Many workers lose their benefits because they fail to follow the proper North Carolina Workers’ Compensation laws. They may also lose their benefits if they are able to return to their pre-injury work. Employers and their insurers are always on the lookout for a way to terminate employee benefits. For this reason, injured employees should work with an experienced North Carolina work injury lawyer who understands what employers can and cannot do.
For starters, a skilled workers’ compensation lawyer will explain that the employer has to follow proper procedures. The employer cannot terminate earned benefits without the approval of the North Carolina Industrial Commission.
(Note: This is very different from Virginia Workers Compensation Procedure, wherein benefits are immediately cut off upon the mere filing by the employer or carrier of an Application to Terminate Benefits.)
The correct procedure in North Carolina is for the employer to file an Application to Suspend or Terminate Compensation. This is otherwise known as a Form 24 Motion. The Motion is completed by the employer and must include the reason(s) for the termination or suspension request, which are all set out on the form itself. The form has a place where the employee must file his or her response within 14 days after the date the Form 24 is filed (or a later time if warranted). The employee does have the right to contest the termination, and you will note that there is space provided for that response on the form itself.
A Form 24 filing should be treated as a nuclear bomb dropped on your case. If you do not spring into action quickly and create a proper response within the 14 days, that could very well be the end of your case.
The hearing on the Motion is often done informally – through a telephone conference or through an informal hearing. In the case of an informal hearing, the hearing is usually conducted within 25 days of the date of the filing. A decision should be made within 5 days of the hearing. The decision can either approve or disapprove the termination or suspension of benefits request. The decision can also hold that a formal hearing is needed.
Either side, employer or employee, can request a formal hearing after the informal hearing decision. At the formal hearing, documentary evidence is submitted and questions can be asked of the worker, a vocational rehabilitation expert, and other necessary witnesses. The formal hearing is “de novo.” – which means the hearing officer does need to consider the results of the formal hearing. In laymen’s terms, it means the formal hearing is a fresh start – a do-over.
Typical reasons an employer requests a termination of benefit
Some of the common reasons an employer will try to cut off your benefits include:
- The employee’s disability has ended. An employee who is receiving temporary disability does not have the right to wage loss benefits indefinitely. If an employer can demonstrate that the employee’s work condition has improved to the point that the worker can do his/her full-time pre-injury job and that work is available for the employee, the termination request will usually be granted.
The employer can also argue that an employee who is physically fit could find suitable work elsewhere if his/her prior job is no longer available. The argument of job availability can be defeated if the employee can show that he/she has actively looked for work in the same general geographical location and that there are no available jobs that meet the worker’s skill sets.
The employee can also argue that he/she is still physically disabled. This argument usually becomes a battle between a company doctor and the doctor that is currently treating the worker. An experienced North Carolina work injury lawyer reviews and may be able to bolster the medical evidence to help persuade the Industrial Commission that the worker is still disabled.
- The worker has failed to take a suitable job. A suitable job depends on the worker’s physical ability and all the availability of work in the area. When the medical evidence is clear, the task of determining whether work is available for each worker usually falls to a vocational expert. The expert reviews the worker’s job skills, education, medical history, work history, and government statistics to determine if the worker should reasonably be able to find work. A skilled lawyer contests negative findings of the vocational rehabilitation expert when warranted, where, for instance, the vocational expert failed to properly screen the job to make sure it fell within the employee’s work restrictions.
North Carolina does permit workers to return to work on a trial basis – to see if the worker can physically do the job.
Worker refusal to cooperate. If an employee fails to cooperate when informed that cooperation is required, the failure to cooperate can be used to terminate benefits. Some of the ways a worker can fail to cooperate are:
- Failure to take the advice or follow the treatment plan of the authorized treating doctor – whether the refusal is justified is determined on a case-by-case basis. We often see this if an employee routinely and repeatedly misses physical therapy appointments or refuses to accept a recommended treatment.
- Failure to appear for an authorized independent medical exam (IME). Sometimes, a worker will be required to see a non-treating doctor so the non-treating doctor can make an independent (though not necessarily impartial) review of the patient’s medical issues.
- Failure to work with or cooperate with the vocational rehabilitation counselor. If a vocational counselor is properly assigned to the worker, the employee must meet with the vocational rehabilitation counselor on the scheduled days and times. Repeated missing of meetings or failures to follow up on job leads or interviews can lead to a motion in this regard.
- Refusal to accept suitable employment. If the vocational rehabilitation counselor has found a suitable job for the employee and the employee unreasonably refuses to accept that job, he or she will likely draw a Form 24 Motion to Terminate benefits.
Similar termination and suspension reasoning applies if the worker has a total or partial disability. If the total or partial disability ends, the worker will lose his or her benefits.
If the hearing decision ultimately favors the employer, then benefits are terminated retroactive to the date the petition was filed. This means that employer is entitled to a credit for any overpayment. Termination proceedings usually terminate the wage benefits only and not the medical benefits. If the worker has not fully healed, the worker should be able to continue medical treatment through the North Carolina Worker’s Compensation system.
If an employer or carrier is trying to terminate or suspend your benefits via a Form 24, contact a North Carolina work injury lawyer immediately.
Don’t delay. If you get a notice of a termination or suspension proceeding, it is crucial that you speak with an experienced work injury lawyer as soon as possible. You ONLY HAVE 14 DAYS TO RESPOND TO THE MOTION. You can lose your income and even your medical benefits if you don’t respond to the termination or suspension petition. You may have strong defenses. For help now, contact Joe Miller Esq. to discuss your case and make an appointment. He can be reached at 888-694-1671. He’s been fighting for injured workers for over 25 years.
