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If I File a Workers’ Compensation Claim in NC, How Do I Receive Medical Treatment and Who Controls It?

As a worker's compensation attorney in NC, I receive lots of questions about medical treatment after job-related injuries.

If I get hurt at work, should I go straight to the hospital? What should I tell them when I get there? Can I choose my own doctors? More importantly, who pays for my treatment?

You simply must be prepared. After all, if you ever find yourself struggling to recover from a serious work injury, the last thing you'll want to worry about is a growing stack of medical bills.

The goal of this article is to provide you with some basic information about what to do and where to go after a workplace injury in North Carolina.

What is covered?

If you have an accepted workers' compensation claim in North Carolina, you are entitled to medical benefits. This usually includes things like doctor's appointments, physical therapy, prescriptions, and even surgery. To put it simply, medical benefits are any treatments that help you recover from your injury.

In many cases, the term "medical benefits" even applies to:

  • Travel costs to and from your medical appointments (if more than 20 miles round-trip)
  • Attendant care
  • Medical equipment
  • Home or vehicle modifications

Unlike a typical health insurance plan, there are no co-pays or deductibles in workers' compensation cases. The insurance company is responsible for 100% of your approved medical expenses. It sounds pretty good, right? But there's a catch.

 

Medical41_06062014Who chooses the doctors?

In North Carolina, the workers' compensation insurance company has the right to direct your medical care. This means they choose which doctors you see, when you see them, and which treatments you receive.

What if I refuse the treatment?
The insurance company might try to cut off your benefits altogether.

What if I request a second opinion?
The insurance company might deny the request or try to weigh in on which doctor you see before agreeing to pay for it.

What if I go to my own doctor?
The insurance company will probably refuse to pay for it. If your doctor makes any new treatment recommendations, they will probably refuse to pay for those as well. If you choose to pay for the treatment on your own, you might not be reimbursed.

As you've probably guessed, these issues can (and usually do) lead to lots of problems. Many injured workers in North Carolina eventually find themselves wrestling with an insurance company over the issue of medical care.

 

So what should I do after an injury?

Report! Report! Report!

If you've been injured on the job, immediately (or as soon as possible) tell your coworkers and supervisors what happened. Written notice is even better. Fill out an incident report. Make sure the details of your accident are consistent. When you get to a doctor, make sure he or she is aware that you had an accident on the job. Your medical records are going to become very important so make sure the doctor knows exactly what happened to you.

Get to a Doctor
If your injury is serious enough, you may be taken to the hospital by ambulance. For all other non-emergencies, ask your employer whether they have an onsite or designated offsite healthcare provider for workers' compensation patients. If so, tell them you need an appointment. Alternatively, work with your employer to locate a nearby healthcare facility that accepts walk-in patients. It could be an urgent care clinic or a hospital, depending on the severity of your injury. When you arrive, make sure you tell the doctor(s) that you were injured on the job and give them the name of your employer.

Establish Treatment
As you recover from your injury, follow your workers' compensation doctor's instructions with regard to medical treatment. If your injury is severe enough, you may be referred to a specialist for further testing, pain management, or surgery. At any point, if you feel uncomfortable or dissatisfied with the quality of your healthcare, it might be a good time to consult with an attorney and explore your legal options within the workers' compensation system.

 

Law0_07312014Call Experienced North Carolina Workers' Compensation Attorneys

You are now armed with some basic knowledge about your right to medical treatment after a work-related injury. However, in our experience, some insurance companies are always finding creative new ways to save money, which could mean denying you benefits.

Even if you are receiving some benefits now, it doesn't mean that it's everything you may be entitled. So, pick up the phone and contact an experienced workers' compensation attorney at the Law Offices of James Scott Farrin at 1-866-900-7078. Your initial case evaluation is free. Remember, nothing is more important than your health.

How Can I Get Medical Treatment Without Health Insurance After A Car Accident

Ambulance_06082014After you've been hurt in a car accident, you'll have to negotiate with the insurance company for how much they may owe you for your damages. And you'll need a lot more than just your words.

