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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.

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.

Should I Negotiate My Own Workers’ Comp Settlement?

After a serious injury on the job, many people may assume that they will be able to return to their life as it was prior to the injury. They may believe they will be able to regain their health 100%, keep their same job, and be able to live relatively symptom free.

Why Workers’ Comp May Want You to Settle

History tells us the reality is often much different when there is a significant trauma or a serious injury that requires an extended period of time to recover. People are often surprised to learn that their employer may not be obligated to hold their job until they reach a full recovery. An injured worker may find that their doctor will not let them return to the type of work they performed prior to getting hurt.

What comes next for many of these injured workers is even more surprising. They are often contacted by the insurance company or the employer about settling their case.

The court, or North Carolina Industrial Commission in workers’ compensation claims, cannot make parties settle a claim. The law does not require an injured worker to enter into an agreement to resolve their case. So why, then, do insurance companies and employers sometimes push workers to enter into a settlement?

They may be looking to end their liability and monetary exposure in your case as quickly as possible.

Is Settling in Your Best Interest?

There are sometimes reasons an injured worker may benefit from a settlement. It may allow them to move on from a difficult work situation. It can take away the uncertainty of a court result. It may allow an injured worker sufficient resources to get treatment on their own without dealing with the insurance company’s doctors. It can also give an injured worker sufficient resources to pursue training for a new occupation. Under these circumstances, settlement can make sense for all parties.

If you are approached by an insurance company or employer with an offer to settle your claim, we urge you to question whether it is fair and in your best interest.

Is the NC Industrial Commission Looking Out for the Injured Worker?

The insurance company and employer may tell you that the Industrial Commission has to approve a settlement and will determine whether the settlement is fair and in your best interest. This is technically true.

During my time at the Industrial Commission, I often approved settlement agreements in which an injured worker did not have an attorney and accepted the employer’s settlement offer. My responsibilities, however, were not necessarily to ensure that the injured worker got the best deal, but instead, that they received at least the minimum required by law. There were certainly times when I sent an agreement back to an insurance company and injured worker indicating that I could not approve the settlement as being fair because the amount was too low. Even in those cases, I could not tell the parties what I thought a reasonable amount was.

More importantly, I could not tell the employee whether I thought he was getting everything he or she may have been entitled to under the Workers’ Compensation Act. In other words, someone may accept a settlement that does not consider their future medical needs, how long it will take them to find a new job, whether they need money for retraining, or to make up future lost wages. So what seems like a fair settlement to the injured worker may actually be a bargain basement deal for the insurance company.

Farrin Workers’ Comp Lawyers Have Your Best Interests at Heart

As a North Carolina Board Certified Specialist in Workers’ Compensation law representing injured workers, I am now able to look out for all of my clients’ potential needs. In fact, that is one of the most important aspects of my role as an attorney – to make sure I try to consider and address each and every need in settlement negotiations.

Our workers’ compensation attorneys want to have a comprehensive understanding of our clients’ medical condition, a thorough understanding of the injury’s impact on their ability to work, even an understanding of the local job market before advising our clients about what may make sense for them. Often this means trying to obtain a second opinion to provide a comprehensive overview of our clients’ medical condition. We often calculate varied cost projections on medical and disability exposure. We do not want any of our clients to enter into a settlement agreement unless it is their decision and that it is in their best interest for their future health and that it makes economic sense.

NC Workers’ Comp Lawyers Offer Free Case Evaluation

If you are contacted by an insurance company about settling your claim, we urge you to contact us or call 1-866-900-7078. We offer a no-cost case evaluation regarding your claim. It may be that the insurance company is being fair with you. We have seen that happen – although it is not the norm in our experience. That is why I hope you take the time to give us a call so you can make that decision for yourself.

How to File a Workers’ Compensation Claim

One of the most important parts of your workers’ compensation claim is the beginning.

Immediately reporting your injury and making sure all the correct forms are filed can help to try to ensure that your claim is accepted. So how do you go about filing a claim?

