Common FAQs About Medical Treatment in North Carolina Workers’ Compensation Cases

Posted on Monday, September 19th, 2016 at 2:00 pm    

Many questions and answers about Worker’s Compensation can be found at the North Carolina Industrial Commission Website. Still, the best recommendation is that a worker review his/her case with an experienced North Carolina Workers’ compensation attorney. The attorney will be current on the relevant laws and legal issues. Mostly, the lawyer will understand many of the practical issues that can help make the difference between a substantial recovery and a minimal recovery – or no recovery at all.

Attorney Joe Miller knows the legal and practical issues. He is also a strong advocate for his clients, most of whom are in pain and worry daily about how they can manage their medical costs and daily living expenses. He has been helping injured workers in North Carolina and also in Virginia get justice for over 25 years. Along the way, he has obtained substantial settlements and awards for thousands of injured workers.

Some of the medical questions his firm advises clients about are:

Who controls the medical treatment?

The employer or the employer’s insurance carrier generally provides the employee with a list of doctors to see and pays the bills for the medical treatment. Employees, with some exceptions such as a medical emergency, treat with the company doctors. If there are good grounds, the employee (with the help of the lawyer) can petition the Industrial Commission for the right to change doctors. Before switching doctors, the employee should get the approval of the employer or, better still, approval from the North Carolina Industrial Commission.

Chiropractic Rules

Generally, an employee can see a chiropractor up to 20 times in North Carolina – if the employer agrees. Employers often agree because the cost for chiropractic services is less than that for pain management and orthopedic doctors. After 20 visits, the chiropractor needs additional approval from the employer.

Can employees be reimbursed for travel expenses for medical treatment?

Employees can be reimbursed in the following instances:

If the travel is more than 20 miles, employees can be reimbursed at the rate of:

  • 25 cents a mile for travel prior to June 1, 2000;
  • 31 cents a mile for travel between June 1, 2000 and January 17, 2006;
  • 5 cents a mile for travel between January 18 and December 31, 2006;
  • 5 cents a mile for travel between January 1 and December 31, 2007;
  • 5 cents a mile for travel between January 1 and June 30, 2008;
  • 5 cents a mile for travel between July 1 and December 31, 2008;
  • 55 cents a mile for travel during 2009;
  • 50 cents a mile for travel during 2010;
  • 51 cents a mile for travel between January 1 and June 30, 2011;
  • 5 cents a mile for travel between July 1, 2011 and December 31, 2012;
  • 5 cents a mile for travel between January 1 and December 31, 2013; 56 cents a mile for travel between January 1 and December 31, 2014;
  • 5 cents a mile for travel between January 1 and December 31, 2015;
  • 54 cents a mile for travel on or after January 1, 2016.

In addition, the North Carolina Industrial Commission permits self-insurers to pay the employee directly for travel expenses – without approval from the Commission.

You need to keep track of and submit your mileage for any and all doctor or therapy visits over 20 miles.

Can an employee see a non-company doctor in case of an emergency?

Yes. The employee can get emergency treatment from a doctor or hospital. The employee must though immediately request approval from the NC Industrial Commission after the fact.

Where should a medical provider send the bill for payment?

The bill, along with the medical records, should be sent certified mail, return receipt requested, to the employer, self-insured employer, or the workers’ compensation insurance carrier. The receipt should be kept as proof of mailing.

Can doctors send medical bills electronically?

Yes. Medical bills, first reports of work injury and subsequent injury reports can be sent through the North Carolina Industrial Commission Electronic Data Interchange (EDI).

When should the medical provider submit the request for payment?

Generally, doctors should submit their medical bills to the NCIC within 75 days of treatment or service. Some extensions can apply such as when an initial work injury claim is first denied and then later approved.

How are IME bills handled?

Bills for Independent Medical Exams (IMEs) are submitted with a special code. The IME includes more than just the exam. It also includes a full review of medical records and a detailed medical report.

How are supplies paid?

“The North Carolina Industrial Commission has adopted nearly 1100 HCPCS billing codes to describe supplies and equipment used in workers’ compensation treatment. However, the Commission has not yet incorporated into its fee schedule all of the HCPCS level codes for supplies and equipment. For example, none of the “J” codes have been adopted.” “If a custom-made orthotic or prosthetic is not contained in the Commission schedule, these items should be paid per agreement between provider and payer.”

Do insurers and self-insurers have to send medical bills to the Industrial Commission?

No, they do not. Insurers and self-insurers may pay all medical bills, including hospital bills, without submitting them to the Industrial Commission for approval.

Can a medical provider bill for administering an intramuscular injection?

Only if an office visit is not charged.

What is a “medical only” claim?

This type claim means that there is no more than one day of lost time, no disfigurement or impairment, and no more than $2000.00 in medical expenses. Basically, it means that the employee will not be paid any lost wages. The employee is entitled to get medical treatment. The employee or the employer’s insurance carrier must still pay all medical bills that are reasonably supported by medical evidence.

Do you have concerns about your work injury medical bills?

Get help now by making an appointment with an experienced North Carolina Workers’ Compensation lawyer. It’s frustrating just trying to get healthy so you can get back to work or so you can, at least maximize your health situation. The last thing you want to do is worry about who is going to pay your bills. An experienced attorney understands how doctors and hospitals get paid when you are hurt on the job. For help now, call lawyer Joe Miller at 888-667-8295. You can also contact him through his online site.

Reasons an Employer Will Try to Terminate Employee Benefits in North Carolina

Posted on Friday, September 16th, 2016 at 2:00 pm    

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 888-667-8295. He’s been fighting for injured workers for over 25 years.

Spine Impairment Ratings in North Carolina Workers’ Compensation Cases

Posted on Wednesday, August 24th, 2016 at 2:00 pm    

Medical impairment ratings are a way of assessing the severity of your work injury. They are used in cases where your injury is permanent as opposed to something that will heal in time. Doctors use various factors to determine the impairment rating that applies to your injury. Doctors can’t just pick a rating out of a hat. They need to justify their rating. That is why the North Carolina Industrial Commission provides guidelines for doctors. Doctors are required to use the guidelines to help them give the final rating/assessment of your injury.
An experienced North Carolina work injury lawyer is needed to help workers fight to get the correct rating. Attorney Joe Miller, who has helped thousands of injured workers for over a quarter century, understands the rating process. Click here to watch his video regarding permanency ratings. He works to let the doctor know all of your medical complaints and how they affect your ability to work. He reviews the medical reports for accuracy and thoroughness to help the doctor see your full medical problem.
One thing that is significant that should be noted: Unlike North Carolina, permanency ratings for the spine do NOT EXIST in Virginia. Ironically, in North Carolina, spinal impairment carries the highest potential number of weeks of impairment of any body part, namely, 300 weeks. The impairment ratings, which are expressed as percentage ratings, for the spine, pelvis, cervix, coccyx, and for ruptured lumbar (back) discs are as follows:

Cervical Spine

Please know that the statutes, as written, refer to the back, not the spine. When rating impairment to the spine, doctors should always refer to it as the back (percentage of the back, not percentage of the spine.)

