As this North Carolina workers’ compensation blog has opined numerous times, when individuals or institutions perpetrate workers’ comp fraud – or any other kind of fraud – “downstream” effects on workers, employers, insurers, and governmental institutions can be profoundly damaging. Indeed, the North Carolina workers’ compensation system works, when it does, because various parties trust one another to act fairly and in good faith.

That’s why it’s so disturbing to read stories like a recent account from Tulsa, Oklahoma, where a local attorney pled guilty last week to embezzling more than $1 million from his clients and conspiring to commit workers’ comp fraud.

According to the Oklahoma Attorney General’s Office, 61-year old Fred Schraeder will receive a “five-year deferred sentence and will pay more than $36,000 in restitution, $500 in fines and a $100 victim’s compensation assessment… Schraeder must surrender his law license and isn’t eligible to reapply while on probation.”

Schraeder did not act alone. He apparently had an accomplice, William Anton, who was sentenced in August to pay over $700,000 in restitution and serve “four consecutive sentences totaling 35-years, with 25-years suspended.”

The Attorney General’s Office claims that Schraeder and Anton embezzled money from clients between 2004 and 2009. They stole from their “personal injury benefits, insurance settlements and workers’ compensation benefits.” Over 49 victims were identified by the Attorney General’s office.

This disturbing story highlights how important it is for sick and injured people to work with trustworthy North Carolina workers’ compensation law firms. Just because an attorney or a law firm boasts a pretty website and ostensibly credible qualifications does not mean that the team will be a “best fit” for you. Before you select your law firm, ask many questions, really research your prospective firms, and make sure you choose a firm that has a reputation for ethical behavior as well as for getting good results in complex cases similar to yours.

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Oklahoma attorney embezzles over $1 million dollars from clients

Charges filed against Schraeder and Anton

The dog days of August are upon us, and, according to an analysis of Travelers Insurance Claims Data, North Carolina workers’ compensation claims at small businesses are peaking.

According to a blog post at InsuranceNewsNet.com, travelers found that, from June through September, “workers’ comp claims peak – approximately one-third of all injuries involve workers under 30 years old.” Common claims include “lower back strains and other back-related injuries and injuries from slips, trips and falls.”

This is the 100-year anniversary of the very first workers’ comp insurance policy ever written, according to Travelers, and maybe now is an appropriate time to reflect on how far the entitlement system has come, as well as on the challenges that the North Carolina workers’ compensation community faces.

One way forward is to zero-in on trends like the ones highlighted in the Travelers report. For instance, if we know that small businesses face a spike in claims during the hot summer months, then maybe we can figure out precisely what is going on during those summer months that makes workers vulnerable.

Are the workers getting too hot and thus endangering themselves due to heat stroke, delirium, or dehydration? If so, that might suggest that a policy for helping workers cool off could make a big difference. Or maybe it’s the type of jobs being done during the summer months. Construction, engineering, remodeling, and so forth might spike during the summer months. Thus, the problem may simply be related to the type of work being done as opposed to heat-specific problems causing degradation of worker performance.

This may seem like an insignificant point.

But we need this kind of analytical thinking to make progress with workers’ compensation reform. What are the root causes of waste in the system? What are the root causes of worker injuries and illnesses? The answers may not be obvious. We may not be able to glean them easily from reports, statistical analyses, or even from meta analyses of claims data.

Good science in any field is notoriously hard to conduct. And well-intentioned policies based on bad science can redound to horrific effect. For instance, if we look at the Travelers data and make the assumption that heat was the problem [instead of the proliferation of dangerous jobs (e.g. construction jobs)], then our policy solutions would not address the problem. We might tell workers to take more breaks, drink more fluids, and stay in air-conditioning more. But we would not address the primary cause (too many dangerous jobs being done), and thus wouldn’t make a dent in the numbers.

Philosophizing aside, if you or someone you care about has a specific, serious question regarding your benefits, a fight with an insurance company, or a battle with an employer, a North Carolina workers’ compensation law firm can help you figure what to do, how to do it, and when to do it.

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“approximately one-third of all injuries involve workers under 30 years old.”

Correlation vs. Causation

On Monday, a woman named Michelle McKee was sentenced to 2 years in prison for defrauding the Colorado workers’ comp system out of $25,000. North Carolina workers’ compensation experts and analysts are closely following the story, as it may have relevance to in-state cases. According to a local news report, McKee had been working as a housekeeper at a hotel, when she hurt her ankle. Although she claimed the injury was work related, an insurance investigation found that McKee had been bragging to friends about cheating the workers’ comp system. She also allegedly admitted to hurting herself not while at work but while out partying (she twisted her ankle after stepping off a curb). The state’s senior assistant Attorney General convinced the court that Ms. McKee had made false statements to collect money – a felony charge. In addition to her 2-year jail sentence, Ms. McKee now faces $25,000 in forced restitution to her old employer, Pinnacol Assurance.