The only way to prove the extent of your injuries is to get medical treatment. This treatment becomes evidence to show why you should be compensated. You have to show what it took to resolve your injury-this becomes the story of why the insurance company should compensate you.

When does the insurance company actually pay you?

This "story" for trying to prove your case begins at the time of your injury and ends at the last date of your medical treatment. This is why you often have to wait until "maximum medical improvement" (or "MMI") before the insurance company will talk about settling and paying your claim. So they are really just reimbursing you for all of the bills you've already had to pay. Note: if the insurance company attempts to settle your injury claim before you are done treating, you are at risk and should contact an attorney right away.

You may also have a right to compensation for other, non-medical things, like how your injuries affect your daily life, time off of work, physical damages (such as scars or disabilities), emotional damages and expenses associated with your medical care.

How can you pay for medical care if you don't have health insurance?

It's worth saying again: treatment is imperative. Without medical treatment to document your injuries, there is no springboard to try to get a settlement. But since most doctors and other medical providers require payment at the time of service, if you don't have health insurance, it may seem impossible to get medical treatment.

Medical20_06082014Emergency Room Visits

After a car accident, most people go to the emergency room (ER) for initial treatment. The ER visit needs to happen early in your treatment, preferably the day of the accident. Remember: you are protecting the connection between your accident and your injuries. You need to go to the doctor as soon as there is an issue from the accident. However, you should not go to the ER repeatedly because an ER is set up for emergency visits only, not for ongoing care. Multiple treatments at the ER risk the insurance company refusing to pay for the multiple ER bills.

Some ERs will attach a "lien" to your bill. A lien means the provider will give you treatment without immediate payment, and instead collect the payment later, out of the final settlement. The lien gives them a legal right to be paid directly out of the settlement.

Other ERs do not automatically attach a lien and instead try to collect payment at the normally-scheduled interval. If the ER tries to collect payment immediately, then you should let them know your treatment was the result of a collision and the status of your case. Ask the ER to give you the option to pay the bill when the case is settled. If this is not an option, offer to pay very small amounts to keep the bill out of collections, and then pay the balance once the case is settled. Bottom line: it is important to stay in touch with the medical provider so they do not just send the bill to collections.

Medical31_07232014Follow-up Care for Muscle Strains/Sprains

After the initial ER care, if you have general muscle strains and sprains, chiropractic treatment is normally a good option, and chiropractors often treat on a lien.

The reason chiropractors are helpful is because they do a good job with soft tissue injuries, which are common after car accidents. Also, chiropractors are highly accessible: you can normally schedule an appointment within a day, which means you are protecting the connection between your accident and your treatment for the accident.  Plus, they often will not require immediate payment.

It is important to not miss appointments - the insurance company may take that as a sign that the appointment wasn't necessary. In general, you should follow the chiropractor's plan, but constantly communicate with the chiropractor about what is working, and what is not working.

Follow-up Care for More Serious Injuries

If you suffered more serious injuries, or you don't feel better after several weeks of consistent chiropractic care, you may need to seek medical attention from a family care doctor or a specialist. You may have to find a clinic or family care doctor who will treat you on a lien, and ask them for a referral to a specialist who can treat you on a lien. These providers can be difficult to find, but if they are available, they can be invaluable to your case.

There are some urgent care facilities that will treat on a lien. You can also investigate free clinics and free medical providers in your area. There are usually links to these services through your local health department. Large providers in our area, like Duke University Health Systems and UNC Health Systems, often provide charitable care services for uninsured individuals.

Finding an Attorney

In many cases, it is important to have well-informed representation that can help direct your case with your best interests at heart. Without an attorney, you risk making a mistake that could cost you. With our team of over 30 attorneys, we have extensive knowledge to assist our clients who are uninsured to get the treatment they need. This is important because settlement is completely related to your treatment.

Negotiating a Lien

If you get treatment on a lien, the extent to which a provider is paid is based on the final settlement. If the provider is not paid in full then you are responsible for the rest. There are some times that the attorney can negotiate with the lien holder to try to reduce the out of pocket expense to the client. For example, once the case settles if the medial provider is only scheduled to be reimbursed 70% of their bill, then the medical provider may agree to not charge the client for the remaining 30%.