Report the Injury to Your Employer

As soon as you are aware that you have been injured at work you should inform your supervisor. Let them know the specifics of how, when, and where you were injured. Let them know about every body part that was injured. Fill out an accident report if your employer offers one, and if they don’t, write out a description of the accident and give it to your employer. This is important because insurance companies can use incomplete accident reports as a reason to deny all or part of a claim. We know. We have seen them use this denial tactic many times. Be detailed about how the injury occurred – particularly noting any unusual circumstances (falling, slipping, etc.).

File a Form 18 with the NC Industrial Commission

It is your responsibility to file your claim with the North Carolina Industrial Commission.

Do not assume that your employer will file your claim with the NC Industrial Commission for you.

To file your claim, you will need to complete a Form 18, which can be found on the Industrial Commission’s website.

Form 18 should be submitted to the Industrial Commission and to your employer within 30 days of your injury.

Include all the requested information, and again, be specific about how the injury occurred noting any unusual circumstances. Include the specific body parts involved. Body parts that are not included may be denied for treatment by the insurance company.

Mail or fax this form to the Industrial Commission at the address or fax number listed on the form. Make copies and give one to your employer. This form is what starts the ball rolling on your claim.

The Industrial Commission will send you an I.C. File Number for your case. The employer/insurer is then notified of a 30-day deadline by which to file a responsive form accepting or denying your claim.

There are a lot of moving parts to dealing with a workers’ compensation claim, and if not done correctly and within the timeframe required, your claim can become complex quickly – and it can even be denied.

Get a Free Case Evaluation From NC Workers’ Comp Lawyers

Notifying your employer and the Industrial Commission and filing a Form 18 is just the tip of the iceberg. If you are concerned about completing the form or dealing with the insurance company, contact us or call 1-866-900-7078. Don’t wait until the clock runs out. If your employer has no notice of the injury, the insurance company can likely use that as a reason to deny your claim when it otherwise might potentially have been accepted.

PS… if you think it is too expensive to hire a lawyer to help you, click here to learn more about our contingency fee. You may be surprised at the long-term consequences of not hiring an attorney.

What You can do if Worker’s Comp Has You Under Surveillance

Some insurance companies may hate sending you a weekly check while you’re recovering from your on-the-job injury. They’re in business to make money, not give it away.

Every time you receive workers’ compensation benefits, that is money coming out of the insurance company’s pocket and going into yours instead. That’s why some insurance companies may try to find ways to avoid paying you benefits. Sometimes that means an insurance company may completely deny responsibility to pay for your injury. When this happens, they pay you no benefits at all, while you fight (sometimes for years) for what you potentially deserve.

Worker’s Comp Insurance Tactics to Pay You Less

Delay

This is what we refer to as their “delay” tactic. We have seen some insurance companies try to wait out the injured worker while they’re hurt, out of work, and in financial distress. We believe they are waiting you out. The longer they wait, the more urgent your need for money becomes, and the less compensation you may be likely to settle for. And that means less money they have to pay out.

Deny

But shortchanging you is not the only way some insurance companies may try to help themselves. Even when an insurance company accepts responsibility for your work injury, they can at any time, try to reduce or even stop paying you benefits.

We have seen them try to cut off injured workers’ weekly checks. Other times they may try to avoid paying for a recommended medical procedure.

No matter how the insurance company may try to keep money for themselves, it is you, the injured worker, who is simply trying to get better and go back to work, that ends up paying the price.

Surveillance

Do insurance companies randomly decide one day that they are not going to pay you? Of course not. They must have “proof” that they don’t have to pay you. To help enlist them in their efforts, they will try to piece together “evidence” to prove your benefits should be decreased or stopped altogether.

We have seen some insurance companies resort to hiring a private investigator to spy on you to try to gain the evidence they need against you.

They may hire investigators to follow you to the gas station or the grocery store or any errand. They may watch you pick up your kids at school. They may stake out your house and neighborhood at all hours of the day and night. The goal is always the same: to create reports, photographs, and video that make it appear that you are not as badly injured as you claim. Then, if the insurance company can create that impression in the mind of a doctor or judge, they may be able to cut you off or shortchange you – even if they have previously admitted responsibility for your injury.

5 Ways to Handle Insurance Company Spying

You cannot stop the insurance company from hiring an investigator to watch you. But you can be smart about your behavior so that you aren’t making it easy for them to avoid paying you benefits.

