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Would You Know if Your NC Workers’ Comp Injury Was Incorrectly Denied?

In North Carolina, there are three basic types of workers’ compensation claims. Each has its own nuances and special circumstances to try to prove to the workers’ comp insurance company that they owe you benefits.

  1. Injury by Accident describes an external factor that caused your injury. Perhaps you tripped and fell or coworker dropped a computer on your foot. Were you injured while driving a company truck? North Carolina law says that you likely must be compensated for injuries that are caused by an accident. Without the help of an attorney we have seen instances where injured workers were denied compensation.
  2. Specific Traumatic Incident occurs when you are able to determine exactly when and where your injury occurred, yet it did not result from an accident. You may have lifted something and your back locked up. Or did you reach for a tool and pull your shoulder? From a workers’ compensation standpoint, specific traumatic incidents typically only apply to spine injuries. Some things that may at first look like a specific traumatic incident can fall under the definition of injury by accident. And many times, a carrier will wrongfully deny a claim (when the injury is to a body part other than your back) based on their argument that no accident occurred. This is one of the many reasons we urge folks to consult an experienced workers’ compensation attorney. There are so many nuances as to whether an injury is or is not the result of a specific traumatic injury. How would you know these nuances? You can bet the insurance company knows them. And they know how to try to deny your claim based on what they suspect you don’t know!
  3. Occupational Disease typically refers to a condition that develops over time as a result of your job duties and/or your work environment. Most people are familiar with carpel tunnel syndrome or exposure to mold, asbestos, or hazardous chemicals. Some workers’ compensation insurance companies will sometimes try to deny these claims and refuse to cover treatment. It is up to you to show that your job elevated your risk of injury. For someone who is not an experienced workers’ comp lawyer, this can be a tough claim to prove. We try to do this every day for our clients. That is another reason we urge injured workers to contact us. These claims can be a very tricky to prove.

Exceptions to Injury by Accident

Different rules apply for injuries to the neck and back, hernias, and repetitious motion injuries such as carpal tunnel syndrome.

In North Carolina, it is generally understood that for an injury to be deemed compensable (in other words, it was an injury by accident), it must occur by accident, and in the course and scope of employment. This definition applies to injuries that result from accidents that are unexpected or unanticipated. You can also think of an accident as an event or interruption that’s not part of the normal, everyday, performance of your job. Were you performing your normal work routine, or did you, for example, have to apply an excessive or unanticipated amount of force to open a stubborn crate?

Unfortunately, this means that not every injury that occurred at work will be considered the result of an accident. In other words, it may not be compensable. Here are some exceptions.

In order to be deemed compensable, spinal injuries must occur as the result of a “specific traumatic incident,” which is a more flexible standard and does not necessarily require an unexpected event. For example, if you sustain a herniated disc while lifting a box at work, even though you may have been performing a routine part of your job in the normal manner, you may very well have a compensable workers’ compensation claim.

Like back injuries, hernia injuries may also be compensable if they are the direct result of a specific traumatic incident of the work assigned. However, a stricter application of the rule applies to hernia injuries compared to back injuries. For a hernia injury to possibly be compensable it must appear suddenly following the injury and it must be a new hernia, and not one that had developed prior to the accident.

Finally, repetitive motion injuries, such as carpal tunnel syndrome may be (or may not be) a compensable occupational disease. Unlike an injury by accident or specific traumatic incident, an occupational disease typically develops more slowly, through prolonged workplace exposure to a particular agent or action. While certain medical conditions are expressly identified as an occupational disease in North Carolina, many are not. I have seen some insurance companies try to deny those that NC workers’ compensation laws state are compensable. These types of injuries represent a very grey area and can be difficult to prove for the uninitiated. One insurance carrier tried to blame an employee’s tendonitis on her pregnancy, claiming that tendonitis is common during pregnancy. For that reason they tried to deny her claim.

