Practice Areas

• Workers' Compensation
• Personal Injury
• Social Security Disability

Firm News

• Workers Compensation: North Carolina Industrial Commission shows we beat both AIG and Zurich in proving that this truck driver for a brick company had two separate accidents which both injured his knee, ultimately disabling him....
• Workers' Compensation: North Carolina Industrial Commission says Liberty Mutual must provide yardcare and housecleaning to an injured brickmason....
• Workers' Compensation: North Carolina Industrial Commission rules that a restaurant dishwasher who slipped and fell, and was taken straight to an emergency room has proven that he was injured on the job....
• Workers' Compensation: North Carolina Industrial Commission sanctions against the insurance company for failing to accept a claim when our client, an insulation installer, was in an auto accident....
• Workers' Compensation: North Carolina Industrial Commission: The Vocational Rehabilitation Professional, from Page Rehabilitation, had a "strained interpretation of suitable employment and the duration of her proposed job search raises serious questions as to whether her objective was to benefit plaintiff or defendants."...
• Workers' Compensation: North Carolina Industrial Commission rules against The Hartford Insurance Company and holds that a nurse who was still on her employer's property when she was hit by a car is within the course and scope of her employment and entitled to workers' compensation benefits....
• Workers' Compensation: North Carolina Industrial Commission finds that Diebold and Broadspire MUST pay weekly benefits even after they fired the injured worker from her "light duty" job....
• North Carolina Industrial Commission: OTP Lawyers stepped in to save an injured plumber whose original lawyer couldn't get the job done against Key Risk....
• North Carolina Industrial Commission: Facing down the Argonaut workers' compensation adjuster in a disputed carpal tunnel case...
• North Carolina Industrial Commission: In this case with Kemper Insurance company the NCIC found that the employer, Cintas, "schemed" to fire plaintiff while she was on light duty....

view all

Library

Workers' Compensation

• Workers' Comp Tips
• My Employer Says They Don't Have Workers Comp Insurance
• Ten Ways to Wreck Your Workers' Compensation Claim, Online Edition
• What is the Present Value of Money and Why Should I Care?
• Five Ways Doctors Can Hurt Your Case

Personal Injury

• How Uninsured Motorist Insurance protects you in a personal injury claim.

Social Security Disability

• Five Social Security Disability Tips
• What on Earth is a Workers' Compensation Offset?
• What People Applying For Disability Need To Know

General

• The Ten Worst Insurance Companies

view all

Testimonials

"From the initial interview until the check came I was treated like family. I have and will continue to recommend you to friends and family."

"I was impressed with your firm from the beginning... Although I'm sure you are totally busy with cases I always felt as though mine were the only one you were handling. All my calls were promptly returned and I really appreciate that."

"You were right up front about what the workers' compensation adjuster would try to do. I did not know anything about workers' compensation laws. I think your firm did an amazing job for me and my family."

"You were abale to spot the problems immediately and fix them."

"There's no way I could have gotten the same results without your help."

"Your office a very, very profesional office. You have always treated me with great respect, honesty, and integrity."

"You absolutely are the experts in Workers' Compensation law. You never made me feel foolish."

"You know every aspect of workers' comp and used that to my benefit."

"You were very knowledgeable and treated me with utmost respect."

"I never had another worry after hiring you."

more

How the North Carolina Legislature Made It Worse to Be an Injured Worker

How the State Legislature Has Made it More Difficult for

Injured Workers to Get Workers Compensation Benefits

In 1929, the North Carolina State legislature created the Workers Compensation Act. The purpose of this was, and is, to provide swift compensation for the employee while limiting the liability of the employer. This tradeoff saw injured workers losing the possibility of compensation for pain, suffering, loss of full benefits, etc., while making it considerably easier for them to get some benefits. This was made clear by the North Carolina Supreme Court as early as 1932 when the Court stated that [one of the guiding principles of the Act was prompt payment of those limited benefits.] Unfortunately what started out as an evenly balanced system has grown increasingly tilted in favor of employers. This is due largely to the overwhelming amount of financial pressure the employers and insurance companies exert on the legislature. No, those lobbyists aren’t just in Washington, D.C. They’re in Raleigh as well.

