Frequently Asked Workers’ Compensation Questions

Posted on Monday, July 1st, 2019 at 10:29 am    

Workers have the right to ask questions about their workers’ compensation claim. Experienced work injury lawyers are happy to answer all your North Carolina and Virginia workers’ compensation questions.

Anyone who is injured while working on their job has questions about their rights. Anyone who suffers an illness due to workplace conditions needs to understand their rights. The best advice for any employee who becomes injured or ill working is to make an appointment with an experienced North Carolina or Virginia workers’ compensation lawyer. He can answer your questions, guide your through the workers’ compensation process, and advocate on your behalf.

Some of the more common questions, employees have about workers’ compensation include:

Who can benefit from workers’ compensation?

Generally, only employees of a company can file for work injury benefits. Independent contractors are typically not eligible. The good news is that the employer does not get to decide who is an employee or an independent contractor. The work relationship is determined by a variety of factors. The main factor is whether the employer controls the work performance of the worker or if the worker controls how he/she does their job. Some of the additional factors that determine whether a worker is an employee or not are who provides the tools to do the job, who controls the hours of performance, and how the worker is paid.

Employers with only one or two employees may not be required to carry workers’ compensation insurance. Larger workers normally must have workers’ compensation insurance for each of their employees. As with most laws, there are some exceptions.

Must I show the employer was negligent?

No.  Workers’ compensation in both North Carolina and Virginia is a compromise. The employee only must show that an accident happened at work or that an illness is due to unique workplace conditions. The employee does not even need to show the employer failed to follow normal business safety standards. The trade-off is that the employee cannot make a claim for “pain and suffering” damages. Also, workers generally only get 2/3rds of their average weekly wages during the time they can’t work – and not the full 100%. There are also caps on how much an injured or ill worker can receive, typically up to 500 weeks.

There are a few exceptions. In Virginia, employers may challenge the right of a worker to demand work injury benefits if the worker intentionally caused his or injures – such as through getting into a fight with a coworker or getting into an accident while intoxicated. In North Carolina, any such showing will reduce the recovery by 10%. 

Also, in North Carolina, there was once an exception if the employer could be found to be guilty of intentional misconduct that caused the accident. The misconduct has been interpreted as meaning that the employer must have been substantially certain that the conduct that the employee was ordered to engage in would result in injury or death.  In those circumstances, there was once some possibility that the employer in North Carolina could be sued directly. This was known as a Woodson claim, named after the poor gentlemen who was ordered to his death by his employer, straight into a ditch the employer knew was about to collapse. 

Unfortunately, in more recent times, it has been widely recognized that the North Carolina Court of Appeals has essentially eliminated any possibility that one of these Woodson claims will ever see the light of day. 

What are the standard work injury benefits?

Injured workers typically receive two types of benefits:

  • Medical compensation. The goal of workers’ compensation is to help the worker return to his or her job. Workers who are injured often start their medical care by going to the local emergency room. If there is a severe problem, they may be admitted to a hospital for tests and for surgeries. Patients then can treat with their family doctor and any specialists who might reasonably help them heal. Specialists include pain management physicians, orthopedist, neurologists, cardiac care doctors, psychologists, psychiatrists, and other doctors. 

 

Patients who are injured at work also usually treat with chiropractors, physical therapists, vocational therapists, and other health care providers.

 

These medical care providers should submit their bills to the employer’s workers compensation insurance carrier. The insurance carrier has a duty to pay these medical bills if they are reasonable, medically necessary, and related to the injury.

 

Other types of care that the insurance company should cover include the cost of medications and medical devices.

 

  • Wage loss compensation. Workers typically in both North Carolina and Virginia are entitled to receive 2/3rds of their average weekly wages during the time they can’t work. This is generally referred to as temporary total disability (TTD). There are caps on the amounts so that workers who earned too much money will only receive the cap limit. There are also limits on how long benefits can be paid –up to 500 weeks in Virginia and North Carolina. 

 

Workers who have a partial temporary disability and who can return to work receive at a lower-paying job receive 2/3rds of the wages they lose by accepting the lower paying job. This is called temporary partial disability (TPD). 

 

Workers who are no longer receiving TTD and have a permanent disability in a specific body part may be entitled to pay based on the type of disability they have in that body part. This is referred to as permanent partial impairment (PPI). Payments are made according to a percentage disability rating and a scale of weeks set forth via statute, depending on the type of disability (such as hearing loss or the loss of use of a hands, feet, arms or legs) and the degree of impairment.

