% down to the $260,500 figure.

While financial experts understand how much money a settlement will earn if it obtains, for example, three percent per for 30 years, the experts don’t know whether the interest rates may change over time.

  • It may be that the interest rate decreases during the 500-week period. In this scenario, a three percent return is a good deal;
  • If may be that the interest rate increases over time. In this scenario, the three percent return is a bad deal

Generally what is done is that the parties argue and usually compromise over the discount rate during negotiations. The defense obviously wants to pay less so they will use a higher discount rate, where the injured worker’s attorney will argue that while higher interest rates are available, the investments that produce them are often more risky and volatile, and less safe.  The injured worker’s lawyer will argue that something safe would be something like treasury bonds or other such instruments, which typically pay something like 3-4%, depending on the year. Defense attorneys will argue for investments in the 6-8% range or higher.

Life Expectancy Determination and Future Medical Care

In both North Carolina and Virginia, while most employees are limited to TTD payments up to 500 weeks, that is not the only component that goes into figuring up the value of a potential settlement.  There is also the lifetime medical award, and this is where it is important to understand your life expectancy. For instance, if you are on certain expensive prescription medications for your injuries, and it is likely you will have to remain on them for the rest of your life, this could be a huge component and “exposure” to the workers compensation carrier which may motivate them to settle your claim.

As an example, let’s assume you are a 55-year-old male injured worker in Virginia. Using the table for Virginia below, we are entitled to assume your life expectancy is 24.3 years. Let’s say that you are taking an expensive prescription that is costing the comp carrier $500.00 per month. That translates to an annual cost of $6000.00 x 24.3 years, which is a future prescription cost of $145,800.00. Along with future potential surgeries, or other treatment as recommended by your doctor, this future medical treatment can form a significant component of any demand to fully and finally settle your claim.

North Carolina uses the following life expectancy figures for worker’s compensation cases (just the first few years and then increments of five years are provided):

  • 18 58.8
  • 19 57.9
  • 20 56.9
  • 25 52.2
  • 30 47.5
  • 35 42.9
  • 40 38.3
  • 45 33.8
  • 50 29.3
  • 55 25.1
  • 60 21.1
  • 65 17.5
  • 70 14.2
  • 75 11.2
  • 80 8.5

Virginia uses the following life expectancy figures (for both genders, for just men, and for just women)

  • Age Both Men Women
  • 18 60.3 57.7 62.8
  • 19 59.3 56.7 61.8
  • 20 58.4 55.8 60.8
  • 25 53.6 51.2 56
  • 30 48.9 46.5 51.1
  • 35 44.1 41.8 46.3
  • 40 39.5 37.2 41.5
  • 45 34.9 32.8 36.9
  • 50 30.5 28.5 32.3
  • 55 26.2 24.3 27.9
  • 60 22.2 20.4 23.7
  • 65 18.4 16.8 19.7
  • 70 14.8 13.4 15.9
  • 75 11.7 10.5 12.5
  • 80 8.9 7.9 9.5

Note that we typically do not discount the future medical component of the settlement because of the ongoing very high increases in medical costs. When calculating medical costs, we are using static figures available to us now, so any future lump sum on the future medical already has a built-in discount as we are not considering those future increased costs.

Additional lump sum benefit considerations

There are other factors that are crucial in determining the amount of any full and final settlement. Some of these factors are:

  • The number of weeks you already received benefits must be calculated.
  • Lump sum settlements can also be used if you have an impairment that has been rated but not if you are currently receiving TTD benefits.  
  • The availability of other public benefits. You must consider your Medicare benefits. You should consider your SSI (Supplemental Security Income) and SSDI (Social Security Disability Insurance) benefits. A settlement can affect how much SSDI you receive. This may require a Medicare Set Aside.
  • The availability of private benefits such as disability insurance or other health insurance
  • Your financial situation before you settle
  • The likelihood that you are going to be able to find a job after settlement—are you currently in vocational rehabilitation and are they close to finding you a job?
  • Your age and skill set
  • Whether you’ve reached maximum medical improvement
  • What are the amounts of any outstanding, related medical bills that the carrier has not yet paid? This should be part of any settlement as well.
  • Many other factors

After the future TTD estimates and Future Medical costs are added up, we will typically then present a figure that we request for our demand in the case. Other components that might go into the demand are future medical travel costs, future x-rays, MRI’s or other medical monitoring. We also always ask that the carrier pay any outstanding, related medical costs that have not yet been paid. In addition, ongoing weekly payments typically continue until issuance of the Settlement Order by the Virginia Workers Compensation Commission or Industrial Commission.

Note that if you are a current Medicare recipient, ALMOST NONE OF THIS APPLIES as you will have to engage in a MEDICARE SET ASIDE (MSA) and Medicare will have to approve the MSA amounts in order for you to receive any kind of medical settlement. In these circumstances, your future medical costs will be calculated by one of any number of companies who will submit a report estimating the cost of your future, injury-related care to Medicare for approval. You or your attorney will have no control over determining those estimates.   The only items that will fall outside the purview of the MSA are items that would not be covered by Medicare. For instance, certain prescriptions are not approved by Medicare for treating pain.

We recommend that you do not try to negotiate your lump sum full and final settlement or clincher on your own. You can’t renegotiate the lump sum payment if you make a mistake. Any worker considering a full and final settlement (called a clincher in North Carolina) should consult with an experienced North Carolina or Virginia workers’ compensation attorney. You may be wildly underestimating what your case is worth.

Do not settle your claim without speaking to an experienced work injury lawyer. Attorney Joe Miller Esq. has been helping injured workers get justice for over a quarter century. He understands how to negotiate and what wage and medical benefits you are entitled to. To learn what your rights are, please call lawyer Joe Miller at (888) 694-1671. You can also reach him through his contact form.

What Is Mediation?

Posted on Tuesday, September 5th, 2017 at 2:22 pm    

Attorney Joe Miller explains what mediation is and how it can be helpful:

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