While not every work-related injury will be compensable under North Carolina workers’ compensation laws, many injuries are, and may likely entitle you to benefits. But how would you know your injury is compensable? We know. And we know how to try and prove it.

What Makes James Scott Farrin Workers’ Comp Lawyers Different?

We will often use a team approach when handling workers’ compensation cases. Any number of attorneys and paralegals may work on your case in addition to firm resources. (You, incidentally, are part of that team.)

We may consult with any one of our attorneys and paralegals that previously worked for insurance companies. They know first-hand how some insurance companies may try to delay, deny, and defend your claim because they have seen this happen from the inside.

Nearly half our workers’ comp attorneys are NC Board Certified Specialists in Workers' Compensation law. We think this is a pretty big deal as it is the highest level of specialization available in North Carolina, and only a small percentage of NC attorneys can make that claim. Very small.

We may consult with one or both of our two former North Carolina Industrial Commissioners on your case. (The North Carolina Industrial Commission (NCIC) is the impartial agency that administers and enforces workers' compensation laws.)

We may seek the counsel of our former North Carolina state senator who helped write some of North Carolina’s worker’s compensation laws.

Several of our attorneys have more than 10 years of experience. Some speak at seminars for other workers’ compensation attorneys. Others have written books about various areas of law, and three have received coveted awards for workers’ compensation, including:

  • Best Lawyers in America “Best Lawyer1” and “Lawyer of the Year2” for Raleigh (twice)
  • North Carolina Super Lawyers Magazine “Rising Star3 ” and “Super Lawyer4” (three times)

Get a Free Case Evaluation From NC Workers’ Comp Lawyers

When it comes to trying to get the benefits you may deserve from the workers’ comp insurance company, there is a lot at stake. That is why we urge anyone who has been injured on the job to contact us or call 1-866-900-7078. We will try to ensure that all the necessary measures are taken to try to prove your right to benefits.

 

1 “Best Lawyer” Matt Healey from 2013–2018; Barry Jennings from 2015–2018
Since it was first published in 1983, Best Lawyers® has become universally regarded as the definitive guide to legal excellence. Best Lawyers is based on an exhaustive peer-review survey. For the 24th edition of The Best Lawyers in America (2018) more than 58,000 leading attorneys cast more than 7.4 million votes on the legal abilities of other lawyers in their practice areas. Lawyers are not required or allowed to pay a fee to be listed; therefore inclusion in Best Lawyers is considered a singular honor. Corporate Counsel Magazine has called Best Lawyers “the most respected referral list of attorneys in practice.” For more information regarding the standards for inclusion, visit 
www.bestlawyers.com.

2 “Lawyer of the Year”: Matt Healey in 2015 and 2017.
Only a single lawyer in each practice area and designated metropolitan area is honored as the “Lawyer of the Year,” making this accolade particularly significant. Lawyers being honored as “Lawyer of the Year” are selected based on particularly impressive voting averages received during the exhaustive peer-review assessments conducted with thousands of leading lawyers each year. Receiving this designation reflects the high level of respect a lawyer has earned among other leading lawyers in the same communities and the same practice areas for their abilities, their professionalism, and their integrity. For more information on the rules of inclusion visit 
www.bestlawyers.com.

3 “Rising Star”: Ryan Bliss in 2018; Matt Healey from 2010–2013; Barry Jennings from 2011–2013.
Published by Super Lawyers. To be eligible for inclusion in “Rising Stars,” a candidate must be either 40 years old or younger or in practice for 10 years or less. “Rising Stars” undergo a rigorous, multiphase process which combines peer nominations with third-party research. Each candidate is evaluated on 12 indicators of peer recognition and professional achievement. Selections are made annually on a state by state basis. While up to 5% of the lawyers in any state are named “Super Lawyers,” by Super Lawyers magazine, no more than 2.5% are named to the “Rising Stars” list. For more information regarding the standards for inclusion, visit 
www.superlawyers.com.