CERVICAL SPINE FRACTURES
• Single, healed, with little or moderate anterior compression and without neurological findings
o Body = 10%
o and/or posterior elements—arch, transverse process (additional) = 5%
• Two or more vertebrae, each additional = 50% of above
• Add, for neurological
o Quadriplegia = 100% of man
o Nerve root, one arm, or both arms: Functional rating is added to cervical spine percentage.

CERVICAL DISC
• Anterior discectomy, with or without fusion—free of neck and arm pain—no weakness = 5%
• Postoperative—with recurrent episodes of significant cervical and arm pain associated with objective findings = 10-15%
• Posterior laminectomy—removal of ruptured disc—free of neck and arm pain—no weakness = 5%
• Postoperative—with recurrent episodes of significant cervical pain associated with objective findings = 10-15%

Thoracic Spine
• THORACIC SPINE FRACTURES (Treat As CERVICAL SPINE, A) (Correction, July 8, 2016)
• THORACIC DISC (rate as Ruptured Lumbar Disc)

Lumbar Spine
LUMBAR SPINE FRACTURES (including lower three dorsal vertebrae)
• One body = 10%
• and/or posterior elements (arch and/ or transverse process) = additional 5%
• (Two or more) = 50% of above
• Add for loss of motion
o Mild (0%-25% limitation) = 5%
o Moderate (25%-50% limitation) = 10%
o Marked (50% or more limitation) = 20%
• Add for neurological changes: (paraplegias are established)
o One or both legs, functional rating.
B. INVERTEBRAL DISC (rate as Ruptured Lumbar Discs)

*This Section clarified as of February 15, 2000*
What happens if you have more than one back injury?
If a claimant has two injuries to the back and has separate impairments, these ratings should be calculated separately and then combined. Do not add the percentages of impairment. A few examples follow:

FIRST EXAMPLE: 40% (A) & 20% (B)
• In this example, the first percentage of impairment, 40% (A) is subtracted from 100%.
o 100% – 40% = 60% (C)
• The second percentage of impairment 20% (B) is calculated from the remaining percentage (C), which in this case is 60%.
o 20% of 60% = 12% (D)
• The total percentage of impairment is the sum of 40% (A) plus 12% (D).
• 40% + 12% = 52% total percentage of impairment

SECOND EXAMPLE (When total exceeds 100%): 70% (A) and 40% (B)
• In this example, the first percentage of impairment 70% (A) is subtracted from 100%.
o 100% – 70% = 30% (C)
• The second percentage of impairment 40% (B) is calculated from the remaining percentage (C), which in this case is 30%.
o 40% of 30% = 12% (D)
• The total percentage of impairment is the sum of 70% (A) plus 12% (D).
• 70% + 12% = 82% total percentage of impairment
Pelvis (ate as percentage of spine unless acetabulum is involved)
• SYMPHYSIS SEPARATION = 10%
• ILIUM
o With pelvic ring intact = 0%
o With pelvic ring displaced 1″ or more = 10%
• ISCHIUM
o Healed, no deformity = 0%
o Healed, deformity and pain = 5-10%

• FRACTURED ACETABULUM-(evaluate on basis of hip disability-see hip section)
• PELVIC RING DISPLACED PLUS SACROILIAC JOINT DISPLACED (if leg shortening, add that) = 15%
Sacrum
• Healed, no pain = 0%
• Healed, with significant residual deformity = 10%
Coccyx
• Healed, no pain = 0%
• Healed, deformity and significant objective signs = 5-10%
• Excised (as above under healed fractures)

Ruptured Lumbar Discs

The following guide is suggested for use in rating of patients with ruptured lumbar discs from the standpoint of permanent partial impairment to the back, as recommended by the North Carolina Orthopaedic Society and the neurosurgeons of North Carolina:
• Typical episode of back and leg pain that completely recovers without neurological defect on conservative therapy = 0%
• Same as (1) with recurrent episodes of significant back pain associated with objective findings = 5-10%
• Postoperative-removal of ruptured disc-free of back and leg pain-no weakness = 5%
• Postoperative-with recurrent episodes of significant back pain associated with objective findings = 10-15%
• Postoperative-removal of ruptured disc and spinal fusion. Same as (3) = 25%
• Postoperative-removal of rupture disc and spinal fusion. Same as (4) = 25-30%

We should mention one final note on impairment ratings, which is also discussed in Joe Miller’s Video on impairment ratings. If your work injuries prevent you from returning to work, you should not really get too caught up in an analysis of the ratings. Unless you have at least two ratable body parts severely injured, the ratings are not going to be much of a factor in valuing your case. This is because you are limited to 500 weeks total TTD. The ratings cannot add to that total. So in most cases, if you are unable to return to work, the future potential TTD that you may draw is going to be far more significant than anything that a rating can provide you.

Make the Call to a Strong North Carolina Work Injury Advocate Today

The treating doctor is often one that is on a list of doctors chosen by the employer or the employer’s insurance company. To help this doctor make as objective a decision as possible, it helps to have an experienced North Carolina work injury lawyer on your side. An experienced lawyer explains to workers that they need to inform the doctor of all their complaints. The lawyer reviews the medical reports to see if the doctor is following the North Carolina Industrial Commission guidelines. For strong legal counsel phone North Carolina Workers’ Compensation attorney Joe Miller now at 888-667-8295 . You can also complete his contact form.

Rating Guidelines for Upper Extremity Impairments in North Carolina

Posted on Monday, August 22nd, 2016 at 2:00 pm    

Here are more impairment rating guidelines for physicians to use in North Carolina work injury cases. The guidelines are meant to be a starting point. Doctors should also factor into their impairment ratings the oral examination, functional tests, diagnostic tests, and the prognosis for the injured worker.