As this blog has often discussed, North Carolina workers’ compensation fraud matters create tensions throughout the system and ultimately harm all major players involved: insurance companies, employers, legislators, and genuinely injured employees. It’s this latter category that is most vulnerable – subsequent to fraud cases like this one, legitimately hurt workers will likely have a harder time in Colorado collecting benefits without hassle. When insurance companies and employers grow suspicious of claimants, they tend to require higher burdens of proof and conduct longer investigations as to the veracity of claims.

If you’ve been the victim of undue harassment, frustration, or non-compliance by your employer or your employer’s insurance company, it may behoove you to seek out the counsel of a North Carolina workers’ compensation attorney to figure out how to resolve your situation adequately, get the benefits you want, and get these issues off your mind so you can focus on recovering and fixing your financial circumstances.

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Michelle McKee

Colorado workers’ comp system

Congress’ investigative arm, the Government Accountability Office (GAO), wants to clamp down on North Carolina workers’ compensation fraud (and workers’ comp fraud throughout the country). According to the official GAO website, the government is seeking information about beneficiaries secretly working second jobs, overstating claims, or collecting money owed to a deceased worker.

In fiscal year 2009, the U.S. Office of Workers’ Compensation Programs paid more than a quarter of a million workers over $4.1 billion (disbursed through four programs) for workplace injuries and illnesses. Many of these workers resided in North Carolina. (To be more specific, only $2.73 billion was spent on federal workers or their survivors, per the GAO’s report.)

It’s nice to see the government trying to clamp down on North Carolina workers’ compensation fraud, since systemic abuse doesn’t just hurt “faceless” corporate entities and government agencies with big pockets. Fraud “pays forward” throughout the system and creates mistrust, frustration, gridlock, friction, and bureaucracy.

When insurers and employers become more suspicious of beneficiaries’ intentions and actions, they throw up more roadblocks to prevent getting scammed. Inevitably, legitimate claims get held up in the dragnet. What’s the most appropriate response to this kind of abuse? Should scam artists, schemers, and those who aid and abet workers’ comp fraud be punished harshly?

Perhaps a better solution would be to disincentivize fraud through some non-punitive way. A broad and deep analysis of typical workers’ comp fraud crimes, for instance, might reveal certain patterns of behavior and typical perpetrator motivations. Policy analysts could then work towards solving would-be perpetrators’ problems in advance to prevent them from turning to the dark side and seeking to exploit vulnerabilities in the system.

If you or someone you care about needs help with a benefits issue, a reliable, honest, and aggressive North Carolina workers’ compensation law firm can help you move forward.

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Government Accountability Office (GAO)

Fraud “pays forward” throughout the system

A workers’ comp case way out in Aurora, Colorado has caught the attention of the North Carolina workers’ compensation community because of the heart breaking realities at the center of it all.

Martin Lobatos and his wife Belen Lobatos were indicted on 18-counts last Friday, after Colorado investigators alleged that the couple collected $140,000 worth of workers’ comp claims from Pinnacol Assurance. Lobatos worked as a roofer until September 8, 2008, when he sustained a terrible fall off of a ladder. He went back to work a month later but started complaining of ongoing vertigo and dizziness from his accident. Six months later, in April 2009, Lobatos’ doctors maintained that he had fully recovered.

Lobatos was fired and later collected a $20,000 settlement from Pinnacol Assurance. In the fall of 2009, however, Lobatos began experiencing more symptoms, such as memory loss, having trouble recognizing his children, dizziness, and a host of other frustrating problems. His doctors agreed. In March 2010, Lobatos claimed to be “fully catatonic.” And he allegedly acted catatonic in medical exams. But witnesses later saw him driving around, shopping, engaging in activities in a decidedly non-catatonic state. This evidence allegedly led to the investigation and ultimately to the allegations and 18 count indictment against Lobatos and his wife. If convicted of the crime, the Lobatoses could face fines of $750,000 each and a dozen years in prison.

Obviously, North Carolina workers’ compensation fraud (and such fraud elsewhere in the country) is an enormous problem, and perpetrators should be held to account. But is it really fair to slap these people with $1.5 million in fines and over 10 years in prison? Many homicide cases don’t get punished that severely. Again, this is not to say fraud shouldn’t be punished appropriately. But the punishment must fit the crime, and the context of the crime should also deeply inform the legal remedies.