If you've been injured, time is not on your side. Click here to have one of our attorneys review your case for free. Remember, there's no attorney's fee unless we recover compensation for your claim.

 

Social Security Disability Insurance (SSDI) Versus Supplemental Security Income (SSI)

The Social Security Administration (SSA) is responsible for two major programs that provide benefits based on disability: Social Security Disability Insurance (SSDI), which is based on prior work under Social Security, and Supplemental Security Income (SSI). Under SSI, payments are made on the basis of financial need.

Disability_061320141.) Social Security Disability Insurance (SSDI) is financed with Social Security taxes paid by workers, employers, and self-employed people. To be eligible for a Social Security benefit, the worker must earn sufficient credits (also called quarters) based on taxable work to be "insured" for Social Security purposes. Disability benefits are payable to blind or disabled workers, widow(er)s, or adults disabled since childhood, who are otherwise eligible. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker. SSDI recipients or beneficiaries commonly receive Medicare.

2.) Supplemental Security Income (SSI) is a program financed through general revenues. SSI disability benefits are payable to adults or children who are disabled or blind, have limited income and resources, meet the living arrangement requirements, or are otherwise eligible. The monthly payment varies up to the maximum federal benefit rate, which may be supplemented by the State or decreased by countable income and resources. SSI beneficiaries commonly receive Medicaid. Effective January 1, 2015, the federal benefit rate is $733 for individuals. Since SSI is a poverty program, if you have too many resources or too much income you are not eligible. (See example: http://www.ssa.gov/ssi/text-resources-ussi.htm).

For more information, on SSDI and SSI benefits, visit the following pages:

Still have questions or need help applying? We have an experienced Social Security Disability team made up of former Disability Examiners and a North Carolina State Bar Board Certified Specialist in Social Security Disability.

Contact us today for a free case evaluation by clicking on the link or calling our toll-free at 1-866-900-7078.

My child was hurt. I missed work. Will the insurance company pay me for time off?

Child Carseat_07212014When a minor is injured in a car accident, many questions arise. The biggest concern is your child's health and safety. Sprains and strains are some of the most common injuries from car accidents and require appropriate medical treatment to resolve. Of course, some injuries are even more serious and demand intensive treatment. What happens if you have to take time off work to take your minor to doctors' appointments? Will the insurance company reimburse lost wages?

If your child is injured and you miss work to take him or her to medical appointments, you will need proper documentation in order to have the best chance of recovering your lost income from the insurance company.

Lost Wages Form

When you take time off work, you must show that the hours you missed (therefore, the wages that you lost) were for the sole purpose of taking your child to the doctor.

You will need your employer to verify (in writing!) the date(s) you missed work, the hours you missed, and the amount of money you make per hour. At our firm, we created a "lost wage form" that takes only a few minutes to fill out and records information you need to try to prove your lost wages to the insurance company.

Be "Reasonable"

By law, the amount of time you missed from work must be "reasonable." To decide whether something is "reasonable," the insurance company does not consider your individual opinion and beliefs. "Reasonable" means you used a degree of care that an ordinary, competent person would use in the same or similar situation: You must act sensibly, do things without serious delay, and take proper, but not excessive, precautions. For example, if you say that you took your child to the doctor, the appointment would not likely take all day and result in a full day of lost wages.

Remember "reasonableness" in everything. This also applies to the type of treatment that you seek for your child's injuries. Again, in most cases, car accidents result in sprains and strains. Medical treatment should begin at the time of injury, and normally includes an immediate visit to the emergency room. The emergency room visit not only provides an initial assessment to treat injuries, but also protects the connection between your child's accident and the treatment for the accident. (In order to create evidence to show why your child should be compensated, you must show a continuous timeline of treatment and what it took for the injuries to resolve.)

Medical Care for a Child Vs. an Adult

After the initial emergency room visit, you may miss time from work to take your child to ongoing medical appointments. The type of treatment underlying these appointments must also be reasonable.