For a deeper understanding of why the impairment ratings can impact directly the amount of benefits you deserve, watch this video by attorney Joe Miller. He has been a tough advocate for injured workers for over 25 years. His counsel includes working with workers and doctors to fight for the right rating for each worker’s unique set of physical problems.

Upper Extremities

Many of the decision points for doctors are medical terms of art. A few that can help guide the discussion are:
• Ankylosis is stiffness of the joint(s) due to abnormal adhesion and joint bone rigidity.
• Arthroplasty is an orthopedic surgical procedure performed to help restore function of the joints.

The upper extremities means the thumbs, fingers, hands, wrist, elbows, shoulders, and the arms. Doctors should use the follow guidelines to decide if the digit, hand or arm should be rated:
• If damage is limited to the digits (fingers) distal to the metacarpophalangeal joint, then the digit itself should be rated.
• If there is anatomical damage proximal to the metacarpophalangeal joint, a rating for the hand should be given, including any consideration for the digit as a percentage of the hand.
• If anatomical damage includes an area proximal to the elbow joint, the disability rating should be for the arm and include any percentage which would have otherwise been credited for the hand or digits.
“ANKYLOSIS” AND “LIMITED MOTION WITH PAIN.”
Fingers
• Ankylosis of distal IP joint (in optimum position) = 35% of digit
• Ankylosis of proximal IP joint (in optimum position) = 50% of digit
• Ankylosis of metacarpal-phalangeal joint (in optimum position) = 45% of digit
• Any of the above in malposition = up to 100% of digit
Wrist
• Ankylosis in optimum position = 35% of “hand”
• Ankylosis in malposition = up to 100% of “hand”
o Limited motion, mild = up to 10% of hand
o moderate = up to 20% of hand
o severe = up to 25% of hand

Elbow
• Ankylosis in optimum position = 50% of arm
• Ankylosis in malposition = up to 90% (Straightened position not as disabling as marked flexion).
• Limited motion and pain
o Flexion and extension (accounts for 60% of elbow function)
 20º motion in middle range = 35% of “arm” (80 to 100%)
 40º motion in middle range = 30% of “arm” (70 to 100%)
 120º motion in middle range = 5% of “arm” (45 to 160%)
o Pronation and Supination account for 40% of elbow function
 Total loss in neutral position = 25% of hand
 20º motion each way from neutral 20% of hand
 60º motion each way from neural 5% of hand
 Arthroplasty of elbow using prosthesis = 40% of arm
Shoulder
• Ankylosis in optimum position = 50% of “arm”
• Ankylosis in malposition = up to 80% of “arm”
• Resection end of clavicle (distal to coranoid and trapezoid ligaments) = 5% plus limitation
FRACTURES
• Fingers and Metacarpals. Mal-alignment, shortening, stiffening, etc., rated according to function of finger. Express as “percent of digit” if loss is distal to MP joint; otherwise, as “percent of hand,” calculated from the sum of each involved digit, reduced to its known percent of hand.
• Carpals: Rated according to function of wrist.
• Forearm fractures
o Mal-alignment. Rated primarily on limited motion in wrist joint. Add for angulation, shortening, weakness, etc. Express as “percent of hand.” Occasionally the elbow must also be rated for loss of motion, expressed in “percent of the arm” and the total impairment calculated from the sum of the parts reduced to their relative percent of the whole.
o Excision of fractured radial head. Full motion with no pain = 10% of arm. Otherwise rate on basis of loss of motion and pain in elbow and wrist.
o Excision of distal end of ulna. Rated on basis of adjacent joint function with minimum loss of 10% of hand
• Fractures of humerus
o Mal-alignment. Rated primarily on basis of limited motion and pain in shoulder and elbow joints, and expressed in “percent of arm.” Add for angulation, shortening, weaknesses, etc., not reflected in loss of joint function.
• Fractures of shoulder girdle. Rated according to function of shoulder joint. Add for pain and weakness in non-union.
• Fracture into a joint. In general, add 10% if minimal displacement, and more if joint surface is irregular. Any time a joint is entered surgically for repair or excision of a part, the minimum impairment is to be 10%
LACERATION OF THE HAND (TENDON, NERVE, JOINT, ETC.)
• Loss of sensation (complete and noticeable) (exclusive of tendon damage)
o ½ of distal phalanx = 25% of digit
o ½ of finger = 100% of digit
• Division of flexor sublimis with full extension of finger
o Tendon only = 10% of digit
• Division of flexor profundus
o Tendon only = 75% of digit
• Division of both profundus and sublimis tendons.= 90% of digit
• Arthrodesis of distal IP joint = 35% of joint
• Arthrodesis of proximal IP joint = 50% of digit
• Arthrodesis of MP joint = 45% of digit
• Above ratings are for arthrodesis in optimum position. Add for malposition.
• “Contractures” of joints or “limited motion and pain.” Impairment determined on basis of severity as compared to arthrodesis of the joint.
PERIPHERAL NERVE INJURIES:
(Rated on basis of loss in the “hand.” If lesion is high and involves structures above biceps insertion, then loss is rated on the “arm.”)
• Ulnar nerve injury
o Complete motor and sensory = 60% of “hand”
o Complete motor and partial sensory = 50% of “hand”
o Motor only = 40% of “hand”
• Median nerve injury
o Complete motor and sensory = 90% of “hand”
o Complete motor and partial sensory = 60% of “hand”
o Motor only to thumb = 35% of “hand”
• Radial nerve injury
o Motor and sensory = 75% of “hand”
• Above estimates are given prior to any reconstruction and may be reduced considerably by reconstructive surgery.
• If contracture has occurred in the digits, additional impairment should be added.

Speak with an Experienced North Carolina Workers Compensation Attorney Today

A slight variance in an impairment rating can be a huge difference in a worker’s wallet, particularly if the injured worker has returned to alternate employment and is earning the same as pre-injury. To help you get the right rating, it is crucial that speak with a knowledgeable North Carolina injury lawyer who understands the complex medical jargon and who has worked with work injury doctors. For help now, call North Carolina Workers’ Compensation attorney Joe Miller today at 888-667-8295. You can also fill out his contact form.

Lower Extremities Guidelines for North Carolina Workers’ Compensation Cases

Posted on Wednesday, July 27th, 2016 at 11:30 am    

These are the guidelines for doctors and physicians who have the task of determining the impairment rating for a North Carolina work injury cases. The guidelines are different than the American Medical Association guidelines. Physicians should use the North Carolina guidelines and not the AMA guidelines are their starting point.