Injured and ill workers may also be entitled to vocational rehabilitation; however, although this is technically a benefit it is usually not helpful to an injured workers case. It is typically utilized by the workers compensation insurance company to “trip up” the injured worker or apply pressure to settle the claim, or reduce the liability of the workers comp insurance company by finding a job-ANY job—for the injured worker. Voc Rehab is typically employed with workers who aren’t expected to return to the same type of job they did before the injury. 

Which doctors must I see? 

Normally, in Virginia, the employer will have a panel of three doctors for each type of injury or illness – starting with a list of family care doctors. Employees must choose one of the physicians on the list of doctors – for their type of injury or illness. If a referral is needed to a specialist such as an Orthopedic or Neurosurgeon, then additional panels must be provided by the workers compensation insurance company. 

In North Carolina, unfortunately, there are no panels, rather, the insurance company usually chooses a treating physician. 

If there is a good reason, then employees can seek permission from the Commission to see a doctor of their own choosing. A good reason may be that it is clear the doctor isn’t helping the injured worker get better he or she is still in pain – and still can’t work. Experienced North Carolina and Virginia work injury lawyers often have working relationships with a variety of physicians. The lawyer may be able to seek approval to switch to one of these doctors – or to an independent new doctor. 

In Virginia, this process is not easy. It really depends whether the authorized treating doctor has indicated that he or she no longer wants to see the injured worker. If the authorized treating doctor has not released the injured worker from care, for instance by saying “prn” in their office notes which means “patient may return as needed,” then it may be more difficult to seek a switch. 

Although there is no means to obtain a “second opinion” of a doctor formally through the Workers Compensation Commission by injured workers in Virginia, workers are free at any time to seek alternative care at their own cost. 

In North Carolina, there does exist a process to obtain an Independent Medical Examination—at the expense of the employer. 

Lawyer Joe Miller has helped thousands of injured and ill employees get their full workers’ compensation benefits. He represents workers in North Carolina and Virginia. He’ll answer your questions and explain the workers’ compensation process. He’ll work aggressively to help you get all the benefits you deserve. To review your case now, call  attorney Joe Miller at 1-(888) 667-8295 or use my contact form to schedule an appointment.

Vocational Rehabilitation Rights for North Carolina Workers

Posted on Thursday, June 27th, 2019 at 10:21 am    

Workers who can’t return to their old job may be entitled to vocational rehabilitation benefits. Vocational rehab benefits can include the cost of being retrained or to obtain additional education.

In most North Carolina workers compensation cases, injured and ill workers are compensated in two ways:

  • They are compensated for their medical bills. These are the hospital, doctor, and therapy bills the worker’s care medical providers are due – for helping the worker return to work to maximize their health. Medical bill payments also include the cost of drugs and medical devices.
  • They are paid for a portion of their lost wages. Generally, workers are paid 2/3rds of their average weekly wages up to 500 weeks. There are adjustments in the pay depending on whether the worker has a total or partial disability – i.e., whether the worker can return to a lower paying job with work restrictions, or remains totally disabled from work. 

Some workers, however, are not able to return to their pre-injury job because of their injuries or work-related illness. Sometimes, the worker’s doctor will authorize work with restrictions, otherwise referred to as “light duty,” – but the employer won’t be able to accommodate the restrictions. Since the goal of workers’ compensation is to help the worker earn an income, North Carolina offers another option called vocational rehabilitation.

For example, often workers who work in construction or industry depend on being physically fit to do hard physical labor. If a worker severely injures his or her back, loses function in a hand, or loses an arm; the worker can no longer do these jobs. With proper education, though, the worker could be re-trained to work in a clerical or administrative job. The worker might be able to learn technical skills that could be useful to many companies in the same job sectors or different job sectors altogether. 

Of course, the success of much of this depends on the age and current educational level of the injured worker. A 29-year-old worker is far more likely to be capable of re-training than a 59-year old laborer without a high school education. Usually, the injuries are more severe and pronounced in the older worker, and as they say, it is harder to teach an old dog new tricks. 

How vocational rehabilitation is defined

Worker’s compensation includes services that are designed to help a worker obtain suitable employment. These services typically include:

  • An assessment of the workers job skills, education, and abilities.
  • Determining what type of new job the worker could do if he/she was properly trained.
  • Reviewing the skills, degrees, and certifications that could help the worker obtain work in a new field.
  • Identifying the problems that restrict a specific worker from doing certain physical or mental tasks in a job.
  • Understanding what community college or other classes might help the worker learn new skills.
  • Understanding what college programs could help the work.
  • Providing counseling for workers looking for a new job – such as how to interview, where to apply, and how to prepare a resume.

