North Carolina Worker's Compensation - Help For Injured North Carolina Workers

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  1. #1
    Join Date
    Mar 2009
    Posts
    5

    Unhappy Broken Back and Workers Comp

    I broke my back compression fracture of t-4 in a work related accident. I have also lost my job due to the fact i filed a workers comp claim(filed with dept of labor). They wanted me to just go to doctor and let them pay for it. Luckily i told doctor it was work related and that part worked out. But I was injured on 7-3-08 and up to today there is no way i could do my job everyday without massive amounts of pain. I also have to 2 bulging discs in my neck found in one of the MRI's from same injury. I hired a lawyer few weeks ago after i got fired to handle workers comp because they offered me 5000 dollars to settle, and i kinda laughed at them. I have been to rehab, physical therapy, I am now receiving back injections which none of the above has done anything to help. I am just curious on what to expect as I have not heard anything from the lawyer, and i know things take time, im just curious how much, and what kind of things to expect, and of course any other information you might want to throw at me would be greatly appreciated.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Broken Back and Workers Comp

    Once a worker’s doctor determines that his or her medical condition is not expected to improve or worsen significantly in the future then he or she has reached a point of “maximum medical improvement,” which is the end of the healing period. The doctor may assign a percentage rating to the body part that was injured. There is a statutory schedule of benefits which can be used to calculate the dollar amount of that rating in terms of PPD. For example, a 10% PPD rating to the back translates to thirty weeks of payment of PPD at the compensation rate of the injured worker. That is because the schedule of injuries provides that an individual with 100% disability to the back may receive three hundred weeks of compensation, and three hundred weeks times 10% is thirty weeks.
    If the worker has not returned to work at the same or greater wages than he or she was earning at the time of injury then the worker may elect to be paid, in lieu of the impairment rating, the benefits for partial wage loss up to the three hundred week cap.


    http://workerscomp.ncbar.org/Legal+R...e.aspx?id=3575

  3. #3
    Join Date
    Mar 2009
    Posts
    5

    Default Re: Broken Back and Workers Comp

    Wow, do they make this stuff purposefully a pain in the rear?? Thanks for the quick response though. I kind of understood that, so it basically seems i am waiting on the "best recovery i can hope for at this point"? Then an assessment and go from there. I have not returned to work, I honestly do not think i will be able to perform the job i was doing before the accident. I did it for about 6 months after the accident (and suffered what i feel to be undue pain and suffering) as i was clear that i would lose my job if i said that i didn't think i was able to.

    Also, I just received in the mail today (for the, god i don't know how many times) a bill from the hospital where I was treated for the injury, I have forwarded the bill to both my employer (in the past before I was fired) and the workers comp insurance company. Some one in refusing to pay it. The bill clearly shows the treatment date was the date of injury. I am confused and frustrated with this. I pretty sure that's what the ins company want, me to get fed up and give up, but jeez is it legal to push the bill on me like that...

    Again, thank you for the response and any information you have on this subject.

  4. #4
    Join Date
    Mar 2009
    Posts
    5

    Default Re: Broken Back and Workers Comp

    Forgot to ask, what is the compensation rate the number time the example of 30 weeks that you were talking about.

    Thanks

  5. #5
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Broken Back and Workers Comp

    depends on your wages and date of injury.
    there is a table on the state web site
    http://www.ic.nc.gov/

  6. #6
    Join Date
    Mar 2009
    Posts
    5

    Default Re: Broken Back and Workers Comp

    ok if i was looking at the right form, that is less than my normal wage. What do they do about that?

  7. #7
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Broken Back and Workers Comp

    workers comp is not like civil liability insurance; it's "no fault". the burden of an injury is shared by employer and employee.
    the unpaid amount, among other things, is your share.
    Last edited by .SH; 03-29-2009 at 03:57 PM.

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Broken Back and Workers Comp

    ok if i was looking at the right form, that is less than my normal wage. What do they do about that?
    In WC you don't receive your full rate of wages... the wage loss benefits are based on your AWW/average weekly wage...and are not taxable. They are subject to the max amount your AWW will support based on the 66.666% formula.
    Q: At what rate of pay?
    A: 66 2/3% of the average weekly wage, not to exceed $816.00* (2009 maximum) per week.

    * The maximum weekly benefit is adjusted annually.
    Q: How long is the employee eligible to receive lost-time weekly benefits?
    A: Until the employee is able to return to work. http://www.ic.nc.gov/ncic/pages/faq.htm#payments
    The providers are billing you in the event your claim is denied. You should not have to pay this bill, at least until the final outcome on the compensability issues in your claim are finalized. IF the claim is legally denied, you could be responsible for the bills.


    Q: What happens when the employer refuses to acknowledge the claim?

    A: When liability for payment of compensation is denied, the Commission, claimant, his or her attorney (if any), and all known providers of health care shall be promptly notified of the reason for such denial. The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the denial of liability.

    If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.

    Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers’ compensation claim.
    Q: How long does it normally take for medical bill approval?
    A: Medical Fees has to wait for the insurance carrier to send the bill. Once it is received, bills are approved on a daily basis. After approval, Medical Fees sends the insurance carrier or self-insured a medical bill analysis, stating the approved amount.
    Q: How long should a medical provider have to wait for reimbursement?
    A: G.S. §97-18(i) states "If any bill for services rendered under G.S. §97-25 by any provider of health care is not paid within 60 days after it has been approved by the Commission and returned to the responsible party, or within 60 days after it was properly submitted, in accordance with the provisions of this Article, to an insurer or managed care organization responsible for direct reimbursement pursuant to G.S. §97-26(g), there shall be added to such unpaid bill an amount equal to ten per centum (10%) thereof, which shall be paid at the same time as, but in addition to, such medical bill, unless such late payment is excused by the Commission."
    If your claim is denied... you have to file for a hearing to litigate the issues...
    If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.
    Frequently Asked Questions are here...http://www.ic.nc.gov/ncic/pages/faq.htm#medicalbill

    Be sure to keep ALL of your billing statements...you want to be sure all the medical has been paid before you accept any settlement to your claim.

  9. #9
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,049

    Default Re: Broken Back and Workers Comp

    If you are unable to work your case is worth a lot more than the rating to your back is likely to be. The rating will be a percentage of the 300 weeks. Be wary of settlement offers.

    I recommend you sit down with your lawyer and discuss what to expect. You need to ask about "TTD" and "return to suitable employment." You should also discuss "TPD" and "PPD under the schedule and under the loss of earning capacity provision" as well as PTD (permanent total disability).

    If your lawyer is a competent work comp lawyer he or she will know what all these terms mean.
    Last edited by complwyr; 03-31-2009 at 08:56 AM. Reason: correct typos
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  10. #10
    Join Date
    Mar 2009
    Posts
    5

    Default Re: Broken Back and Workers Comp

    God I hope so, otherwise, I am in trouble. Thank you for the reply. I appreciate all the information about this, I feel minutely more informed, FAR more than when I started this adventure. The sad thing is, I am not getting this information from the one that is getting paid. Odd eh??

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