Doctors and physicians should use their own evaluation of the patient and their own experience in making their final impairment ratings decisions.

What must be remembered is that usually, unless the employee has returned to full duty or a job paying the same or more as his or her pre-injury job, the impairment rating is seldom the most significant aspect of a seriously injured worker’s case. Many lay people get caught up in this and believe that the rating is the most important thing. It is not.

What is most important is what your doctor says about your future ability to perform work. Will you be able to return to your pre-injury job? If not, what other kind of work will you be able to do? These are usually the most important questions which will determine the value of your claim.

To see a video regarding impairment ratings generally, please click here.

General Lower Extremity Guidelines

Where a joint of the lower extremity has reparative, reconstructive surgery and a part of the joint removed or repaired with resultant osteoarthritis or traumatic arthritis anticipated, consider a minimum of 10% impairment of the joint.

Evaluation of impairment following fractures of the femur and/or the tibia and fibula is done by first evaluating any shortening and assigning impairment resulting from this; then determining the function of the adjacent joints and arriving at the impairment of these joints. The impairment is then the combined total resulting from shortening, deformity, and the impairment of the adjacent joints.

Malrotation and angulatory deformities that persist following injuries will be considered in evaluation of permanent impairment.

More Specific Lower Extremity Guidelines

  1. Shortening of Leg
Shortening      AWW Impairment to Whole Leg
·       ½ inch      4%
·       1 inch 8%
·       1½ inch 16%
·       2 inch 24%
·       2½ inch 32%
·       3 inch 40%

 

  1. Hip—Percentage of Impairment of Whole Leg
  • Ankylosis of the hip in optimum position (in less satisfactory position, appropriately higher percentage) = 50%
  • Arthroplasty of hip using prosthesis or cup (optimum results) = 40%
  • Limitation of motion of Hip
    • Mild Deformity = 15%

Example: AP motion: between 0 degrees and 80 degrees flexion

Lateral motion: 15 degrees adduction to 15 degrees abduction

Rotation: 20 degrees internal to 20 degrees external rotation

  • Moderate Deformity = 30%

Example: AP motion: 20 degrees flexion to 70 degrees flexion

Lateral motion: 10 degrees adduction to 30 degrees abduction

Rotation: 0 degrees internal rotation to 20 degrees external rotation

  • Severe Deformity = 60%

Example: AP motion: 30 degrees flexion to 50 degrees flexion

Lateral motion: 30 degrees adduction to 40 degrees abduction

Rotation: as much as 10 degrees internal rotation to 30 degrees external rotation

  1. Knee—Percentage of Impairment of Whole Leg
  • Ankylosis in optimum position (Ankylosis in less favorable position increasing impairment up to 90% with the knee in a non-weight bearing position) = 50%
  • Arthroplasty of knee using prosthesis or cup (optimum results) = 40%
  • Limitation of motion of Knee
    • Motion between 0 degrees to 60 degrees = 30%
    • Motion between 0 degrees to 90 degrees = 15%
    • Motion between 0 degrees to 110 degrees = 5%
    • Motion between 45 degrees to 135 degrees = 45%
  1. Ankle and Foot—Percentage Impairment of “Foot” (Leg below the Knee)
  • Ankylosis of ankle in favorable position (10 to 15 degrees equinus) with normal motion of foot = 40%
  • Ankylosis of foot (subtalar) in optimum position with normal ankle motion = 25%
  • Ankylosis in less favorable position up to = 90%
  • Ankylosis of foot and ankle (pantalar arthrodesis) in favorable position (10 or 15 degrees equinus) in neutral position of foot = 60%
  • Ankylosis of any toe = 50% impairment of the toe
  • Limitation of motion of ankle
    • Motion between 90 degrees and 120 degrees = 10%
    • Motion between 100 degrees and 115 degrees = 25%
    • Motion between 105 degrees and 110 degrees = 50%
  • Limitation of motion of foot
    • Motion of inversion of 20 degrees to eversion of 20 degrees = 10%
    • Motion of inversion of 10 degrees to eversion of 10 degrees = 20%
    • Motion of inversion of 5 degrees to eversion of 5 degrees = 40%
    • Fixed varus position = up to 90%
  • Ankylosis of subtalar joint = 25%
  • Triple arthordesis of foot = 30%
  • Displaced tarsal fractures considered as having a minimum of 5% impairment of the foot with optimum reduction. In the case of this portion of the foot, impairment is determined mainly upon the general position of the longitudinal arch and/or weight bearing position of the metatarsal heads with respect to the transverse arch rather than by evaluation of motion of the adjacent joints.

A few medical terms

Ankylosis is also known as anchyloses. It is joint stiffness due to abnormal adhesion and joint bone rigidity. It can be caused by injury or disease. The doctor will examine to see if the rigidity is partial or complete.

Arthroplasty is an orthopedic surgical procedure. It is done to relieve pain and restore joint function. In the procedure, the articular surface of a musculoskeletal joint is remodeled, replaces, or realigned.

Get a Professional North Carolina Work Injury Attorney on Your Side

The employer and the employer’s insurance company will have a lawyer fighting to terminate or minimize your benefits. You need a strong advocate that understands that small differences, such as a 20% impairment rating vs. a 10% impairment rating, could mean a significant difference in money for you. To speak with an experienced and aggressive North Carolina work injury lawyer, call for help now. Please contact North Carolina Workers’ Compensation attorney Joe Miller today at 888-667-8295 . You can also complete his contact form.

 

Rating Guide Criteria for Doctors in NC Workers’ Compensation Cases

Posted on Monday, July 25th, 2016 at 11:00 am    

The North Carolina Industrial Commissions provides guides to physicians for determining how to rate the impairments for specific types of injuries. The guidelines are just a starting point and not a precise definition. Doctors who are making an evaluation of the impairment rating of a worker can use the guides but they should also factor in the intangible factors such as the amount of pain the worker can endure, how weak the employee is, the dexterity of the worker and other factors.

The guides are for injuries to the upper extremities, lower extremities and the spine. In North Carolina work injury cases, the doctor examines the affected body part and then assigns an impairment rating based on how well or how poorly the worker can use that part. Oftentimes, the doctor defers to a functional capacity examination (FCE) to help determine the level of loss of function. For example, the doctor may say the worker has 20% permanent impairment in his or her right upper extremity (arm). The impairment rating is just one factor in the amount of wage loss benefit the employee will get and the length of those benefits.

