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What is Worker’s Compensation?

Workers’ compensation is a type of personal injury law that applies only to workplace injuries and illnesses. It is unlike regular personal injury law in that the injured person does not have to prove that someone else was at fault in causing the injury. All the injured person has to prove is that he or she was injured by an accident while they were doing their job. The accident could have been the employer’s fault, or the worker’s fault, or no one’s fault.  As long as an injury arises within the “course and scope” of the injured worker’s job, then it’s covered.

Two Important Exceptions to the Accident Rule

 There are a lot of exceptions in law.  Here are two of the most important in workers’ compensation:  If you hurt your back at work or you developed a hernia at work, then you do not have to show it was the result of an accident.  Generally speaking, you just have to be able to point to a specific time while you were working that the back pain or hernia started. So, if you have filed a workers’ comp claim for a back injury or hernia and the insurance company has denied your case because they claim it was not the result of an accident, you might want to fight that denial.

Got Denial?  Call me at 919-683-2175 for a free consult!

 


What Doctors Can I See in a Comp Claim?

Before I get to the main topic of this post, I’d like to talk about a word that I will be using both here and in other posts.  That word is “carrier.”  Any employer that has three or more employees is required to “carry” workers compensation insurance (or prove that they have enough money to be their own insurance company, which is called being self-insured).  The workers compensation insurance company is called the “carrier.”  And since in the vast majority of cases the employer is not self-insured and has workers’ comp insurance, and since the insurance company is paying the bills for the employer, we usually just use the word “carrier” to describe the employer and its insurance company, or both.  Now, to the topic of choice of doctors.

One of the main benefits in workers’ compensation is medical care.  In some ways, it’s better than “regular” health insurance because the carrier is required to pay 100% of the medical bills, including prescription drugs.  There are no medical or prescription co-pays in worker’s compensation cases.  That’s the good part.  Here’s the not-quite-so-good part:  An injured worker generally has to go to the doctor that the carrier chooses.  You may live in Durham and want to see an orthopedist at Duke or Triangle Orthopedics.  You can always ask the carrier if you can see the doctor you have in mind, but if the carrier wants you to go instead to a doctor in Raleigh or Chapel Hill, then that’s where you have to go if you want worker’s comp to pay for it. The doctor the carrier assigns to your case is called the “authorized treating physician.”  There are a few exceptions to this general rule.  One is if there is an emergency and you cannot contact the carrier to arrange to see the authorized doctor.  Another exception would be if you ask the carrier to let you go to the doctor of your choice, and the carrier agrees to that.  A third exception would be if you feel that the doctor assigned to your case is not helping you, then you may request the Industrial Commission to order the carrier to allow you to switch doctors.  The Industrial Commission may or may not grant that request, but you do have the right to ask.

Another exception arises when you get to the end of your healing period (which is called maximum medical improvement, or “MMI”).  If you have received an impairment rating, such as 15% to the back, or 20% to the foot, you are automatically entitled to a second opinion of the rating, at the carrier’s expense, by another doctor of your choice.  Which doctor to choose for the second opinion is a critical decision.  Please let me help you with that — just give me a call at 919-683-2175.