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THE WORK COMP BLOG

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Workers' Compensation Claims: Three things that can happen

Three (3) things can happen if you file a workers’ compensation claim. The insurance carrier may accept the claim and pay your medical bills and send you weekly checks, which are two-thirds of average weekly wage over the last fifty-two (52) weeks. The carrier may agree to pay only medical expenses, and only while the company is trying to determine if your injury is work-related. If they decide that it is NOT work-related injury, then they can stop paying for medical treatment. Finally, the carrier may deny your injury was work-related.

A claims adjuster will be assigned to your case to help ensure your weekly checks and medical bills are paid, as well as to arrange recommended medical care. However, a claims adjuster works for the insurance company and his or her goal is to get an injured worker back to work as quickly as possible while spending the least amount of money on medical treatment.

Adjusters are always on the lookout for ways to stop weekly checks. The law requires them to get a court order before checks can legally be stopped. Before a court order can be signed, adjusters or their lawyers must file a written application to terminate a worker’s benefits (Form 24). The most common grounds for stopping checks are non-compliance (such as failing to attend physical therapy, training classes, or doctor appointments) and refusal to return to work when offered a job position.

An injured worker is given seventeen (17) days to respond to the Form 24. If the Form 24 was filed for non-compliance, the defendants must prove that the employee had not been compliant, and the employee must then prove that that he or she has complied, or has a good reason for not complying.

If the Form 24 was filed as a result of an employee refusing to return to work to a job the employer has deemed to be suitable position, the injured worker must prove that the job was unsuitable. Form 24 hearings are held by telephone conference.

This information is only a generalization and should not be construed to be legal advice. Every workers’ compensation case has different facts that must be evaluated by an experienced workers’ compensation attorney.

P: 828-252-2852

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FREQUENTLY ASKED WORKERS' COMPENSATION QUESTIONS

Q. I was involved in a car accident while working. Can I make a claim against the car insurance in addition to the workers’ compensation insurance company?

A. Yes. You will likely have a workers’ compensation claim regardless of how the car accident occurred. If the wreck was caused by someone else’s negligence, you will also have a personal injury claim against the responsible party. You should consult a lawyer familiar with both personal injury and workers’ compensation law to make sure these claims are brought in proper legal procedure. Failure to coordinate both claims could result in enforceable liens of one or both of the insurance payouts.

Q. Can my employer fire me while I am on workers’ compensation?

A. No. The Retaliatory Employment Discrimination Act (REDA) specifically prevents employers from firing you because you filed a WC claim against them. REDA protects you from any firing, demotion, punishment, or other retaliatory action the employer may try to take against you. You may be able to sue for monetary damages for a REDA violation. REDA also covers co-workers who testify in WC hearings on behalf of an injured worker. For guidance in filing a REDA claim, you should contact the NC Department of Labor at (919) 807-2796 or 1-800-NCLABOR.

Q. What if my work injury causes or exacerbates my depression or other mental illness?

A. Work injury related depression and other mental impairments may be compensable under NC Law. Our appellate courts are regularly expanding the consideration of mental and physical ailments that result from your employment and/or inability to work after a physical injury. If you believe your work injury caused or deepened any mental difficulty you might have possessed before or after the actual injury, you should fully discuss your thoughts with your mental counsellor. The Industrial commission is increasingly aware of and open to the concept that mental ailments can be as significant as physical ones.

Q. Are back injuries that are not “accidents” covered by Workers’ Compensation?

A. Yes. Generally, a work injury must be an “accident” to be compensable. Back injuries do not have to meet this requirement. NC law accepts back injuries that do not result from “accidents” if the worker can trace the injury to a “specific traumatic incident.” The more precise the time of the incident, the more likely the back injury claim will be compensable. ANY back injury should be prompted reported and checked out by a qualified physician. The details of the incident should be given very carefully and completely to both employer and medical providers. Many back injuries do not become symptomatic until several days later.

Q. What type of physical ailments are considered disabling under WC law?

A. The key to the question of whether you are disabled under WC law or not is based on how the physical or mental ailment(s) you have impact your ability to earn money. No exact listing or threshold exists in NC law for what determines a disability. If you are unable to work at the same job you held down before the accident, you are likely disabled under our law. NC law recognizes both physical and mental disabilities.

Q. Who provides and directs medical treatment resulting from a workers’ compensation accident?

A. The employer or its insurance company, subject to any NC Industrial Commission orders, provides, and directs medical treatment. The NC Industrial Commission may permit the employee to change physicians or approve a physician of employee's selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.

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Contemporaneous Workers’ Compensation and Social Security Disability Claims

Contemporaneous Workers’ Compensation and Social Security Disability Benefit

Compassionate North Carolina Social Security Disability Lawyer

David Gantt describes his History in Helping People with Workers’ Compensation and Social Security Disability Cases

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