Generally, the way it works is in accepted claims, when the worker reaches maximum medical improvement and is provided with permanent work restrictions by his or her doctor, if the employer is unable or unwilling to accommodate the injured workers’ restrictions, a vocational rehabilitation assessment will be ordered by the workers comp insurance company. 

Although these services one would think are a benefit, usually, the carrier will avoid paying for items that might truly assist in improving the worker’s skills and their ability to get a new job, such as education from a Community College or a degree from one of North Carolina’s many great universities. When Vocational Rehabilitation was classed as medical treatment back in 2011, many thought this would indicate a change in the way Voc Rehab could be used in North Carolina. 

Alas, this change has not come to be. This is because the true purpose behind most vocational rehabilitation situations is to stop benefits to the injured worker based on the injured worker’s failure to comply with the plan, or otherwise to apply pressure on the injured worker to settle his or her case as soon as possible. Often, the vocational counselor can be extremely annoying, sending seemingly endless streams of emails and calls and constantly hounding the injured worker to engage in job searches. This is by design. 

Who provides the Vocational Rehab Services

Normally, an approved vocational rehab specialist must be approved to work on behalf of the injured worker. Vocational rehab specialists are generally paid for their services in the same way doctors paid. The specialist helps identify the workers’ abilities, skills, the type of new skills needed, and course selection. This is typically done in an initial assessment, which is usually attended by the injured workers’ attorney as well. There may be written testing to determine the skill level of the employee with regard to the worker’s math and/or language skills. 

Subsequently, the vocational rehab specialist also assists monitors the worker’s success in applying for jobs and attending interviews. In some cases, this may include providing job leads to be followed up on by the injured worker, as well as scheduling actual job interviews. 

Technically, vocational rehab specialists do not work for the employer – though the progress the worker is making will be reported to the employer and the injured worker. But they do work for the workers compensation insurance company and this needs to be understood.  

If the vocational rehabilitation specialist is not helping the worker obtain suitable skills or suitable employment by, for instance, continually requiring the injured worker apply for jobs that are no longer available or which are clearly beyond the physical capability of the worker–the employee can seek to have a new vocational rehab specialist appointed. 

Generally, the rehab specialist will begin by preparing a return-to-work plan. The return to work plan should review all possible job options including:

  • Keeping the current job with the current employer
  • Getting a new job with a current employer
  • Job training with a current employer
  • Suitable employment with a new employer
  • Job training with a new employer
  • Vocational rehabilitation to get ready for a new job
  • Other possibilities including self-employment

Workers who refuse to comply with a vocational rehab plan ordered by the North Carolina Industrial Commission  may lose their compensation benefits until they do comply with the plan.

Most workers comply with new training requirements. They may object to unreasonable demands by the specialist – such as applying to jobs they have no chance of getting.

Experienced North Carolina workers’ compensation lawyers understand when it is likely that a vocational rehabilitation expert will be hired and how to prepare the injured worker in dealing with the often rigorous demands of vocational rehabilitation.  

As with most laws, some exceptions may apply – some severely injured workers may not be required to learn a new trade or skill – because there’s no reason to expect they will be hired. In other words, if it would be futile for the injured worker to be required to engage in vocational rehabilitation, due to their level of impairment, lack of education, and age, then a motion may be made by the attorney to excuse the injured worker from having to participate in vocational rehabilitation. 

The employee does not have to reach maximum medical improvement in order to be required to engage in vocational rehabilitation. Generally, employers or employees can ask for vocational rehabilitation if the worker hasn’t returned to work or if he or she is earning less than 75% of his/her average weekly wages and are receiving other approved benefits.

The vocational rehabilitation plan should be in writing and tailored to the individual worker’s needs.

Attorney Joe Miller fights for all injured workers. He has decades of experience working with vocational rehabilitation specialists. He understands when employers and insurance companies are truly interested in helping an employee get a new job and when the employer (or insurance company) is just trying to terminate a worker’s benefits or apply pressure to settle.  To learn if you are likely to end up in vocational rehabilitation, call attorney Joe Miller at 1-(888) 667-8295 or use my contact form to make an appointment.

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.

Read the full video transcription here.

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. Read the full video transcription here.

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.

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