4 “Super Lawyers”: Matt Healey from 2014–2016.
Published by Super Lawyers. “Super Lawyers” undergo a rigorous, multiphase process which combines peer nominations with third-party research. Each candidate is evaluated on 12 indicators of peer recognition and professional achievement. Selections are made annually on a state-by-state basis. For more information regarding the standards for inclusion, visit 
www.superlawyers.com.

Will I Lose Benefits if I Don’t See a Doctor Right After My Work Injury?

A question I am sometimes asked by perspective clients is whether their workers’ compensation benefits can be denied if they did not see a doctor immediately after their work accident.

Seeing a doctor immediately after a work injury can help your work injury claim.

While there is no strict requirement that you must see a doctor immediately after a work accident, it is generally a good idea to see one as soon as possible. Having a medical doctor evaluate your injuries after an accident offers documented proof to the insurance company and your employer that you sustained an injury. The insurance company isn’t simply going to take your word for it. Without documentation, the insurance company or your employer may not believe that you were injured and they could try to deny your claim. We’ve seen this happen.

Notify Employer of Injury Within 30 Days (In Writing)

The very first step you should take after you are injured on the job is to notify your employer of the injury and accident. The law requires you to provide this notice within 30 days of the accident. The notice can be either in writing or by simply telling your employer of the injury and accident. While you can certainly verbally tell your employer that you were injured, experience tells us it is always safer to put the notification in writing. Again – you need documentation that you informed your employer. And your employer needs documentation. You can send an email, write a letter, or send a text message telling your employer when, where, and how you were injured on the job.

Get Medical Treatment as Soon as Possible

After informing your employer of your injury, they may direct you to a specific doctor for medical care. What we’ve seen happen is that often the employer will send you to a medical facility, such as an urgent care-type facility. Make sure you attend that medical appointment and explain to the doctor exactly how you were injured and tell them all of the medical problems you are having related to the injury. It is important to be clear and direct when communicating with the doctor so hopefully they can document the circumstance surrounding your injury and accident so that your employer and insurance company can understand exactly what happened.

If your employer or their insurance company do not direct you to medical care after your report of an accident, then you should let them know that you are going to seek care on your own. If they are unwilling to provide you medical care you can use health insurance if you are covered to obtain this medical care. If you do not have health insurance and your injury is causing major problems, then seeking treatment at an emergency room can be an option. Or, an urgent care-type facility is also a good option if you do not have health insurance and are able to afford the cost of the initial visit.

If the employer or their insurance company directs you to medical care, they will be able to access the medical records from the initial visit. The law allows this access so they can further direct your medical care. If they choose to direct your medical care, it is generally a good idea to allow them to do so and to cooperate with the medical treatment they provide. If you choose not to go to the doctors they send you to, that can sometimes be a basis for denying your claim.

Overall, it is important that you notify your employer immediately after an accident at work where you sustained an injury. It is also important to seek medical care as soon as reasonably possible. If you do not notify your employer or if you delay your medical care, you could be creating a situation where the insurance company and your employer may eventually try to deny your workers’ compensation claim.

Why Is Immediate Medical Care So Important?

When you go to the doctor they will document your injuries, how and when you said you received them, and they will outline a plan of care. Without this documentation, it can often be difficult for an attorney to effectively help you if there is not enough information documented that proves you were injured around the time the injury and accident occurred.

In sum, not seeking immediate medical treatment is not an absolute bar to obtaining workers’ compensation benefits, but it certainly can make obtaining those benefits much harder if you sustained a significant injury at work.

These are just some of the reasons that we always urge injured workers to contact us as soon as possible. There are so many traps and pitfalls injured workers can potentially fall into simply because they are not experienced in workers’ comp law.