What’s frustrating here is that many injuries that ultimately send people to seek the services of a North Carolina workers’ compensation firm don’t manifest immediately after an accident. A fall off of a ladder, for instance, may lead to a temporary concussion that seems to resolve after few weeks or months…only to give way to longer term, chronic, and confusing injuries months or even years after the fact.

Again, it’s impossible to weigh in on the Lobatos’ case without far more information. But victims of workplace accidents or illnesses should understand that they may go through a similar kind of rollercoaster – feeling bad after the accident, then feeling better again for a while, then feeling suddenly worse for no apparent reason. This is why it’s so important to contact professionals, like experienced law firms and good doctors, to build evidence, stay within the bounds of the law, and maximize your chances for getting the money and support you need to get back to work and support your family.

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Pinnacol Assurance

Martin Lobatos fraud

The New York Times and other media outlets – including niche North Carolina workers’ compensation blogs! – have spent months reporting about a crazy series of claims out of the Golden State. According to California Labor Code Section 3600.5(b), employees who are temporarily assigned to the work in CT can make claims for long-term injuries.

Section 3600 may not seem like an overly fascinating piece of law, but injured former NFL players (and other ex-athletes) have been leveraging Section 3600 to file for a rainbow of out of state claims. Recently, a Republican in the California state legislature demanded an overhaul to CA workers’ comp rules to prevent “retired professional athletes with no significant nexus to California to file claims for long-term injuries in the state.”

According to an article in the Insurance Journal, Republicans like Curt Hagman believe that “retired professional athletes who never play for California based teams should not be afforded remedy for claims of cumulative trauma under California’s injured workers statutes.” Technically, California taxpayers may not be responsible for paying the out of state claims. But the jurisdictional issue has raised more than a few alarms, especially now that California is practically drowning in a horrific, multiyear fiscal crisis.

Could something similar happen here in the North Carolina workers’ compensation system? Probably not. California’s uniquely structured laws and history have combined to create this Section 3600 debacle. There is no equivalent law on the books in NC. In fact, it’s far more likely that injured North Carolina athletes will file for claims in California than vice versa.

The debacle raises even bigger and broader questions, such as: how can we systematically determine whether injuries occur from cumulative or single traumatic events? How can the workers’ comp system more fairly and accurately divvy up costs among taxpayers and among states? If ex-NFL players are all reporting chronic injuried stemming from their time in the league, how deep does this problem go? And will the newer generation of NFL stars – who play bigger, faster, and more aggressively – suffer even more cumulative damage in the years and decades to come?

For help with a specific question regarding your potential benefits, struggles with an insurer, or debate with an employer, connect with a reputable North Carolina workers’ compensation law firm.

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Curt Hagman

Section 3600

Last Wednesday, the NC house passed sweeping and massive reforms to North Carolina workers’ compensation law. The overhaul, led by Republican Representative Dale Folwell, stirred passionate emotions on both sides of the debate. This blog post will examine some of the reader comments in the June 6th issue of the Winston-Salem Journal to give you a sense of the flavor of the debate going on.

The Journal quoted Fletcher Steele, the President of Pine Hall Brick Company — a business owner. He shared very enthusiastic comments about the legislation: “North Carolina workers’ compensation law should be focused on taking care of injured workers and helping them return to work when they are able. Thanks to Rep. Folwell’s leadership, our state may soon have a modern, effective workers’ compensation system that works for both employers and employees, and that is also good for jobs.”

The responses to his editorial reveal a complex debate.

For instance, one commenter who claimed to be a “CEO in a field that… sees more than its fair share of WC claims” said “it’s not surprising Mr. Steele would say WC insurance has contributed to slow job growth. From a macro view, I feel that the state’s cutting of education money will do far more harm to NC’s future job prospects than… this legislation will be able to overcome. The 2009 HS grad rate was only 70%. Hate to see what rates will be in the future. No education equals no jobs.”

Another anonymous commenter, who went by the handle “AJV,” laced into Mr. Steele’s suggestion, even suggesting that the NC Chamber of Commerce “ghost wrote” the editorial. AJV wrote: “so let’s see: he is CEO of a brick company. Potentially a very hazardous work environment… those pesky worker bees having bricks fall on them… breathing in caustic dusts, et cetera. Let’s say that a worker is paralyzed when a pallet of bricks falls on him. What’s a CEO to do? Cut profits. And then what? They expect his company or insurance carrier to take care of that unfortunate worker whose [labor has helped the company profit]?… They busily craft their solution: Limit the worker to no more than 500 weeks of compensation and then dump them for the tax payers to directly support. Sweet! Win! Win! Win! (that is the company, chamber and insurer). “

As these comments clearly illustrate, the debate is passionate and not necessarily civil. Such is the nature of modern politics, perhaps.