After being seen in the emergency room, it is best for your child to follow up with his or her pediatrician. Then follow the advice of your pediatrician in terms of the type of follow up care the child needs. Keep in mind that children's injuries typically resolve very quickly in comparison to adults. Observe your child: if he or she seems to be back to normal, this is not strange. Children are resilient and heal fairly fast. If you continue treating after your child is well, an insurance company will likely question the "reasonableness" of these actions.

Bills3_06082014Document, Document, Document

Keep good records of the time that you are out of work and make sure your employer can corroborate the time you missed from work and that the time relates-back to the date(s) the child had doctors' appointments. This way, you have a better argument to recover your lost wages from the insurance company.

If your employer refuses to sign something that corroborates your personal statement, and there is nothing to show loss of income during the time period you took off, it will be difficult to prove lost wages. If you can get a medical excuse from the doctor's office showing that you were at your child's appointment then provide that paperwork, along with information from the employer. The more evidence you have, the better.

  • Proper documentation is most important to recover lost wages.
  • Documentation from your employer should include verification of the date(s) that you missed work, the hours that you missed, and the amount of money that you make per hour.
  • Documentation from the doctor must show that you attended the appointment with your child, such as a medical excuse, or "absence" note.
  • Remember "reasonableness" in everything.

Focus on Your Child - We'll Take Care of the Rest

In the aftermath of a car accident, having an attorney provides peace of mind to know a strong legal team is fighting for your child's rights while you focus on your child's recovery. You shouldn't have to worry about whether or not you'll be paid for the time you have to take off to take your child to the doctor - that's what we do.

We understand you need every penny during times like these and that's why we will fight for everything you may deserve.

The information in this article is meant to provide a general snapshot on how to claim your lost wages. Contact us right now to see if we can help protect you and your family.

Contact Information

Raleigh Law Office

5848-100 Faringdon Place
Raleigh, NC 27609
Phone: 919-834-1184
Toll Free: 1-866-900-7078

Durham Law Office

280 South Mangum Street, Suite 400
Durham, NC 27701
Phone: 919-688-4991
Fax: 800-716-7881

Fayetteville Law Office

517 Owen Drive
Fayetteville, NC 28304
Phone: 910-488-0611
Toll Free: 1-866-900-7078

Charlotte Law Office

201 McCullough Drive, Suite 220
Charlotte, NC 28262
Phone: 704-599-1078
Toll Free: 1-866-900-7078

New Bern Law Office

1505 South Glenburnie Rd, Unit P
New Bern, NC 28562
Phone: 252-634-9010
Toll Free: 1-866-780-3422

Greenville Law Office

702 G Cromwell Dr.
Greenville, NC 27858
Phone: 252-355-5205
Toll Free: 1-866-780-3227

Greensboro Law Office

300 N. Greene Street, Suite 850
Greensboro, North Carolina 27401
Phone: 336-665-7072
Toll Free: 1-866-900-7078

Goldsboro Law Office

214 South William Street, Suite 3
Goldsboro, NC 27530
Phone: (919)-731-2581
Toll Free: 1-866-900-7078

Henderson Law Office

514 Dabney Drive, Suite 200
Henderson, NC 27536
Phone: 252-492-4600
Toll Free: 1-866-900-7078

Roanoke Rapids Law Office

709 Julian R. Allsbrook Highway
Roanoke Rapids, NC 27870
Phone: 252-537-9670
Toll Free: 1-866-900-7078

Rocky Mount Law Office

3202 Sunset Avenue, Suite B
Rocky Mount, NC 27804
Phone: 252-937-4730
Toll Free: 1-866-900-7078

Sanford Law Office

703-B South Horner Boulevard
Sanford, NC 27330
Phone: 919-775-1564
Toll Free: 1-866-900-7078

Wilson Law Office

2315 Airport Blvd Suite A
Wilson, North Carolina 27896
Phone: 252-246-9090
Toll Free: 1-866-900-7078

Winston-Salem Law Office

301 N. Main Street, Suite 2409-C
Winston-Salem, NC 27101
Toll Free: 1-866-900-7078