  1. Always follow your doctor’s orders. Your doctor knows best what activities you should avoid while you heal. If the doctor tells you not to lift more than 10 pounds, don’t lift more than 10 pounds. The biggest risk of surveillance is that the investigator will see you doing something outside the restrictions put on you by the doctor. If that happens and the doctor is allowed to see the surveillance, the doctor may think you have been exaggerating your symptoms. In a worst-case scenario, the doctor may decide to no longer treat you.
  2. Be thoughtful. If you aren’t following your doctor’s orders about activity restriction, it may not necessarily be because you are not injured. More likely it might be because you weren’t thinking about what you were doing, or you were in a hurry, or distracted. Life happens, and you have to lift your 20-lb toddler out of her car seat. That happens to all of us. But when you have a work injury, and an insurance company may be paying someone to watch you, the cost of being thoughtless can be significant. Violating your doctor’s restrictions just a handful of times could suggest to the insurance company and the doctor that you’re not as injured as you claim to be.
  3. Remember: appearances count. Sometimes surveillance can be harmful even when you are not caught doing something against your doctor’s wishes. Even simple appearances can be enough to cause problems. For example, let’s say your doctor told you not to push more than 10 pounds. And let’s say you’re mowing your lawn with a self-propelled lawnmower that doesn’t require pushing more than 10 pounds. And let’s further say there’s an investigator recording you. All the doctor may see when he watches this video is someone who is well enough to do yard work, including pushing a potentially heavy lawnmower. You can explain to the doctor that the mower is self-propelled, but the damage may already be done. We are not suggesting you become paranoid, but it is important to be aware of how your activity may look to an outsider.
  4. Don’t talk to a suspected investigator. If you think an investigator is watching you, don’t confront them or interact with them. They will not be intimidated by you, and they will only use the interaction to gather information from you that the insurance company may later try to use against you.
  5. Hire a workers’ compensation lawyer. When you try to take on the insurance company yourself, it is not a fair fight. History tells us that many insurance companies may try to figure out ways to maximize their profits and minimize your They have adjusters and lawyers, many of whom spend their time trying to determine the best ways to do this. Surveillance is just one tactic they sometimes rely on.

Get Your Free Case Evaluation From NC Workers’ Comp Lawyers

To try to make sure the insurance companies do not use surveillance or any other self-serving tactic to deny you benefits, call the Law offices of James Scott Farrin. Our workers’ comp attorneys represent clients throughout North Carolina and have the knowledge, experience, and dedication needed to try to see to it that the insurance company doesn’t get away with painting your injuries to be less than they really are, just to save a few bucks. Contact us today or call 1-866-900-7078. Your initial case evaluation is absolutely free.

Don’t Let an FCE Derail Your Right to Workers’ Comp Benefits

Is your workers’ compensation doctor recommending a Functional Capacity Evaluation, often referred to as an FCE? If so, I’m sure you have lots of questions. While an FCE can be a useful tool to explore your physical limitations after a work-related injury, there are certain things you need to know before moving forward.

What is an FCE?

I like to think of an FCE as a physical therapy session on steroids.

FCE’s are typically scheduled at a physical therapist’s office where you will be asked to perform a number of physical tasks over a designated period of time. You should expect to spend approximately three to four hours completing the testing. While all evaluators conduct their FCE’s differently, you will likely be asked to walk, lift, stretch, push, pull, bend, and possibly do other exercises. The evaluator will record each task you complete and the extent to which you are able (or unable) to complete it.

However, an FCE is not a simulation of the actual work you were performing when you were injured. For that reason, the results of an FCE may not provide a definitive answer as to whether or not you are able to return to your pre-injury job. In a workers’ compensation context, the FCE report is typically forwarded to, and interpreted by, your authorized treating physician.

Why does my doctor want me to complete an FCE?

FCE’s are commonly used to determine return‐to‐work readiness and quantify your functional limitations after a work-related injury. Most doctors are not trained to make comprehensive determinations regarding your physical abilities. Therefore, they require a little outside help. That’s where the FCE comes in.

However, sometimes it may not be in your best interest for a doctor to rely too heavily on an FCE to determine which jobs you are physical capable of performing. While FCE’s are often treated as the best way to determine your work abilities, that’s probably not the case.