Another commenter, who wrote under the handle “native heal” responded to AJVs point: “I have known Fletcher Steele for many years and have had a good business relationship with him for many years as well. He is a good man in an imperfect work situation, as are many others who’ve run large corporations. I am also quite certain that Mr. Steele has a vast more amount of knowledge about workers’ compensation issues than you or I will ever have. I [would rather] light a candle to illuminate the shadows rather than stand in the shadow and throw rocks.”

The rancorous debate notwithstanding, you and your family likely have significant and serious questions about how these laws might affect your potential benefits. An experienced, reputable North Carolina workers’ compensation law firm can answer those questions and help you feel relaxed, prepared, and in control to meet the challenges ahead.

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North Carolina Senate passes workers compensation reform bill

Pine Hall Brick Company

On Thursday, May 12, a House committee worked feverishly on North Carolina workers’ compensation legislation designed to relax employer responsibility for workers’ comp claims.

The AP has reported that the current sticking points “include whether employers, their attorneys and their insurers should have greater access to the medical records and doctors of an injured worker. Another issue is whether to cap temporary payments for a totally disabled worker at nearly 10 years.”

Powerful figures in the North Carolina workers’ compensation system are currently “at the table” per the AP, including insurance companies, legal representatives, NC workers’ comp lawyers and the Chamber of Commerce. Workers filled the hearing room in a bid to influence the proceedings. As of 6:41pm on May 12th, no compromise had been yet worked out, but observers remained hopeful that something could be accomplished.

It’s easy during moments like these – when everything seems to be on the line – to get defensive and to start about thinking in catastrophic terms. If you are a hurt or injured worker, for instance, you might worry that reforms will result in unexpected and decidedly unwelcome changes in your recuperation plan and your family’s financial strategy. And, depending on your situation and the outcome of the debate, you very well might have to adjust your expectations.

But it’s a good idea to remember the difference between what productivity guru Steven Covey once designated your “circle of control” and your “circle of influence.” Unless you are currently in the assembly room right now, chances are the bill is way out of your hands. Your best strategy for success, therefore, is to react appropriately to whatever laws get passed (or don’t get passed).

Part of dealing with the fallout effectively is getting good help. A North Carolina workers’ compensation law firm can help you understand how the new laws might influence your benefits and take the smartest, most efficient steps towards minimizing any negative fallout.

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House committee works feverishly on NC workers’ comp

Catastrophic thinking

In this two part blog post on the possible reform of the North Carolina workers’ compensation system, we’re going to boil down legislation proposed recently by business groups.

According to an Associated Press article from April 22nd, business groups are practically giddy about the potential to alter North Carolina workers’ compensation laws to reduce employer costs and set limits and constraints.

The AP quotes Bruce Clark, the President of a business group called Capital Associated Industries: “a multi-million dollar event with no legal means to ever end or settle the open-ended, lifelong claim… this is not what good and fair workers’ compensations do around the country and it should not happen here.”

The newly Republican controlled state General Assembly aims to prioritize workers’ comp reform, and the proposed bill will do the following:

• Limit temporary total disability payments to approximately 9.5 years (currently, these payments can last a lifetime)
• Extend benefits for families of workers who die on the job from 400 weeks to 500 weeks.
• Burial benefits will also be ratcheted up by an additional $10,000.
• A provision will be inserted that “would allow employers, their attorneys and their insurers access to the medical records and physician of an injured worker seeking compensation.”
• Workers will be restricted in how they choose the physicians who treat them.

Advocates of hurt workers admit that some people do try to “game” the system by staying on workers’ comp too long or even faking symptoms. But they also point out that insurance companies and employers work relentlessly to challenge claims. The AP article quoted an advocate: “every insurance company works overtime to limit payouts, sometimes by putting injured workers on a carousel of different doctors until one provides an employer friendly diagnosis.”

The AP article then discusses the sad case of a 42-year old Randolph County man, Levy Grantham, a tree trimmer who seriously hurt his back, arm and shoulder on the job. Grantham’s “employer’s insurer… sent [him] to five doctors after the initial diagnosis in a pattern of persistent refusal to provide timely treatment.”

So the debate rages on, and both business advocates and advocates of hurt workers are more than well aware of the stakes. In a subsequent blog post, we will discuss possible outcomes to this fractious debate and analyze the deeper implications.

If someone you care about needs immediate help with a claim or a benefits issue, connect with a North Carolina workers’ compensation law firm to go over your resources.

