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WHO PAYS FOR MEDICAL BILLS?

 

WHO PAYS FOR MEDICAL BILLS?

‚ If you have a compensable workers’ compensation claim, the private insurance company is responsible
for paying 100% of your medical bills.
‚ That includes doctor’s visits, prescriptions, x-rays, MRI’s, physical therapy or any other type of medical
device you might need.
‚ Additionally, you are entitled to recover mileage reimbursements for your trips if they are more than a
20-mile round trip.
‚ The insurance company generally gets to select the doctor who treats you, but I’ll talk more about that in
another video.
‚ The doctor’s office often demands authorization from the workers’ compensation carrier before they will
treat you. Have your employer contact the doctor’s office to send the insurance information to them for
authorization.
‚ Do you have a right to see a doctor outside of the workers’ compensation system? Absolutely. The
question is, who is going to pay for it. If you’ve seen a doctor that is not authorized by the workers’
compensation carrier, please contact my office as soon as possible so that we can start the process to get
that bill paid.
‚ If you need medical treatment that is not being authorized by the insurance company, we can file a
motion with the Industrial Commission to demand that they authorize the care you need. Please contact
my office as soon as possible so that we can get that process started.

Who get to Choose the Doctor you see?

WHO GETS TO CHOOSE THE DOCTOR WHO TREATS YOU FOR YOUR INJURIES?

In 2011, the business community convinced the legislature to strip workers’ of the right to pick their own
doctor. Now, the insurance company controls what doctor’s you will be seeing first and also any
specialists who will see you later for your care.
‚ What rights do you have, then, for a second opinion for treatment? Well, under the new law you do have
some rights to petition the Industrial Commission to ask that they require the insurance company to pay
for a second opinion for treatment. Contact my office so we can help you get that done.
‚ Do you have rights for any other opinions? Yes! You have a right to a 2nd opinion on an impairment
rating given to you by your doctor. What’s an impairment rating? It’s a percentage of a loss of use of a
body part. So, for example, you have a knee surgery and the doctor removes part of the cartilage in your
knee.

‚ You’re going to have a permanent impairment rating to your knee. You have the right to a 2nd
opinion on that amount of impairment rating. The 2nd opinion doctor can talk about the impairment
rating but, unfortunately, under the new law, they can no longer talk about whether you are able to go
back to work and whether you need any future medical care as a result of that injury.

Can I Get Fired For Fling a Workers’ Compensation Claim?

WHAT BENEFITS ARE YOU ENTITLED TO AFTER YOU’VE BEEN INJURED ON THE JOB?

‚ If you have a workers’ compensation claim, you’re entitled to benefits for three things:
1. Medical treatment;
2. Payment for time out of work;
3. Payment for any permanent injury that you sustain.
‚ Workers’ compensation does not pay you for any of the pain or suffering or anguish that we know are
present in every workers’ compensation case.
‚ That’s why I think it’s important that we maximize your recovery for the benefits that you are entitled to.
‚ I will talk more about these benefits in other videos.

 

 

How is Permanent Injuries Valued

HOW IS A PERMANENT INJURY VALUED?

If the doctor finds that you have a permanent injury, you are entitled to compensation for that based upon
your ability to return back to work. We have the obligation to show how the injury affected your ability
to earn wages.
‚ There are three ways that we can put a value on a workers’ compensation case with a permanent injury:

‚ The law changed in 2011, which affects some of the injured workers’ benefits. We will be certain to
look at the date of injury and address how the changes in the law affect your benefits.

1. The first is based upon the impairment rating or percentage of loss of use of the body
part that the doctor assigns;
2. Second is based upon an inability to return to the wages that you were making before you
got hurt; and
3. Third is based upon your inability to return to work in any competitive employment for
your lifetime.

 

 

 

How do you get paid Back for Time Out of Work?

HOW DO YOU GET PAID FOR YOUR TIME OUT OF WORK?