As noted above, the data from your FCE must be interpreted by your treating physician and applied to real world jobs. Unfortunately, they don’t take into account the day-to-day rigors of your actual occupation. For that reason, it’s very important for you to educate your doctor about the essential functions and physical demands of your job before they make a determination about your readiness to return to work.

What do I need to know before I perform my FCE?

Most FCE facilities believe they are able to determine when someone is exaggerating their symptoms or failing to give 100% effort during testing. In my opinion, the “science” behind these methods is shaky at best. Even so, the evaluator’s findings will often make it into the FCE report, which is likely to be seen by your doctor. For this reason, it’s important for you to talk to the FCE evaluator prior to testing about their expectations of you. Ideally, you should plan to at least attempt any task you believe you are physically capable of performing and give the maximum amount of safe effort.

FCE’s are just one piece of the puzzle when it comes to your overall physical limitations and ability to return to the workforce. You should always discuss the results with your doctor and be sure to address any issues you encountered during testing.

Enlist the help of workers’ comp specialists

If you have additional questions about FCE’s, please feel free to contact an experienced workers’ compensation lawyer at the Law Offices of James Scott Farrin. Six of us are NC Board Certified Specialists in workers’ compensation law. Of the approximately 28,000 North Carolina licensed attorneys* only 148 (less than 1%) are North Carolina Board Certified Specialists in workers’ compensation law.

What does it mean to be board certified? It means you have an attorney who shows special knowledge and proficiency in their specific area of law, having undergone additional training (and other intense analysis) to become certified as a specialist.

Get a FREE Case Evaluation from NC Workers’ Comp Lawyers

If you are asked to get an FCE, I urge you to get legal advice by contacting us or calling 1-866-900-7078. If we are able to take your case, we will try to ensure that you are well prepared for your FCE in your efforts to preserve your rights to workers’ compensation benefits.

 

*Figures provided by the N.C. State Bar as of December 2017.

3 Ways Your Workers’ Comp “Recorded Statement” Can Trap You

After an injured worker reports or files a claim for a work injury, the employer has to promptly investigate and respond to the claim “at the earliest practicable time...”

As part of that prompt response, the law allows the employer or insurance company to request a statement directly from the employee about the facts surrounding how the work injury occurred. This is called a recorded statement.

Sometimes the recorded statement is a straightforward process where an injured worker is allowed to simply recount how they were injured. Other times I have seen some insurance adjusters use the recorded statement as a way to lead an injured worker to say something that may be damaging to their case so the insurance company can deny their claim.

3 Ways Recorded Statements Can Trap You

  1. The state of North Carolina requires employers to pay only for injuries that occur as a result of an accident or occupational disease.

    An accident can be a slip, trip, or fall and it can also be an untoward, unusual, or unexpected event. Based on my experience, employees typically do not want to damage their relationship with their employer even after they have suffered injuries. Yet some adjusters will throw phrases at them like “normal job duties” or “doing your job in your regular way” as a way of trying to prevent the employee from explaining what actually happened to cause their injury. When employees hear these types of phrases, some may feel that it is pointing toward faulting the employer. Typically the clients I have dealt with do not want to cast blame on their employer for their injury nor do they want to get the employer in trouble even if the employer was to blame. These clients typically want to assure their employer and the employer’s insurance company that no one was at fault. Yet I’ve seen some insurance adjusters take advantage of this mindset to lead these employees to state that there was nothing unusual that occurred when they were injured. They may ask leading questions to the employee so they provide an account of events which may not be entirely accurate. Sometimes they won’t allow the employee to provide an open-ended account of events – as this often leads to acceptance of needed medical and disability benefits. Instead, they may be more likely to ask specific questions that might potentially lead to denied benefits.

