Pros and Cons of Workers’ Compensation Mediation in North Carolina

Posted on Monday, December 5th, 2016 at 2:00 pm    

What is mediation?

After the injured worker files a work injury claim and requests a hearing on the case, the North Carolina Industrial Commission will first order the parties to a mediation conference. The parties can either agree to have the mediation or disagree in which case the NICC will make the decision whether a mediation is advisable or a waste of everyone’s time.

North Carolina worker’s compensation lawyer Joe Miller will review with you the pros and cons of mediation. Many cases do settle at the mediation. Mediations can be worthwhile, even if the case doesn’t settle, because they can help narrow the issues and help get advance knowledge of what the insurance carrier for the employer thinks.

At a mediation, typically the lawyer, for the insurance carrier and employer appears alone, and the insurance adjuster is on standby on the phone. Although they are technically supposed to appear, many times, it is more expedient to waive their appearance so the mediation can take place at a time more convenient to the injured worker and his or her attorney.

The worker appears at the mediation with his/her attorney, and there is a mediator who tries to resolve the disputes. The mediator is a neutral party—typically an attorney knowledgeable in workers compensation law, selected by the parties from an approved list of qualified mediators. He or she is usually an attorney who has received training on how to mediate disputes. The mediator does not make any decisions or rulings, other than to declare an impasse if the parties cannot reach an agreement.

The mediation usually begins in a conference room at an agreed-upon location, with the mediator explaining the process. Each side then states its positions. This is usually a short statement of the facts relevant to the dispute.

Then, the two sides typically split up and go into two different rooms. The mediator go back and forth between each room, speaks to both sides to identify the issues, identity the disputes, and try to reach a solution. The mediator then gets input from one side and then walks to the other room to hear the input from the other side. Before the mediator leaves the room to head to the other, he or she will usually be given a monetary figure. On the injured worker’s side, this is called a “demand.” On the insurance company’s side, this is called an “offer.”

In this way, many disputes are resolved. The back and forth continues until hopefully, the offer and demand figures move closer and closer, until either there is a settlement or until there is an impasse. If the case cannot be resolved, then the mediator notifies the NICC and the case is set up for a hearing.

Preparation for the Mediation

Injured workers should review their mediation case with their attorney well in advance of the mediation. Strategy and experience are crucial to a successful mediation and typically our office will schedule a “mediation preparation” call or session a week or two prior to the mediation. Well in advance of the mediation, the injured worker’s attorney will be reviewing all of the relevant medical records and will typically have issued a “demand letter” to the insurance adjuster or his or her attorney.

This is done because the employer’s and insurance company’s lawyer often needs to get authority to settle the claim. This refers to the amount of money that the insurance company is willing to authorize the attorney to offer to resolve the claim.

Accordingly, the more they know about the case beforehand, often the better. Unlike a hearing, where surprise can work in your favor because the parties cannot walk away from a hearing – in mediation, the element of surprise can be a disadvantage because the party that is surprised can just refuse to settle and demand a hearing.

On the other hand, one does not want to come to the mediation as a “beggar.” If the insurance company thinks the worker is desperate for a settlement, then they will “low ball” and not offer the true value of the claim. Accordingly, it is best to engage in at least some “poker playing” and not appear too eager to settle. An experienced North Carolina worker’s compensation attorney will therefore advise you to “keep your cards close to your chest” when engaged in a mediation setting.

Mediations are confidential. This means that statements by either side cannot be used at the hearing. There is a trade-off though. While the statements can’t be used, the words don’t evaporate. The lawyers will know what was said and use the facts in those statements to their practical advantage by engaging in discovery about anything that is learned in mediation that was not known previously.

Mediators often review the potential outcomes of a case and the odds of success for each outcome. A mediation resolution usually means some compromise. Preparation helps because an experienced lawyer will explain which compromises are minor in the long run and which compromises cost a lot of money. Both sides usually walk away from the mediation slightly unhappy. The keys to a successful compromise are to balance properly the odds of winning, the money at stake, and the needs of the injured worker.

Mediation is generally useful only when the injured worker knows the full extent of his/her injuries and their full medical prognosis. It doesn’t make sense to mediate if the worker hasn’t reached his/her full point of medical improvement. Clients who have reached full medical improvement may need to still treat to maintain their medical level. But if the patient doesn’t know if he/she can still get better, mediation is usually not advisable.

This is why usually, well before mediation, the injured workers’ attorney will write to the workers’ treating physicians to obtain their opinions on the likely course and cost of future care. These opinions will accordingly be used to help form the demand letter to the insurance company.

Injured workers should understand that the result of a full and final settlement at mediation is typically a lump sum payment. This means the worker will forfeit the right to continuing medical bill payments and continuing lost wage benefits for a one-time cash settlement. An experienced workers’ compensation lawyer will review:

  • The outstanding medical bills;
  • The length of time temporary total disability or temporary partial disability would continue to be paid to the worker;
  • The need for and cost of additional medical treatment for the work injuries for the remainder of the worker’s life;
  • Any permanent partial impairment ratings to any particular body part;
  • The ability of the worker to return to work – with or without restrictions—in his or her pre-injury job, or in alternate employment;
  • Whether the worker remains completely disabled to perform any work and if so, if that disability is likely to remain past 500 weeks.
  • Whether the worker is a current Medicare recipient or anticipates qualifying for Medicare in the next 30 months.

Because the ability to obtain temporary total disability typically ends at 500 weeks of benefits, many times the future medical benefits become very important and a can be key issue is figuring out the value of any potential workers comp settlement. Joe Miller Esq. works with your doctors to determine your medical diagnosis, your prognosis, the type and extent of the medical treatments needed, and the expenses for each treatment going forward. Sometimes these things can be estimated, sometimes it is much more difficult. The cost of medications and medical equipment such as prosthetics will also be part of the settlement equation.

Speak with an Experienced North Carolina Workers’ Compensation Attorney today

North Carolina worker’s compensation attorney Joe Miller has been helping injured workers in North Carolina and Virginia get justice. He has helped thousands of clients get the compensation they deserve. He understands the ins and outs of mediation. For help now, please call Joe Miller at (888) 694-1671 or fill out his online contact form