If you’ve had a compensable injury, the private insurance company (the workers’ compensation carrier)
is obligated to pay you for your time out of work.
‚ Generally, you have to have a doctor’s note taking you out of work before any benefits can be paid. That
doctor’s note has to be sent to your employer, who sends it to the insurance company, who reviews it and
then makes payment.
‚ You’re not entitled to be paid for the first seven days that you’re out of work. But if you’re out of work
for more than 21 days, the workers’ compensation carrier has to come back and pay you for the first
seven days.
‚ How much are you paid when you are out of work? The workers’ compensation law says that you are
not entitled to 100% of your wages, but that you are entitled to receive 67%, or 2/3’s, of your average
weekly wage. Your average weekly wage includes any type of bonuses, overtime, or additional money
that you earned for the year prior to your injury.
‚ When would your workers’ comp checks stop? There are four reasons, once your checks get started, that
they could stop:
1. First, you go back to work;
2. Second, the doctor says that you can return to work without any restrictions.
3. Third, you settle your workers’ compensation case; or
4. The Industrial Commission gives the insurance company permission to stop your checks.
‚ Why would they stop your checks? Perhaps you’ve refused suitable employment; perhaps you’re
working under the table; perhaps you are claiming that your injuries are more severe than they are; or
perhaps you’re refusing to get medical treatment that your doctor’s have ordered.

 

 

What to do If Workers Comp claims are denied

WHAT IF YOUR WORKERS’ COMPENSATION CLAIM IS DENIED?

‚ What if the insurance company doesn’t believe that you have a compensable claim? They’ll deny your
case. Let me give some common examples of reasons for denial:
1. First of all, the employer may say that you were not working for them at the time you were hurt.
2. The insurance company may say that you were never hurt at all and that you were lying about
your injury.
3. They may say that your injury doesn’t meet one of the three theories of liability under the
Workers’ Compensation Act. The Plaintiff has the obligation to show that they were injured by
an accident, by a specific traumatic incident, or an occupational disease.
Those could also be reasons why the insurance company chooses to deny your case.
‚ If the insurance company denies your claim, we are going to try and get them to reverse that decision,
because that is the fastest way to get benefits for you. If we can’t get them to reverse their decision, we
can file a Form 33, requesting a hearing before the Industrial Commission and present your case to a
judge who can force the insurance company to award benefits to you.
‚ What happens to you in the meantime? You’re in a very tough position. Workers’ Compensation will
not be responsible for paying for any medical bills or for any time out of work. That must come out of
your pocket during the period of the denial. We help our clients by seeking low-cost clinics and
encouraging them, if it’s possible, to file for unemployment or return to work in a light duty job so you
have some monies during this difficult time.

Workers Compensation Rights in North Carolina

WHAT IS WORKERS’ COMPENSATION AND HOW DOES IT WORK IN NC?

‚ Workers’ Compensation is a state law that requires employers to purchase private insurance to protect
their employees.
‚ It is designed to pay for injured workers.
‚ It is not a state run program. It is not funded by the taxpayers.
‚ The law requires that the insurance company for a compensable workers’ compensation claim pay for
three things:
1. Medical treatment;
2. Payment for time out of work;
3. Payment for a permanent injury.
‚ N.C. law specifically excludes any coverage for pain and suffering or anguish in a workers’
compensation case.
‚ If you have been injured on the job, three things must occur before the insurance will pay:
1. You must report the injury to your employer;
2. Your employer must report the injury to their insurance company;
3. Your employer or the insurance company should direct you for medical treatment, but if there is
any delay, please seek medical treatment on your own immediately.
‚ It’s important to know that in North Carolina, getting hurt on the job in and of itself is not enough to have
a compensable claim. The injured worker has the obligation to prove if they have a compensable injury
in one of three theories:
1. An injury by accident;
2. A specific traumatic incident to

 

 

What is the Industrial Comission

WHAT IS THE INDUSTRIAL COMMISSION:

‚ The North Carolina Industrial Commission is an administrative agency charged with managing workers’
compensation claims.
‚ There are different departments at the Industrial Commission, but it is essentially the court system for
workers’ compensation claims.
‚ They have the obligation to resolve disputes and award benefits to injured workers.

CAN YOU SUE YOUR EMPLOYER IF YOU HAVE BEEN INJURED ON THE JOB?

CAN YOU SUE YOUR EMPLOYER IF YOU HAVE BEEN INJURED ON THE JOB?

‚ No. North Carolina law says that employees are limited to benefits under the Workers’ Compensation
Act.
‚ I believe that employers in North Carolina have a license to kill. There have been a series of decisions
under a case called Woodsen, in which the Court of Appeals and Supreme Court have held that unless an
employee can show that the employer put them in a position that was substantially certain to cause
serious bodily injury or death, they have no claim outside of the Workers’ Compensation Act.
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