  1. Another tactic I have seen some insurance adjusters use, is to try to limit the nature of the injury that occurred. Workers’ compensation is designed to cover any injury that occurs as a result of an accident. If someone is involved in a highly traumatic event, they may have injuries to multiple body parts. I have seen some adjusters ask leading questions to try to limit what an employee can later claim as being injured in the accident. Again, it is a process of putting words into the claimant’s mouth. An adjuster I deal with quite often frequently asks questions like, “So you only injured your knee?” When in fact, more than the knee was injured. Again, this puts the employee in a difficult spot. They do not want to claim conditions that are unrelated to the accident. They only want what is fair and necessary to heal and return to work. This leaves some injured employees minimizing their symptoms in order to “go along” with the process.
  1. Some insurance companies we have dealt with have also occasionally used the recorded statement to attack the injured employee by asking irrelevant and offensive questions. This might include asking employees about other health conditions which are unrelated to the injury, personal information which may be uncomfortable for an employee to provide, and prior health information which an employee wishes to keep private. It puts the injured worker, who is simply trying to get treatment for their work injury, in an uncomfortable position.

They may not want to share past details of their life – nor are they legally obligated to in a recorded statement. Some have confided to us that they are worried the employer will find out about their private health conditions. Those details have no bearing on what occurred at work. It’s a Catch 22. If the injured worker declines to answer these unfair and invasive questions, some insurance companies may use that as a basis to deny needed benefits. If they do answer them, the insurance company may find reasons to deny the claim.

Benefits of a Workers’ Comp Lawyer in Recorded Statements

Answering recorded statements can be tricky for some injured workers to answer. If they are not answered in the precise manner that is clear to the adjuster that workers’ comp benefits should be covered, the statement can result in unfounded denial of benefits.

I take these statements very seriously for my clients.

I will only allow my clients to give a recorded statement with my guidance. And I do not allow an insurance adjuster to ask unfair, leading, or inappropriate questions.

I have had many, many clients come to me with denied claims simply because they did not seek the assistance of an attorney before giving their recorded statement. These statements can be a mine field for claimants. They are frequently used in evidence by employers and insurance companies in court to support a denial of a claim. It is only by adequate and thorough preparation that a claimant is in the best position to give a statement. It is also with the guidance of experienced legal counsel that they can try to avoid providing an incorrect account of events.

As stated earlier, I always advise my clients not to give any statement whatsoever to the insurance company before consulting with me and without me present. There are so many ways we’ve seen injured employees hurt their workers’ comp claim by talking to an insurance adjuster, without realizing how some of their statements may be misinterpreted in the best interest of the insurer.

I, or any of our workers’ compensation attorneys, can help you prepare to speak truthfully about your claim, and in ways that do not harm your case. We will be on the call with you to make sure the adjuster does not take advantage of you or twist your words. If a written statement about the events of your injury is the best option, we will coordinate with you to prepare a truthful statement to help protect your right to benefits.

Get a FREE Case Evaluation From NC Workers’ Comp Lawyers

If you are faced with giving a recorded statement to a workers’ comp insurance adjuster, contact an experienced North Carolina workers’ comp lawyer at the Law Offices of James Scott Farrin before saying anything. You don’t want to inadvertently damage your case before getting a professional evaluation.

Contact us or call 1-866-900-7078 for a free case evaluation.

Denied Treatment by Workers’ Comp? You Have More Rights Than You Know

Many people call in and tell me that the workers’ compensation insurance company is not paying for all their medical bills. Understandably, this is a very worrisome situation.

If a workers’ compensation claim has been accepted, the law requires that the employer and its workers’ compensation insurance company provide medical treatment and pay the bills for any treatment that is “medically necessary.” That same law, however, gives the employer and its insurance company the right to “direct” any employee’s medical care.

What I have seen happen is that the workers’ compensation carrier will not pay for visits to a doctor that they did not pre-approve. Certainly, the workers compensation carrier is typically liable for any medical bills incurred from EMS and emergency room visits. But outside of these general and necessary bills, my experience has been, you may have to fight for what you want.

Workers’ compensation is responsible for paying for medical visits, diagnostic tests, epidural steroid shots, physical therapy, surgery, and related rehabilitation services that are deemed medically necessary. If, for example, you want them to pay for home care by a relative, that is typically not compensated, unless the relative is a licensed medical provider.

What Is Covered Under NC Workers’ Compensation?

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 for any treatments that help you recover from your injury.

Compensation can include, in many instances:

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

The workers’ comp insurance company is responsible for 100% of your approved medical expenses, so you are not responsible for co-pays as with regular health insurance.