We are experienced. Our North Carolina workers’ compensation attorneys at the Law Offices of James Scott Farrin have the knowledge and experience to fight for you if the insurance company tries to deny you the medical treatment you need to get better. Based on our team’s 150 years of combined experience, it is almost always a good idea to speak with us about your circumstances. Our confidential case evaluations are free, and you may learn that you’re entitled to more than the insurance company claims.

Get a Free Case Evaluation from NC Workers’ Comp Lawyers

If you are injured at work and your claim is denied for reasons relating to medical treatment, or the insurance company and employer are failing to provide you medical treatment, contact us today or call 1-866-900-7078 so we can discuss working together to try to protect your rights.

P.S. Want more good reasons to contact us about your work injury? Click here.

Is Lane Splitting Dangerous?

A new California bill that defines and regulates lane splitting in the state has prompted other states, including North Carolina, to consider renewing attention to this debate.

Lane splitting – aka lane sharing or white-lining – is when a motorcyclist or scooter cuts between lanes of slower-moving traffic, or pulls in front of stopped traffic at a red light.

It is currently illegal to split lanes in North Carolina and in every other state except California. If you have ever driven on the Hollywood Freeway in Los Angeles or the Oakland Bridge in San Francisco, you can at least understand why California allows lane splitting. Nothing moves because these and many other California roadways are often idling bumper to bumper. Sitting on a hot bike in bumper-to-bumper traffic can be a miserable experience.

Lane splitting is deemed by some to be safe, if done by experienced and safety-minded motorcyclists. Others disagree, insisting that there is too much potential for catastrophe.

When Andy W. was in a motorcycle wreck he learned the hard way that the insurance company was not on his side. Click here to read what led Andy to us, and to a settlement* he was very happy with.

Pros and Cons of Lane Splitting

A 2015 study by the University of California Berkeley found that the risks of lane splitting can be somewhat mitigated under certain circumstances. For example, the study found that splitting is safest at 50 mph and under and also if motorcyclists traveled at a speed difference no greater than 15 mph than surrounding traffic.

Advocates point out that lane-splitting can help prevent motorcycles from becoming a stationary target in the event of an accident, particularly rear end accidents. California does have slightly fewer fatalities from rear-end collisions per registered motorcycle than other states, although there is no research to support why.

Some say lane splitting can be good for drivers, too, because it can help to reduce traffic congestion and carbon emissions from idling in traffic.

Opponents, on the other hand, make some worthwhile points about the potential dangers inherent in this practice – most of these dangers originating from other drivers.

  • Unexpected doors opening
  • Sudden lane changes from other vehicles
  • Vision impairment around large trucks
  • Collisions with turning vehicles
  • Too high of speed differentials when splitting lanes.

There’s one caveat to the Berkeley study that opponents emphasize. It found that of the motorcyclists involved in nearly 6,000 collisions in California, 17% had been lane splitting.

Consequences of Lane Splitting in North Carolina

The motorcycle accident rate nationally is significant when compared to cars — motorcyclists are 29 times more likely to be killed in a wreck, according to the National Highway Traffic Safety Administration (NHTSA). Still, the California bill, in combination with the potential benefits of easing traffic congestion, has made lawmakers in other states, including ours, open to considering this practice.

One of the primary challenges of legalizing lane splitting in North Carolina is that drivers may not be prepared for the change. This could lead to an upsurge of motorcycle accidents, which could result in even more injuries and fatalities – at least initially.

There are legitimate arguments for and against this practice. On a personal note, about the only time I could see myself even considering lane splitting would be if traffic were at a complete standstill. Regardless of where you fall in this discussion, I hope you have safe and enjoyable ride!

What are your thoughts about lane splitting? Tell us on Facebook.

Get a Free Consultation From North Carolina Motorcycle Injury Lawyers

If you or someone you know has been injured in a motorcycle accident of any kind, contact the Law Offices of James Scott Farrin or call 1-866-900-7078 for a free and confidential case evaluation.

 

* Each case is unique and must be evaluated on its own merits. Prior results do not guarantee a similar outcome.