The final impairment rating should be based on the physicians’ knowledge, the clinical examination of the patient, and the doctor’s experience.

Some Recent Concerns by Doctors about the North Carolina Impairment Requirements

Some of the more recent issues that doctors and lawyers have raised about when and how to do their impairment ratings are:

Rating and Release

Due to some changes in the law, impairment ratings are becoming more and more important in North Carolina work injury cases.

Recent changes, for example, allow a worker to be forced to engage in ‘fake’ jobs if some residual disability prevents him from actually getting and keeping a job, and the doctor agrees it would help the injured worker, regardless of whether or not he has reached “maximum medical improvement”. This change has meant more litigation, between the employer and claimant, about the ability of the worker to perform the tasks in a given available job. The ratings, along with the analysis of the worker’s physical limitations can help or hurt the employee’s argument that he/she is not able to do the specific available job.

The rating can be given when the patient has reached maximum medical improvement even though the doctor may have already concluded that additional surgeries or additional medical treatments will not help the worker.

The North Carolina Industrial Commission guidelines for impairment ratings are not the same as the American Medical Association ratings. There is not a direct correlation between the two. Doctors, in North Carolina work injury cases, should begin with the Commission guidelines because those guidelines were designed to match the North Carolina Workers’ Compensation Statute.

The Right of the Worker to Get a Second Opinion as to a Rating

The employer is obligated to pay for the first medical opinion and treatment as to any permanent partial impairment. The employee can get a second medical opinion with a doctor of his choosing only as to the rating – at the employer’s expense, after the employer obtains a rating and where the worker is dissatisfied with the impairment rating offered by the worker’s original treating doctor. The employer and insurance carrier can also request that a second medical opinion be obtained. In some cases, such as where the worker does not have legal counsel, the Commission may recommend that there be an independent medical opinion. Litigation often centers around the situation where the two medical opinions contradict each other. Workers should review the right to a second opinion with an experienced North Carolina Workers’ Compensation attorney.

For a more in-depth discussion of your rights to a second opinion under NC Workers Comp Law, Click Here.

Medical Records

The medical provider should understand that the following people are entitled to medical rehabilitation records, the testimony of the doctor, and the opinions of the doctor – as a matter of course:

  • The patient if not represented by an attorney
  • The patient’s counsel
  • The employer or the insurance carrier, usually through their attorneys and/or nurse case managers or insurance adjusters.

If one side (employer or employee) has the records, then the other side should be able to get those records, without charge. In most respects, therefore, at least as to the employer and its representatives, the rules and laws on privacy and privilege as to your medical privacy do not apply.

The medical records, along with the history and patient notes, can often help determine if the work injury is compensable. For this reasons, workers should consult with their work injury lawyer before seeing their doctors. The lawyer can help explain what questions may be asked. Submission of the medical records and opinions can often mean that there is less of a need to depose the treating doctor – depending on how clear and concise the records are.

Rehabilitation Personnel

Insurance carriers often use nurse case managers to monitor the care the patient is getting, to help the employee keep scheduled appointments and take the prescribed treatments. These nurses may also help the employee return to a job they can manage. The Workers’ Compensation law does allow for these nurse case managers.

Many employees, employee counsel, and even the doctors have complained that the nurse case managers are not acting as facilitators. They are acting as advocates for the employer or insurance company. Doctors should understand that the nurses are to act only as facilitators. Nurse case managers cannot direct the worker’s treatment. Decisions with regard to the patient’s treatment always remain with the worker’s treating doctor. If the employer attempts to direct treatment in opposition to the worker’s doctor, the worker can and mostly likely should request that the Commission put a stop to such behavior.

Doctors should also understand that the nurse case manager does not have the right to be present in the examination room at all times. The patient is entitled to a private conversation with his or her doctor.

Call North Carolina Work Injury Attorney Joe Miller for Help Now

If you were hurt while working on the job, you need a lawyer who will fight for you. A strong advocate understands the legal and medical complexities of workers’ compensation Cases. Often the difference between a good result and a bad result can be the attention to detail and a full understanding of the law. To speak with a strong advocate today, please phone lawyer Joe Miller today at 888-667-8295 . You can also complete his contact form.

Functional Capacity Exams (FCE’s) in North Carolina and Virginia Workers’ Compensation

Posted on Wednesday, July 20th, 2016 at 2:00 pm    

A Functional Capacity Evaluation (FCE) is oftentimes performed in both Virginia and North Carolina Workers’ Compensation cases. It is typical performed once the injured worker has reached MMI (maximum medical improvement) as determined by his or her authorized treating physician.

The purpose of the FCE test is to determine the severity of a physical impairment. It is used to evaluate the extent of the impairment, the likelihood of the success of future treatments, and mostly the ability of the worker to do his or her job. The test is usually performed by an occupational or other physical therapist – someone who understands how impairments impact various occupations. It usually lasts several hours, and sometimes even takes two office visits to complete.

Attorney Joe Miller has been advising injured workers for over a quarter century. Part and parcel of this advice is explaining some procedures such as functional capacity exams (FCEs) that are done for evaluation purposes only. He helps the client prepare for the exam by informing the worker what to expect and how to prepare for the exam ahead of time. It is his attention to all the little details and his strong advocacy that has enabled him to help thousands of injured workers obtain significant recoveries.

What happens at the functional capacity evaluation?

 

The physical therapist will typically examine the following:

  • The worker’s functional abilities via various modes of testing
  • Very specific testing including range of motion, lifting capacity, pain tolerance and more
  • Evaluation as to whether the employee can return to the job he/she did before the injury
  • Sometimes there is commentary on what might help the employee get back to work
  • What other medical treatment might help
  • What physical limitations any potential employer will have to consider for this particular employee
  • Permanent partial impairment ratings for the injured body part.

The entire test can take several hours. The employee will be asked to perform many tasks such as bending, carrying objects, walking, climbing, pulling, fingering, kneeling, talking, testing his/her range of motion, balance, and other work factors. The occupational or physical therapist will tackle the limitations from many vantage points such as sitting and standing.

The physical therapist will typically then use the standards set forth by the U.S Department of Labor’s guidelines to rate the employee’s work capabilities based on the testing performed.