The most recent setback for workers across the State occurred with the amendment to the Workers Compensation Act which became effective on October 1, 2005. Before then, an employer and/or its insurance company was required to make a decision within fourteen days of notice of the injured worker’s claim. At that point the defendants could (1) accept the claim and pay benefits on a Form 60; (2) deny the claim on valid grounds, using a Form 61, and provide the injured worker with a “statement of the facts, as alleged by the employer, concerning the injury or any other matter in dispute; a statement identifying the source, by name or date and type of document, of the facts alleged by the employer; and a statement explaining why the facts, as alleged by the employer, do not entitled the employee to workers’ compensation benefits” (NCIC Rule 601); or (3) start “payment without prejudice to later deny the claim” on a Form 63.

Under the pay without prejudice (note that “prejudice” has the legal meaning of “finality.”) provision if an employer could not complete an investigation within two weeks they would pay the injured worker while they concluded their search for the facts. This situation was consistent with the initial goal of the Workers Compensation Act – to provide swift compensation to the injured worker. Most lawyers correctly interpreted this statute to require defendants to accept, deny, or pay without prejudice within fourteen days. If they failed to deny the claim the insurance company gave up the right to do so. Anything less was to deny the purpose of the Act.

Sadly, the current legislature has lost sight of those early goals of the Act. The 2005 amendments to the Workers Compensation Act give the employers and insurance companies 30 days to conduct their investigation. If they take longer than 30 days then the injured worker may ask the Industrial Commission to order a decision by the defendants. Unfortunately the division of the Industrial Commission responsible for addressing these grievances is the most-overworked, understaffed one. Thus defendants can reasonably anticipate that it will take at least 60 days before the Industrial Commission responds. It is not unusual for the Industrial Commission to take 180 days to respond to these petitions, or “motions” as they are called by lawyers. This means that employers and insurance companies now have at least 90 days to decide whether to pay a claim. During this time the injured worker is not receiving any pay or any benefits which places a huge financial burden on them.

In these situations the insurance companies will carefully balance the potential sanction assessed by the Industrial Commission against the benefits they could reap by violating the law. Thanks to the legislature they have avoided the “death penalty” of having their late denials thrown out. In fact the legislature specifically protected the insurance companies by prohibiting the Industrial Commission from striking the defenses with prejudice. So what exactly has the Industrial Commission been doing to instill fear in the heart of insurance companies? They might fine the defendants $250.00.

The defendants are playing the odds that you will return to work, shift your medical care to health insurance, and let your workers compensation claim slip away. Just as bad, they are trying to force you into settling your case for far less than it’s actually worth by putting you in a financial bind when the defendants know yours is a valid claim.

So what does this mean for an injured worker? Anyone injured on the job should immediately begin documenting their witnesses, their doctors’ visits, and their efforts to report the claim. It won’t be enough to simply tell your supervisor – the proper documentation must go to the adjuster. Although the amendment doesn’t specifically address this, it should be expected that the Industrial Commission will give additional time if the insurance company claims that they didn’t receive the report of injury from the employer. Thus it is absolutely critical that the adjuster is identified, contacted, and that the contact is documented. Remember: the adjuster is a professional, trained to reduce the number of claims that are admitted, and to reduce the benefits paid in those few cases they do accept.

At our offices we have had a lot of success in obtaining either accepted claims or a pay without prejudice. In our experience the earlier we get on the claim the greater the likelihood that it will be accepted. While no one likes to go running to lawyers as soon as something goes wrong workers compensation claims should be an exception to this rule. The rules are so lopsided in favor of the defendants that any injured worker needs to at least speak with a lawyer to find out what can be done to even the odds. The odds can, indeed, be evened. But it isn’t easy and requires knowledge and experience. With the proper planning and calculations we have been able to secure success after success for our clients. While the legislature has made this more difficult for us we remain dedicated to that single goal.