Who Controls Your Care Under Workers’ Comp?

In North Carolina, your workers’ comp insurance carrier has the right to choose which doctors you see, when you see them, and which treatments you receive. (They may even appoint one of their approved nurses to “watch over” you. Click here for more about who these nurses may really be watching out for.) If you refuse certain treatments, they can (and likely will) discontinue benefits.

If you want a second opinion, you have the right to request it. Be forewarned. The insurance company might deny your request or try to direct which doctor you see before they agree to pay for treatment.

You have the option of requesting to see your own doctor. Based on my experience, however, the insurance company is likely to refuse to pay for that. If your doctor makes any new treatment recommendations, they will probably refuse to pay for those too. If you choose to pay for the treatment on your own, they may not reimburse you.

Delay, Deny, Defend Schemes Do Not Deter Us

As you've probably guessed, these issues can (and usually do) lead to lots of problems for the injured worker who is only trying to heal so they can get back to work and get on with their life. Yet instead of moving on and healing, many of them find themselves wrestling with their insurance company over denied medical treatments.

We’ve seen so much of these denial tactics that we developed a book called Insurance Companies (and Others) Behaving Badly.

I have been a lawyer for more than 25 years and I’d like to be able to say I have seen it all when it comes to insurance company denials. Truth be known, they seem to never stop inventing new reasons to try to deny injured workers. But their denials don’t deter me or any of our other workers’ comp lawyers.

NC Workers’ Compensation Lawyers Offer FREE Case Evaluation

Based on our team’s 150 years of combined experience, it is almost always a good idea to speak with us about your workers’ comp questions and issues. Our confidential case evaluations are free, and you may learn that you’re entitled to more than the insurance company claims.

If workers’ compensation is refusing to pay for any medical treatment, or if they are denying approval of medical treatment, contact us or call 1-866-900-7078 to learn how a workers’ compensation lawyer from the Law Offices of James Scott Farrin could potentially benefit you.

Things You Should Know About Your Workers’ Compensation Case

At the Law Offices of James Scott Farrin, our goal is to try to provide the absolute highest quality legal representation in your workers’ compensation case. The insurance companies already know we mean business. We want to let them know that you mean business too.

While we are fighting for you against the insurance company, we also want to provide you with first-rate customer service. The philosophy of the Law Offices of James Scott Farrin is time tested – treat our clients the way we want to be treated. In a workers’ compensation case, this means keeping you informed and giving you the same quality advice that we would give our loved ones. Many of our clients think of us first when they need quality legal representation for themselves, family, and friends. We are here to serve you. And we encourage you to contact us if you have any questions whatsoever.

We know that suffering a work-related injury can be a major irritant, even in the best circumstances. At worst, it can be a life-shattering event like it was for Christopher. Click here to read his inspiring story. For exactly this reason we strive for your complete satisfaction with our firm’s representation of your case.

Here are some things you should be aware of as we proceed through your workers’ comp case:

  • You are part of your workers’ comp team. The most important part, really. Your participation is key to a potentially successful outcome of your case.
  • Please keep the lines of communication open. We will strive to do the same from our end. We will explain the facets of a workers’ compensation case. For example, how some insurance companies may troll the social media accounts of a claimant to try to find a photo, a post, or other seemingly insignificant evidence and use it to deny medical treatment compensation.
  • Keep up with your medical appointments as best you can. Informing your doctors about all of your injuries is critical. It can mean the difference between an accepted or a denied workers’ compensation case.

Others on Your James Scott Farrin Workers’ Comp Team

Any number of attorneys and paralegals who may work on your case are on your team, as well as the numerous other resources our firm offers.

Several former defense attorneys and paralegals that worked for insurance companies. We’ve worked for the “other side,” so we know what you’re up against. We know some of their delay, deny, and defend strategies because we’ve seen it from the inside.

More than half our workers’ comp attorneys are NC Board Certified Specialists in Workers' Compensation law. This is the highest level of specialization available in North Carolina, and only a small percentage of NC attorneys can make that claim. Very small.

Two former North Carolina Industrial Commissioners. The North Carolina Industrial Commission (NCIC) is the impartial agency that administers and enforces workers' compensation laws.