  • Functional Capacity Exams (FCE’s) in North Carolina and Virginia Workers’ CompensationHere, the worker may be required to move or lift up to 10 pounds.
  • Here, the employer can comfortably handle 10 pounds and sometimes up to 20 pounds.
  • Workers who can do medium work can exert between 10 to 25 pounds comfortably and can handle up to 50 pounds on occasion.
  • Heavy. Here, workers can handle 25 to 50 pounds frequently and sometimes up to 100 pounds.
  • Very heavy. This worker can exert up to 20 pounds constantly, 25 to 50 pounds frequently, and over 100 pounds occasionally.

The Role of the Workers’ Compensation Attorney

The test is sent to the treating physician. The employer or insurance pays the FCE professional so it is crucial to review what happens with your attorney before you attend the evaluation. The physical therapist and employer is looking to see if you are faking or exaggerating your physical difficulties.

WARNING: There are some known FCE facilities that are “rigged” against employees, so it is critical that you inform your attorney as to the FCE facility where you are referred as soon as possible. Your attorney may be able to get the facility switched, especially if your treating doctor did not specify the facility where the testing will be performed in his or her referral.

The lawyer will explain what happens, what your rights are, and that you should not be a hero – you should say what hurts you and where. In some cases, particularly in North Carolina, your attorney may ask for a reevaluation of the FCE if the disability rating by the doctor appears to be incorrect. Your attorney will work hard so the FCE professional has the correct job description and that the facility is known as one that conducts unbiased testing.

How the FCE is used

There are two types of FCE tests:

  • Job Specific. This type of FCE focuses on the ability of the worker to perform the tasks of a specific job. Sometimes it is done at the therapist’s office but it can also be done at the job site. The aim here is to see if the employer can do his/her prior job – with our without restrictions.
  • General Purpose/Combination. These more common FCE’s are usually done if the job no longer exists or if the job functions have not be set, or if we are attempting to learn the employee’s capabilities in the previous job and in any potential alternate job. The tests are standardized. The test helps to determine if the worker can do future jobs that arise.
  • Permanent Impairment Ratings to Body parts--The FCE can also be used to determine the impairment rating for any worker with a permanent injury in a ratable body part. The impairment rating is a percentage that is assigned to the particular body part. For more on Permanent Impairment Ratings and what they mean, please see this video.

 

Contact an Experienced Work Injury Lawyer Before You Take a Functional Capacity Exam

The employer and insurance company are seeking to get you back to work as soon as they can so they can stop making benefit payments. North Carolina and Virginia lawyer Joe Miller has the experience and skills to fight early returns to work. He also understands how permanent impairment ratings should help you not hurt you. If you were hurt on the job, call attorney Joe Miller for help at 888-667-8295. You can also complete his online form for an appointment.

Typical Types of North Carolina Workers’ Compensation Injuries

Posted on Monday, July 18th, 2016 at 2:00 pm    

Workplace accidents and illnesses happen for many reasons. It is important to work with an experienced North Carolina work injury attorney who knows the common kinds of claim types. It isn’t necessary to prove fault on the part of the employer because fault is not an element of workers’ compensation law. But the type of accident usually indicates the type and extent of injuries. This is important because many employers will try to get the employer to return to work before the worker is ready. Experienced work injury lawyers work with doctors so they know how long injuries should really last and what complications may arise.

Skilled workers’ compensation lawyers also understand when injuries may be permanent, when they might result in the need for vocational retraining, and what disability injury ratings may apply. Attorney Joe Miller has this essential knowledge. For over a quarter century, he has helped thousands of injured workers in North Carolina and Virginia get Strong Justice SM – full compensation for all kinds of work injuries. Some of his work injury knowledge is based on his experience and knowledge of the laws and rules surrounding Workers Compensation in North Carolina.

Here’s a sampling of the more common injury types.

1) Overexertion

Many physical labor jobs such as construction work, industrial job, and health care work require constant pushing, pulling, lifting, and carrying. The constant wear and tear can cause damage to muscles and joints. For many workers, there is the one extra push or pull, lift or carry, that wrenches their back, strains their neck or causes acute physical pain, or a heart attack. Overexertion injuries are very common workplace accidents.

2) Slip, fall or Trip and Fall Accidents

Falls around the workplace are very common. They can happen for many reasons such as loose tiles, wet surfaces, poor lighting, wires, or torn carpets. Inventory or equipment that isn’t properly stored or put away can cause slip and fall accidents too. Workers are especially susceptible to slips and falls or trips and falls because their focus is on their immediate task and not looking down at the floor. Slips and falls can happen in almost any work environment including restaurants, medical facilities, construction sites, retail stores, and industrial warehouses.

3) Serious Falls on flat surfaces or from Heights.

In typical slips and falls, the worker falls on a ground or floor-based surface due to some slippery substance such as ice, water, oil or grease. Some falls take place at heights, causing much more serious injuries and even death. Examples of these serious falls are falls from a ladder, a scaffold, or a roof during construction or during an inspection. Falls down stairs can happen in almost any work environment. The farther the fall, the more serious the injuries will normally be.

4) Being Struck by an Object

Without warning, a piece of retail inventory or a piece of heavy equipment can fall on a worker causing broken bones, nerve damage, bruises, amputations, and other medical complications. Falling objects are common in any place with inventory and in construction sites. Falling objects are so common at construction sites, that most construction workers are required to wear helmets. Even so, helmets cannot protect when a heavy piece of lumber or metal falls from a high height.

5) Vehicle Accidents

Many workers need to operate a vehicle to perform their job. Many truck drivers suffer serious injuries because trucks rollover or jackknife. Workers who use cars for work also suffer many accidents for many reasons – such as failure of other drivers to follow traffic laws, driver fatigue, texting while driving, faulty truck equipment, and for other reasons. The reason really isn’t important as long as it can be shown that the use of the vehicle was being operated on company time.

6) Equipment Accidents

Machinery and tools can crush, electrocute, or harm a worker in many different ways. Workers at construction sites are especially prone to injury from forklifts, power tools that don’t work, and for other reasons. Some employers fail to provide necessary safety equipment for their workers. Other employers may fail to comply with state, federal and local guidelines. Equipment is not always chosen with the safety of the worker in mind. Workers should be properly trained on how to use the equipment. All equipment should be routinely inspected for defects and signs of wear and tear.