One Key Question Can Make or Break Your Worker’s Comp Claim

While no two workers’ compensation cases are alike, all of them have one thing in common. When you make a claim for workers’ compensation benefits, the workers’ compensation insurance adjuster will likely ask you to give a recorded statement, whereby the adjuster will ask questions and you will answer them.

This blog addresses a critical question you will probably be asked:

“Were you doing your usual work routine when this happened?”

How to Answer Adjuster’s Questions

When you sustain a work-related injury, it is important that you provide a detailed explanation as to how your injury occurred. Leaving out relevant factors could result in denial of your claim even if your employer or the workers’ compensation carrier authorizes you to receive medical treatment and compensation payments.

The North Carolina Workers’ Compensation Act allows your employer and the workers’ compensation carrier to make these payments from up to 90 days after receiving notice of your injury.

The more serious your injury is or becomes, the greater the likelihood the employer, and/or the workers’ compensation carrier, may potentially deny your claim if you have left out relevant factual information in a written accident report and/or a recorded statement.

What Is Considered “Usual” or “Unusual”?

If you have sustained an injury to a body part other than your back as a result of a specific incident at work, the injury must be the result of an unusual set of circumstances for you to obtain coverage. If the injury is the result of a routine activity that you usually do at work, it may not be covered. For example, an auto repairman may routinely get down on one knee to change a tire. If, on a particular occasion, he kneels in the same manner as he routinely does and sustains a meniscus tear to his knee, the injury will probably not be covered.

Insurance companies are for-profit businesses. And some may look for any reason to try to deny some claims. Leaving out factors that show that the circumstances resulting in your injury were unusual at the time of the injury may result in an initial denial of your claim or a denial within 90 days of the notice of your claim.

Typically, even after an injured employee may have been authorized to receive medical treatment for a work related injury and/or received compensation payments, the workers’ compensation adjuster will request that you participate in a recorded statement. The adjuster knows that if they are able to get the injured employee to agree that the injury was the result of how the employee usually performed the activity, then the adjuster can legally deny the claim.

Adjusters sometimes ask fair open ended questions such as, “What, if anything, unusual occurred that resulted in your injury?” It is important when asked this question that you describe all possible unusual factors that may have resulted in your injury.

On the other hand, we have seen some adjusters set out to trap the injured employee. For example they might ask a leading question such as, “Isn’t it true that you were doing your usual job routine when you were injured?” Be truthful, but careful in how you answer this question. They may ask it several times and in several different forms during the recoded statement. Again, it is important when asked this question that you describe all possible unusual factors that may have resulted in your injury.

We believe it is safer that an injured employee secure counsel for advice before going on record with an adjuster. A lot is at stake. Every word you use or do not use to describe a work related injury can determine the outcome of whether your claim is ultimately accepted or denied.

If your claim is denied because you left out relevant facts in a written accident report or in a recorded statement, we urge you to seek legal counsel. Here at James Scott Farrin, we have successfully* helped thousands of injured employees.

Get a FREE Evaluation From an NC Workers' Compensation Lawyer

Sadly, your workers’ comp insurance company may have their own financial interests in mind instead of helping you heal and get back on your feet.

With experienced workers’ comp attorneys who deal with these issues every day, including six North Carolina Board Certified specialists in workers’ compensation law, we do have your best interests in mind. Before you proceed with a recorded statement, contact us or call us at 1-866-900-7078.

*Each case is unique and must be evaluated on its own merits. Prior results do not guarantee a similar outcome.

Contact Information

Raleigh Law Office

4325 Lake Boone Trail, Suite 100
Raleigh, NC 27607
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

2915 Raeford Road, Suite 204
Fayetteville, NC 28303
Phone: 910-488-0611
Toll Free: 1-866-900-7078

Charlotte Law Office

1001 Morehead Square Drive, Suite 350
Charlotte, NC 28203
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