A former North Carolina state senator. He was elected to serve the seventh district of North Carolina for four terms.

Several recognized experts in workers’ compensation law. 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 two have collected several coveted awards for workers’ compensation, including “Best Lawyer1” and “Rising Star2.” One was named “Super Lawyer3” three times and “Lawyer of the Year4” for Raleigh twice.

Attorneys who give back. Attorneys who join our side do it because they want to be advocates. This takes a certain mindset and special heart for service. And service to others is not something we take lightly. Of our 13 workers' comp attorneys, 12 are members of the North Carolina Advocates for Justice, an organization dedicated to improving the quality of legal representation in our state. Many are very active members in their communities – from teaching at local colleges, to counseling the Spanish-speaking community. Serving others is in the DNA of our firm’s culture.

While each workers’ compensation case carries its own unique set of facts and circumstances, the evolutionary process is similar. It can best be described by examining the distinct phases of our process.

The Investigation Phase

The initial phase is one of administration and investigation. This is when we begin to build your case by collecting information such as the NCIC incident reports, reports created by the insurance company’s case managers and adjusters, and in some cases, photographs of your injuries. During this phase, we are gathering information about your accident or injury that is critical for us to try to achieve success.

The Medical Treatment Phase

Next is the medical treatment phase, often called the “healing period.” This is perhaps the source of most frustration for clients. It’s the time when you will be receiving medical treatment for the injuries you sustained. The healing process can be a lengthy one. Patience is more than a virtue – it is a necessity during this phase. You will likely will be assigned a rehabilitation nurse case manager by the insurance company, and we will monitor the medical providers and the rehabilitation nurse to try to ensure that you receive the best treatment possible. The rehabilitation nurse is hired by the insurance company as an overseer, a case manager, or coordinator. These nurses do not work for you, yet they often go with you to your medical appointments and report back to the insurance company. Read more about their role here.

You will eventually reach maximum medical improvement (MMI), which is the end of the healing period. At that point your medical provider will assign you a disability rating and likely release you from treatment. Unless you have specifically requested otherwise, we will not begin to negotiate with the insurance company until you reach this point of your case. Before you reach MMI, we don’t know the extent of your permanent injuries, the permanent work restrictions you may have, and any future medical treatment you might need. Moreover, this is often the best time to seek a second opinion evaluation with a doctor who has not been hand-picked by the insurance company.

The Negotiation Phase

This phase is when we begin the process of resolving your case. Before we can begin negotiations with the insurance company, we make sure we have all of the necessary information:

  • Your disability rating
  • Your permanent physical limitations and work restrictions
  • The future medical treatment you will need as a direct result of your workplace injuries
  • Wage information – including overtime and bonuses – to try to ensure that you are receiving every penny of compensation to which you are entitled

When we have gathered the necessary information, we will perform a thorough and careful evaluation to determine what we believe is the settlement value of your case. We will then call or meet with you to discuss the case value and ensure that all of your questions are answered. During that meeting, we will ask for your authority to submit a settlement demand to the insurance company.

The next step is actual negotiations with the insurance company or their attorney. This is sometimes done informally, but often takes place during a mediated settlement conference. Our clients attend and participate in these conferences. The pledge we make at this stage of your case is to use all our skills and experience to try to negotiate the best possible settlement for you and to help you make the best decision for you and your family.

The North Carolina Industrial Commission must approve all settlements. As such, if your case settles, it can take up to four to six weeks for your settlement check to arrive after the settlement has been reached. We try to shorten this period. We know that this money is critical for your future, and we work hard to try to make sure the settlement is paid expeditiously.

We have many people working behind the scenes on your case. We have dedicated, experienced, and caring professionals at every level working to ensure that we handle your case in a thorough, professional, and timely manner.

NC Workers’ Compensation Lawyers Offer FREE Case Evaluation

We hope this will give you some insight into your James Scott Farrin workers’ compensation team and what you might expect from us. We strive for your total satisfaction as you try to heal, return to work if you are able, and get on with your life.

If you have been injured on the job, contact us or call 1-866-900-7078. Your consultation is free.

 

1 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 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.

3 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.

4 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.

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

517 Owen Drive
Fayetteville, NC 28304
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