7) Repetitive Motion

Repetitive stress injuries are a common workplace occurrence. They can cause carpal tunnel syndrome, pain in the spine, and other complications. The problem with repetitive workplace injuries is that one can typically not recover for repetitive stress injuries. If there is a potential recovery for something such as carpal tunnel syndrome caused by repetitive use, it may be covered as an occupational disease, if certain strict criteria of proof can be met. There must be clear evidence that the type of work performed over time caused the carpal tunnel syndrome and that the public is not equally exposed to this type of work.

8) Violence at work.

Some workers are hurt because of fights with coworkers. Others can be injured or killed because a disgruntled former employee, someone with a mental illness, or just a plain no-good criminal commits a crime on the workplace such as a killing or a robbery. Workers who are injured are usually entitled to workers’ compensation benefits if someone else committed a violent or criminal act. Co-worker violence is only compensable if the violence relates something having to do with the job. Violence brought on by a personal grievance is not compensable.

9) Occupational Diseases.

In addition to accidents, there can be compensation for occupational diseases. Some are well-recognized and listed in the statute book such as asbestosis, silicosis, manganese poisoning and loss of hearing caused by harmful noise in the workplace. Other types of injuries and conditions not listed specifically in the statute can be shown to be an occupational disease if

  1. It can be shown that the disease is due to the characteristics of the particular job the worker was engaged in and
  2. It is not something to which the public is equally exposed.

So for instance, if you were claiming you got a bad case of the flu because of your work environment—and you worked construction—that would not be something you could prove because the public is equally exposed.

But if you worked in a lab that handled flu viruses and you came down with several cases a year of the particular strain that only you handled—likely you would win.

Another example—you claim carpal tunnel syndrome, but your job is driving a car. Everyone drives. Not likely going to win. But if you are a machinist and you work with hand tools all day long—and you are right-handed and the carpal tunnel is in your right hand–that is something else.

In some of these cases, if someone other than the employer caused the accident – the injured worker may also have the right to bring a personal injury lawsuit against the responsible third party.

Speak with an Experienced North Carolina Workers’ Compensation Attorney Today

Whether you are a janitor, a health care worker, a construction employee, a teacher, a certified nursing assistant, a truck driver, an office worker, or anyone in most any type of North Carolina job, you have rights. If you were hurt on the job, you have the right to seek medical help, to demand payment for your fair percentage of lost wages. You may also be able to seek vocational retraining.

Attorney Joe Miller has the skill and experience you need. He is a strong and aggressive advocate for injured workers. For help now, call Joe Miller Law at 888-694-1671 or complete his online contact form. You may be entitled to a substantial recovery.

North Carolina Vocational Rehabilitation Rights

Posted on Friday, July 15th, 2016 at 2:00 pm    

Workers who are injured at work or suffer a work related illness are entitled to more than just a percentage of lost wages. They are entitled to more than payment of surgery, doctor, and prescription pages. They are even entitled to more than occupational therapy. If an employee is hurt and cannot work at his/her prior job, he or she has the right to be retrained so that he/she can return earn a comparable living to the prior job. Retraining can mean learning new work skills and new educational skills.

At the Law Office of Joe Miller, Esq. our legal team understands how upsetting it can be to be out of work. The law firm has more than 25 years of experience helping workers understand all of their rights and demanding the all benefits be paid – especially when the work injury is so severe that the old job cannot be done. Attorney Joe Miller has helped thousands of clients get justice for work injuries. He is ready to help you understand and fight for all of your options.

Why Vocational Rehabilitation is ordered in North Carolina

Vocational rehabilitation is likely to be recommended if your physician releases you to light-duty employment or to work but with restrictions and the claim is already accepted and your pre-injury job will not accept you in a light duty position. If you do return to work but at a lower pay than before your injuries began, you should get 2/3rds of the difference between pre-injury and post-injury pay.

Vocational rehabilitation is touted by the employers and insurance companies as a benefit to the employee by helping him/her earn a livelihood. But unfortunately, more often than not, it is simply a tool used by the workers comp insurance company to either reduce or eliminate their responsibility to pay benefits to the injured worker.

There are many vocational rehabilitation issues. Some of the most common ones, that are detailed in the North Carolina Workers’ Compensation Statute include:

  • The employer can require that the employee undergo a one-time assessment of vocational skills with some exceptions.
  • The employee can request vocational rehabilitation if he/she hasn’t returned to the job and is getting weekly benefits.
  • Rehabilitation may include education and retraining in a North Carolina community college or university. The retraining must be reasonably likely to “substantially increase the employee’s wage‑earning capacity following completion of the education or retraining program.”
  • Generally, the employer chooses the vocational rehabilitation service – one that is approved by the state Industrial Commission. For good cause, an employee (through his/her attorney) can request that another professional service be provided.

There are some exceptions which should be reviewed with an experienced North Carolina work injury lawyer.

Vocational Rehabilitation Services Defined

Proper vocational rehab services for injured workers include a vocational assessment which analyzes the employee’s current skill and also the skills that could be reasonably obtained with proper training. The services should also include an overall plan. The aim of the plan should be to substantially increase the amount of wages the employee can earn.

Some factors that the vocational rehabilitation should also consider are the worker’s medical limitations and the proper sequence of vocational services. A detailed vocational rehabilitation plan should be put in writing so both the employer and employee can understand the expectations and the services that will be required.

The plan should take into account the worker’s education, skills, aptitudes, and experience.

Common Vocational Rehabilitation Services

Typical services to help retrain the worker and get him/her ready for a new job include:

  • Workshops
  • Community supported training.
  • Job analysis
  • Job modification,
  • Job development,
  • Placement skills,
  • A survey of the current labor market
  • Vocational tests
  • Psychometric testing
  • A review of transferrable and non-transferrable skills
  • Work counseling
  • Job seeking training
  • On-the-job training
  • Education

Vocational rehabilitation often includes learning the latest technologies. It can also include learning to use devices and treatments that can help the worker adjust to any medical problems or difficulties.

Changes to the Vocational Plan

The parties can agree to modify or terminate the plan – if both sides agree or Commission enters an order. The best scenario is usually for the employee to return to work at the same company. But sometimes, the worker will need to start work with another company.

If you think you are being treated unfairly by the employer or vocational rehabilitation service or professional, it is wise to consult an experienced North Carolina Workers’ Compensation attorney before considering quitting or failing to comply. If you unjustifiably fail to comply with the vocational rehab counselor, you could lose your workers comp benefits.

