Workers’ compensation claims result from personal injuries occurring in a workplace accident.
Workers’ compensation is a form of insurance that the employer provides for the employee. Employers’ liability extends to injuries incurred on the job. In North Carolina, all employers with three or more regular full or part-time employees must purchase employees’ compensation coverage from private insurance companies authorized by the state to provide coverage.
Under North Carolina law, employers or insurance carriers need to provide necessary medical treatment and disability compensation to eligible injured workers.
Compensation coverage includes medical costs, such as surgeries, drug prescriptions, physical therapy, and rehabilitation. It also covers employee wages (paid at the Compensation Rate), permanent partial disability compensation, occupational and vocational rehabilitation, and funeral expenses in cases involving the death of the employee.
The Workers Compensation insurance carrier is entitled to direct your medical treatment with its own authorized treating physicians. You can anticipate that these physicians and the NCMs (Nurse Case Managers) know who is paying them. There are select opportunities for you to choose your own physicians, but after the 2011 changes to the N.C. Workers Compensation Act, they are limited.
Although some injured workers prefer to keep lifetime medical benefits open, and there are limited conditions under which this is a possibility, there are convincing reasons for buying out future medical treatment.
If you have reached maximum medical improvement from your work, then lifetime medical benefits serve no real purpose because you may not need additional medical treatment. Sometimes you do not get along with the insurance carrier’s hand-picked Workers Compensation doctor. The physicians are provided and financed by the employer. Expectedly, they tend to be on the insurance carrier side and are unreasonably strict about disability and causation issues. On the other hand, you may have a better patient-physician relationship if you can choose your own physician. After settlement, it is reasonable to believe you will get better treatment if you choose your physician for future treatment rather than an insurer-provided compensation doctor. In addition, many injured workers experience better treatment results and mental recovery outside the compensation system. Finally, if you move out of state or to a rural area, there might be difficulties receiving timely health care if you have to wait for the insurance carrier to approve the visit. Cashing out for future medical treatment and dealing with your work injury independently is far simpler and often times leads to a more healthy result for you.
To close lifetime medical benefits, an injured worker needs to negotiate a buyout of future medical care.
The central aspect of these negotiations is future medical costs calculation. Calculating the value of lifetime medical benefits is a factual question, and determining the amount is on a case-by-case basis.
However, certain factors determine future medical costs.
First, future medical costs depend on the residence of an injured employee. Living in a rural area leads to increased expenses for specialized medical care. Travel expenses are also significant.
Secondly, each state has adopted a Workers Compensation medical fee schedule that sets the maximum price for specific medical services. Medical providers must adhere to the scheme in charging each medical service. The total amount of future medical costs directly depends on the prices set out in the state’s medical fee schedule.
The age and life expectancy of an injured worker are also considerations. Those are decisive factors in calculating future medical costs. Younger workers have a longer life expectancy. This could results in a considerable amount of future medical expenses in case of a buyout.
Underlying medical conditions are part of the equation, as well. That includes different chronic illnesses, such as cancer or diabetes. Unhealthy lifestyles, such as smoking and alcoholism, contribute to the total amount. These are conditions unrelated to the work injury, but they negatively affect life expectancy. A shorter life expectancy could result in lower projected medical costs.
The future medical costs are directly related to the severity of injuries. More severe injuries require more complicated medical treatment and longer recovery, which results in heavier expenses.
In some cases, the nature of injury involves additional diagnostic testing. Performing CT scans and X-rays increases the amount of final medical costs. Sometimes additional medical equipment is needed. Prosthetics and other assistive devices add to the expenses, especially if they need frequent replacement.
Recovery from some work-related injuries can be long and complicated. Even after being released from the hospital, the employee will often stay dependent on home health care or skilled-care nursing. Medical home visits over a long period are a serious factor contributing to significant medical expenses.
Different types of work injuries call for a varying schedule of medical appointments. Depending on how many office visits are needed annually, future medical costs vary. Multiplying the average office visit cost with the number of office visits per year represents the total amount of that type of cost.
If the work injury resulted in temporary or permanent physical disability, the employee must make necessary home and vehicle modifications. That includes removing architectural barriers by installing elevators and additional handles, adjusting home utilities and car controls, etc. Understandably, such adjustments lead to an increase in the total amount of medical cost.
Calculating the precise amount of projected medical costs is incomplete without considering the level of recovery progress before settlement. The possibility of health deterioration after the compensation agreement will also affect the negotiated amount.
Finally, in calculating future medical costs, the negotiators need to consider the expected inflation rates and the anticipated rise in health care costs.
If you consider settling your claim with closed medical benefits, consulting with an experienced compensation lawyer is crucial. Bear in mind that there is no precise calculator for determining future medical expense buyout amounts. Reaching a reasonable amount depends both on the factors mentioned above and negotiating skills of your lawyer.
At Morrison Law Firm PLLC, we are highly skilled in analyzing each factor determining the amount of future medical and compensation costs. In negotiating the amount with the insurance carrier, our professionals rely on persuasion techniques carefully crafted and fine-tuned through years of settling compensation claims.
Call us today to schedule your consultation!