Unless the Industrial Commission accepts your claim on Form 21, Form 26A, Form 60, or Form 63 – no request is on file. Form 19, Employer’s Report of Injury, does not establish a claim file. Even if the appropriate Form is on file, statutes of limitation may be running unless the correct Industrial Commission Form accurately describes all of your injuries. For example, a form accepting your claim for CTS (Carpal Tunnel Syndrome) does not include a claim for tendonitis. You must file Form 18 to preserve your rights and specify your injuries.
It’s true. In an accepted case, doctors send copies of their reports to the insurance carrier. You are entitled to free copies of these medical records from the insurance carrier. Rule 607 of the Workers’ Compensation Rules of the North Carolina Industrial Commission and Discovery contains tools for acquiring relevant information regarding workers’ medical records. The claimant has the right to receive information about their pre-existing medical history, the injury leading to the claim, and their efforts to return to work. According to Rule 607 of the Workers’ Compensation Rules, the worker can request a copy of all medical, vocational, and rehabilitation reports, employment records, Commission forms, and written communications with health care providers in its possession. The insurance company must respond within 30 days, providing requested copies without cost. Likewise, the claims adjuster can request relevant medical documentation from a claimant or their attorney to determine the treatment claimant received and the recommendations for further treatment. In addition, Rule 607 requires the requested party to disclose new documentation within 15 days of receipt. Finally, any party can request documentation at any time, regardless of litigation or hearing request pending.
General Statutes 97-25 allows an injured worker to select a physician of his choosing, subject to approval by the Industrial Commission. However, this is a tricky statute, and you will need an attorney to advise you how it works in practice if you are seeking a broad second opinion. While the employer provides medical compensation, the employee can request a second opinion examination for a rating with a qualified physician licensed to practice in North Carolina. The employer authorizes and pays for such an examination. If the employer denies the request, the employee may request that the Industrial Commission order a second opinion examination at the employer’s expense.
Yes, you have. There are two possible situations, depending on the outcome of your claim before the insurance company. If an insurance carrier accepts your claim, they initially send you to the doctor of their choice. However, under specific circumstances, you can request an examination by your doctor, but only with permission from the North Carolina Industrial Commission. Namely, the employee must show by a preponderance of the evidence that the change is necessary to provide relief, lessen the period of disability, or effect a cure. This is very difficult to accomplish in practice without the help of an experienced attorney. The Commission determines whether to allow modification of treatment or health care providers considering various factors. The commissioner acts like a judge, meaning you can appeal the decision in case of denial. The other situation is denying your claim, meaning the insurance company denies you have a work-related injury. In that case, you can freely choose a medical provider for your treatment – but you will not receive reimbursement for your medical expenses or lost wages. And, you are responsible for paying your own doctors.
Yes, you have. If you must travel 20 miles or more for medical care, you have the right to collect $0.55 per mile (note: this rate changes yearly). In addition, disabled employees have the right to chiropractic treatment at the insurance carrier’s cost (if they grant permission). The North Carolina law allows 20 visits. If more than 20 visits are necessary, your chiropractor must request authorization from the Industrial Commission.
According to General Statutes 97-25, there are two ways to keep the right to medical compensation after two years following the employer’s last payment. First, the employee can apply for additional medical compensation from the Executive Secretary of the Industrial Commission. According to Industrial Commission Rule 408, the employee can seek further medical compensation using Form 18M, with copies for the employer or carrier. If the Executive Secretary denies the application, the worker can appeal. The other option is that the Commission orders additional medical compensation if it determines that future medical reimbursement is necessary.
In North Carolina, an injured worker has the right to a second opinion before submitting to any recommended surgery or medical treatment. An employee can seek a second opinion by filing a written request to the employer/insurance carrier. The employer/insurance carrier may respond to such a request within 14 days. In case of denial, the employee can ask the Industrial Commission to order a second medical opinion. In case the request is granted, the employer pays all the expenses.
In North Carolina, the average weekly wage (AWW) is a starting point for determining compensation benefits for a disabled worker. The compensation rate is two-thirds of the AWW. Furthermore, the compensation rate is a basis for calculating the permanent partial disability (PPD) rating and temporary partial disability (TPD) benefits for a worker returning to work after an injury. Most importantly, all these calculations include overtime, bonuses, and non-wage allowances (housing, per-diems).
There are four methods. First, if the employment lasted more than a year, the AWW is the total amount of money earned during a year divided by the number of weeks working. Periods of seven or more days off work do not count. Next, if the employment lasted less than a year, the average weekly wage is the total amount of money earned during that period divided by the number of weeks on the work. In the case of short-term employment, the AWW is approximate to the wages of a similar worker. If previous methods do not apply, the AWW represents the approximate amount of money the worker would earn without injury.
There are three main types of benefits: permanent total disability benefits, permanent partial disability benefits, and temporary total disability benefits. Permanent Total Disability (PTD) is a type of benefit giving an injured worker right to receive lifetime compensation in case of severe brain injuries (complex disturbances of cerebral function, neurological disorders), spinal injuries (paralysis of both hands or legs), loss of both hands, both arms, legs, feet, or eyes, and second-degree or third-degree burns to 33% or more of the body surface. Permanent Partial Disability (PPD) refers to the loss of a part of the body (or its function), resulting in an inability to earn the same wages as before an injury. The worker has the right to PPD after they reach maximum medical improvement (MMI). Thirdly, Temporary Total Disability (TTD) gives them the right to receive benefits equal to two-thirds of their average weekly wage after returning to work. These three types of rewards are known as indemnity benefits or lost wages. Under North Carolina law, the employer does not award the benefits for the first seven days following an injury. But, if your injury caused an absence from work for more than 22 days, you will receive benefits starting from day one. In addition to indemnity benefits, employees in North Carolina have the right to medical, vocational rehabilitation, and death benefits. Medical benefits refer to compensation for medical bills and health care expenses resulting from medical treatment (hospital care, CT scans, bloodwork, etc.). Vocational rehabilitation services include vocational assessment, counseling, job analysis, job-seeking skills training, on-the-job training, etc. Death benefits are the amount of money the employer pays to the spouse or children (as weekly payments or a lump sum).
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