We help our clients deal with:
- Insurance adjusters
- Nurse Case Managers, Rehabilitation Nurses, and Vocational Rehabilitation Specialists
- Compromise Settlement Agreements/Clinchers
- Adjuster-recorded telephone interviews of the injured worker
- Long-term disability insurance and short-term disability insurance
- Medical travel expenses
- Prescription drug costs
- Coordination with unemployment compensation
- Medicare Set-Asides
What Insurance Should Pay. Injured workers are entitled to money for their disability and lost earnings, plus all medical care and rehabilitation that can help the injured worker.
We take cases to hearing before the North Carolina Industrial Commission, negotiate settlements, and assist our clients in getting the benefits to which they are entitled in “accepted” cases.
For injured workers, the workers’ compensation insurance companies present many frustrations. Some of the issues that we help our clients with include:
- Deadlines. After injured, the worker is expected to give written notice to the employer within 30 days of the accident. The outside limit for filing a claim, where the insurance company has not “accepted” responsibility, is two (2) years. Many other deadlines and waiting periods apply for responding to papers sent by the insurance company, for penalties imposed if payment checks are late, and in connection with each step of the hearing procedures at the North Carolina Industrial Commission.
- Disability checks. After injured, when the doctor takes the injured worker “out of work”, he or she should receive weekly “temporary total disability” checks. If the insurance carrier is going to “deny” the claim, the carrier is required to give notice of the denial, in writing. This often does not occur until several weekly checks have gone unpaid. We will communicate with the insurance adjuster (or their lawyer) and request a hearing if the claim is being denied.
- Permanent disability/final settlement. After the injured worker has reached “maximum medical improvement”, the insurance carrier will seek to stop paying temporary total disability checks. Their position will be that the case is ready for settlement. If the worker remains out of work, the worker’s position should be that the temporary disability checks should continue. For career-ending injuries, the law allows the weekly checks to continue, if necessary, for the remainder of injured worker’s life. We help our clients to continue receiving their benefits, and we represent our clients at Industrial Commission hearings where the workers’ compensation carrier is seeking to terminate the weekly benefits. When benefits have stopped, we fight to have the checks resumed until our clients can return to work.
- Denied claims. We take the claims of injured workers to hearings before the Industrial Commission when the claim is denied. Reasons for denial which we may contest may include an argument that the employer was “uninsured”; that the employee was an “independent contractor”; or that the injury was “not arising out and in the course of the employment”.
- Medical care. Medical care is not limited to care for two years after settlement. In fact, lifetime medical care may be available if it will help the injured worker. To get medical care beyond the two-year period, the injured worker must prove that the additional care is medically necessary. Additionally, the insurance carriers often refuse to provide the care the worker wants, including second opinions from medical specialists, additional therapy, or long-term medical management. We help our clients obtain all of the medical care to which they are entitled, including by pushing for “second opinions” and “change of physician”.
- Attorneys’ fees. No attorneys’ fees are charged in workers’ compensation cases, unless approved by the North Carolina Industrial Commission. We provide free consultation and are only paid when the Industrial Commission allows a contingent fee to be paid out of a final settlement or ongoing indemnity benefits. We only ask for a fee when we are able to obtain a settlement, get the employee’s denied benefits started, or when at a hearing we stop the insurance carrier’s effort to terminate ongoing benefits. No fees are charged for medical benefits received by the worker.