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

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

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

The insurance companies for the employers will be looking to take advantage of any mistake to deny your claim or reduce your benefits. The best course of action is to speak with an experienced workers’ compensation lawyer as quickly as possible. An experienced work injury lawyer will guide you through each stage of the litigation. 

Key mistakes workers should avoid

Some of the key errors experienced North Carolina and Virginia workers’ compensation lawyers help their clients avoid are:

  • Waiting to get medical help for any injuries. Employees shouldn’t try to be heroes by refusing medical treatment. Many minor injuries have hidden symptoms. Delay can make a minor injury become more serious. 

Employees should seek help so the injury can be examined, diagnosed, and so a treatment plan can be implemented. Seeking medical help also verifies the injuries. Insurance adjusters may try to argue that the delay means the injuries aren’t that serious. They may also argue that the injuries were due to some other medical condition or some other accident.

Bottom line. Doctors should evaluate your medical condition as soon as possible after an accident.

  • Waiting to report your injury to your employer. Both North Carolina and Virginia require that the employer be given prompt notice of any injuries, actually, in written form, within 30 days of your accident. Most of the time, reporting the injury to your supervisor is sufficient, but ideally, an accident report is much better. This is in part to verify your claim. It is also so the employer can investigate the underlying causes and work to fix those causes so other workers aren’t injured.

In addition, if you suffer a workplace injury, your private doctor may not be able to help you. If your injury is severe and a true emergency that requires surgery or other corrective measures, than the surgeon who treats you in the hospital will usually become your treating physician by default. 

In other scenarios, employers have their favorite providers, usually some type of franchise medical provider such as Patient First, where they will direct you first. 

In Virginia, that is actually not appropriate. Workers’ compensation rules require that employees who are not in emergency situations be provided by the workers compensation insurance company with a list or “panel” of three different health care providers for the employee to choose from. Again, barring a severe, emergency situation, failure to treat with a doctor on the panel in Virginia can affect your rights to workers’ compensation if you later decide to pursue your work injury claim. 

Your choice in treating doctors in North Carolina is unfortunately more restrictive than Virginia.  Unless the injury is severe enough to require immediate hospitalization, the employer and workers compensation carrier typically exercise complete control over your medical treatment. There is no requirement for a panel of doctors in North Carolina; however, North Carolina does have some other provisions allowing for an independent medical examination with an agreed-upon physician that Virginia does not. 

Failing to utilize an authorized doctor can have other negative repercussions. If you attempt to treat for a work accident utilizing your own health insurance, your insurance company may deny coverage on the basis that your employer should be paying for the medical care. 

In North Carolina, the Industrial Commission will typically pay no attention to the opinion of any doctor with whom you treat who was not approved or authorized to treat you by either the workers compensation insurance company or the Industrial Commission itself. 

In Virginia, non-authorized physician opinions carry less weight than the opinion of your authorized treating doctor, but the Commission will consider those opinions nonetheless. 

  • You assume the employer and the insurance carrier have your best interests at heart. It’s a mistake to assume your employer and insurance carrier will automatically pay you if you are injured – even if it’s 100% clear that you were injured while doing your job. It’s also a mistake to assume that – if the insurance company pays you – that it will continue to pay you. The insurance company is only obligated to pay you in Virginia when there is an Award Order approved by the Virginia workers’ compensation commission. If the employer is paying you without a formal order, they can stop paying you as soon as you are released to light duty.  You’ll then have to seek legal counsel and engage in several steps, including a Hearing, to obtain the formal order. It’s better to seek legal counsel right away – even if the employer and insurance carrier sympathize with you.
  • You fail to keep proper medical records, especially work notes. You can’t be paid if there aren’t medical records to support your claim. You can’t successfully counter any effort by the employer to deny your benefits such as arguing you’re fit and can return to work – unless you have proper medical records, which most importantly include the doctor’s note which either gives you an excuse to be out of work completely, or provides you with physical restrictions what allow you to work only within those physical restrictions due to your injuries.  While your doctors will have their own records, it’s up to the employee to have those records as well. When the time comes to file your claim, along with those filings must be records which act as proof of your injuries on the job as well as your ongoing inability to return to that job due to your injuries. Without those records, you have no case.  You should also keep records of the cost to get to and from the doctors if you take public transportation or use a private service such as a taxi or rideshare. You should also document all your symptoms and questions so that you can review the symptoms and questions with your health providers each time you see them.
  • You don’t follow your doctor’s orders.  There are two primary reasons you need to follow your doctor’s medical advice – as best as you can:
    • Your doctor is trying to help you. If you don’t follow his/her advice, your recovery may be in jeopardy. If there is a reason for not following the advice, such as that the treatments are increasing your pain, you should review those concerns with your doctor.
    • The insurance company may try to deny your claim. Insurance companies routinely argue that employees should lose their workers’ compensation wage benefits and that their future medical bills should no longer be paid by the insurance company – if you stop following the doctor’s orders. Insurance companies generally have the right to assume the medical advice you are getting is competent. Any failure to follow a doctor’s orders (unless there is a very good reason) can result in a request to terminate your benefits. 

To make things worse, insurance companies often hire nurse case managers who basically act as spies for the insurance company to check to see if you are indeed following the medical advice of your doctors. I always tell my clients—don’t give them the satisfaction of messing up your case by you not following your doctor’s advice. 

Now sometimes, there are exceptions. The doctor may actually be incompetent, or  otherwise not providing you with a proper standard of care for your work injuries. In those rare situations, there are remedies and things that can be done to change treating physicians. This would have to be discussed with a competent workers compensation attorney. 

  • You think that you are going to get away with be secretive or about a previous injury to the same body part. One of the worst things you can do is lie to your doctor and/or your attorney about previous injuries or accidents to the same area of your body you injured in your work accident. You must understand that the workers compensation insurance company has vast resources at its disposal to discover all of your previous medical care, and the law gives them the right to investigate all of that when you bring a workers comp case. Doctor-patient privilege does not apply. So, one of the worst things you can do is be untruthful to your treating doctor. It will ruin your credibility with the doctor, and even more importantly, with the Deputy Commissioner who will hear your claim. Moreover, by lying about your medical treatment, you make it almost impossible for your attorney to present a “clean case” to the Deputy Commissioner for a decision. Before you even enter the Hearing room, you already have several strikes against you. 

 

Also, understand that unless you were still in active treatment for a previous injury to the same body part at the time of your work accident, it is extremely rare in workers compensation cases that a prior injury or other pre-existing condition will derail a case. The law recognizes that an aggravation of a pre-existing injury is considered a new injury. Your case will likely be fine. That is, unless you try to cover up that pre-existing injury by lying about it. Then you have created a problem in your case where none existed before. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. understands the ins and outs of filing a workers’ compensation. For more than 31 years, he has helped thousands of injured workers get just recoveries. To speak with an experienced North Carolina and Virginia workers’ compensation lawyer, call North Carolina and Virginia lawyer Joe Miller, Esq., at 888-667-8295, or fill out our online contact form.