You should be on the lookout for “sharp practices” by the vocational rehab counselor such as making you jump through absurd and ridiculous hoops, receiving inadequate notice of meetings, and the failing of the counselor to pre-screen jobs to make sure they are within the physical restrictions set forth by your treating doctor.

The same need to consult with a skilled lawyer holds true if you think the plan is fair but circumstances prevent you from meeting the terms. Again, employees who fail to comply with the vocational rehabilitation plan may lose their right to compensation unless the Industrial Commission finds the refusal to cooperate was justified.

Make the Call to an Experienced North Carolina Work Injury Lawyer Today

Vocational rehabilitation can be used as both a sword and a shield. Sometimes the employer uses it as a means to reduce their obligation to pay. Other times, you may be able to take advantage of the law surrounding vocational rehab to improve your ability to earn money or receive additional education—all at the expense of the workers comp insurance carrier. For aggressive advocacy and caring counsel, please phone the Work Injury Center SM at Joe Miller Law at 888-694-1671 and ask for me, Joe Miller, or email me at jmiller@joemillerinjurylaw.com You can also complete my online contact form.

Types of Disability in North Carolina Workers Compensation Cases

Posted on Monday, July 11th, 2016 at 2:00 pm    

Injured workers are entitled to wage loss benefits based on the type of disability they have. Disability is a legal term of art that an experienced North Carolina workers compensation attorney can explain. Worker’s compensation disability determines how long the injured employee gets benefits and what the amount of those benefits are. The correct classification can mean more money and money for a longer period of time.

Workers who have lost limbs, lost an ear, or suffer from severe pain that won’t ever go away should be paid according to their disability – not because the employer or insurance company wants to rush them back to work or wants to save money. North Carolina attorney Joe Miller has been helping injured workers for over a quarter century. He has helped thousands of injured workers get strong recoveries. He has the experience and skills to work with medical doctors and to fight unreasonable classifications.

The four main types of North Carolina work injury disability

Disability in workers’ compensation is different than Social Security Disability and it is different than disability in an insurance contract. Disability, in North Carolina work injury cases, means the employee cannot do the work he/she did before the accident or illness. Workers who can work but with medical restrictions may be entitled to partial benefits, or even full benefits if their employer cannot accommodate them or if they can show that they cannot find work within their physical restrictions.

In order to obtain wage loss benefits, a worker, with the help of an experienced work injury lawyer such as Joe Miller, must show that he/she has one of the following types of disability:

  • Temporary total disability. Many workers are unable to work for a limited period time. When their injuries mend, they are ready to return to work. While they are getting medical attention, these workers are entitled to 2/3rds of their pre-injury wages. When they return to employment, they get their pre-injury salary. Temporary benefits can last for up to 500 weeks if the injury or illness occurred after June 24, 2011.
  • Permanent and total disability. Some workers can never return to work. Their injury or occupational illness is too severe. Workers who reach Maximum Medical Improvement and still cannot work at all may be entitled to additional work loss benefits for life, if, after 425 weeks of receiving temporary total disability, they can show to the Industrial Commission that they are unable to work in any capacity. Workers who have lost the use of both hands, both arms, both legs, both feet, have a severe brain injury , or some combination are generally presumed to be unable to work permanently. There are other presumptions the law offices of Joe Miller Esq. can explain.
  • Temporary partial disability. Here the worker has the ability to do some work, but not the same level of income as before the work injury or occupational illness. The worker gets 2/3rds of the difference between what he/she earned before the disability and what he/she can earn after the disability for up to 500 weeks if the injury or illness occurred after June 24, 2011.

For example, if the worker earned $1000 a week pre-injury and now earns $400 a week, the worker gets 2/3 of $600 ($1,000 minus 400) for a total of $400. Payments are made on a weekly basis until the worker can return to work at full capacity and thus earn his/her full wage.

  • Permanent partial impairment. This is money paid for injuries to specific, ratable body parts. It is calculated on the basis of a percentage of disability to a particular body part which percentage is assigned by the injured worker’s treating physician. These benefits fall under North Carolina General Statutes Section 97-31. This statute includes a schedule of injuries by type and awards the worker benefits according to the schedule. For example, a worker who loses the use of a thumb is entitled to 2/3rds of the average weekly wage for 75 weeks. Another example: If a worker is found to have a 10% disability to the back, that benefit would be 10% of the maximum benefit of 300 weeks for the back, or 30 weeks.

One major caveat: The worker cannot get both the fully weekly benefits for 500 weeks and the scheduled benefit. The worker must elect between the standard weekly disability benefit and the scheduled benefit. The most common cases where the percentage ratings come up are where the injured worker has returned to pre-injury employment. In such cases, the worker’s only additional benefits may be permanent partial impairment.

Employers will often try to encourage doctors to force workers back to work before they are ready. They will also contest the most serious classifications. They will argue that workers have a temporary disability and not a permanent disability. They will assert that a disability is only partial instead of full. They will argue that the injuries are pre-existing and not related to the accident. An experienced North Carolina workers’ compensation lawyer such as Joe Miller will work with your doctors and will make strong legal arguments to help convince the Industrial Commission that your classification matches your inability to work.

How disability affects medical benefits

The type of disability a worker has does not affect the payment of medical bills. All workers, regardless of the type of disability they have, are entitled to seek medical attention to help them get healthy – if they have suffered a workplace accident or illness. Workers can continue to get medical help until it is clear that continued medical help will not improve the workers’ condition – that the worker has reached maximum medical improvement.

If a doctor says an employee can work but with medical restrictions – then the employer and insurance company must pay for any medical expenses to meet those restrictions. Workers with partial disabilities may require medical devices such as prosthetics or medications in order to work.

Workers with a temporary or partial disability may require occupational therapy to learn how to adjust their body to old or new work demands. They employer must pay for this type of rehabilitation. Employers may also be obligated to pay for the travel expenses to see the doctors and to get the proper therapy.

Joe Miller thoroughly and aggressively argues for more than just wage loss benefits. He is a strong advocate for his clients and works to get all related medical bills for any type of disability.

For help with workers compensation disability claims, consult North Carolina work injury lawyer Joe Miller

At the Law Office of Joe Miller, our legal team works to make sure work injuries are classified correctly. For help now, please call attorney Joe Miller at 888-694-1671 and ask for Joe Miller, or email Joe at jmiller@joemillerinjurylaw.com.

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