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NC panel hears effort to change workers’ comp law

NC panel hears effort to change workers’ comp law

Although this blog typically covers news germane to North Carolina workers’ compensation issues, those who report on benefits and entitlement issues have been riveted by an ongoing debate out of Washington state regarding how to reform WA’s workers comp system.

Here’s the latest news in the WA workers’ comp saga.

According to an April 20th AP article, eight moderate House Democrats have unveiled a proposal to change the Washington system. In 2010, Washington Governor Chris Gregoire — along with leaders from the state’s House and Senate — prioritized workers comp reform after evidence surfaced suggesting that the system was in danger of insolvency.

One of the “harder core” plans for reforming the system would have required major concessions from workers. Hurt and injured workers would have to take “lump sum” settlements in lieu of ongoing payouts. While business groups backed this measure, injured workers voiced concerns that the arrangement would leave many in a lurch; and workers who could not afford legal representation would be at risk for decreased protection.

The new “moderate” plan proposed would provide workers some protections. Essentially, it would thread the needle. Workers would get enhanced safeguards, and a study would be conducted in three years to assess how the plan is performing, both in terms of saving money and in terms of protecting workers rights. On the other hand, while settlements from medical claims would be eliminated, “the option for lump sum settlements would remain.”

One interesting factoid from the AP article: “About 85% of compensation costs come from only 8% of all claims.” It’s very likely that a similar breakdown occurs in the North Carolina workers’ compensation system.

The so-called Pareto Principle (also known as the “80-20 Rule”) suggests that, in a variety of natural systems, 80% of inputs yield 20% of the results and vice versa (20% of inputs yield 80% of the results). So, when you get a statistic that says something like “8% of workers’ comp beneficiaries drive 85% of all costs,”– yes, at first, it sounds alarming. But it really shouldn’t be. Distributions of wealth, water, commodities, and basically everything else in the world organically wind up lopsided. This is why a small fraction of the people in the United States – and indeed in every country of the world – owns the majority of the wealth. It’s not a sinister plan – it’s just the way that distributions tend to form.

Getting away from the abstract, if someone you care about needs help from a North Carolina workers’ compensation law firm, don’t wait to get that assistance.

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WA workers’ comp proposal

WA Governor Chris Gregoire

The blogosphere has been on fire since February with worried articles about how and whether the North Carolina General Assembly will fundamentally alter the North Carolina workers’ compensation system. The Republican controlled General Assembly – boosted by business groups – boasts an ambitious agenda to redraw the medical malpractice and North Carolina workers’ compensation systems to limit costs.

Opponents have complained that the proposed legislation could negatively impact hurt workers. For instance, when the changes go into effect:

• workers’ comp will cease after 500 weeks
• individuals who fail to follow their treatment may receive more limited compensation
• workers may lose flexibility in choosing their physicians
• hurt workers may lose certain privacy rights

All told, the North Carolina Industrial Commission (NCIC) processes more than 60,000 claims every year, so the General Assembly’s actions could profoundly change the landscape for hurt workers. Reformers, such as Republican McAlister, have argued that the system is tantamount to a retirement program: “In too many instances, it’s become more of a retirement program instead of taking care of a person until he is ready to go back to work.”

One of the key questions policy makers should look at here is: will the proposed General Assembly changes actually save the state costs and help small business owners? In other words, let’s set aside for a second how precisely these changes would impact hurt workers and ask a more fundamental question: what is the primary purpose of this legislation, and will it accomplish that purpose?

If the state seeks to save money, might there be other ways to make the system more efficient that don’t involve restricting benefits? For instance, could we collectively improve system administration through digital record keeping? Could we enact more data based programs to boost workplace safety and thus reduce burden on the system proactively? Could we help our workers avoid chronic illnesses and obesity by, for instance, regulating soda and sugar consumption on the job? These are all “out of the box” ideas that may or may not be useful, but it’s critical to at least search for “win-win” solutions that will help the state, small businesses and hurt and sick workers alike.

If you need help with a North Carolina workers’ compensation issue, connect with an experienced and highly reputed law firm to protect your rights.

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North Carolina General Assembly

proposed General Assembly changes to workers’ comp

Experts in the field of North Carolina workers’ compensation spend a lot of time ruminating about how to identify and stamp out fraud. When parties bilk the system out of money, not only do the costs ultimately get passed on to insurers, employers and employees who need benefits, but the bonds of trust that hold the system together also weaken.

To that point, the Ohio Bureau for Workers’ Compensation has its hands full dealing with a case of workers’ comp fraud out of Butler County. A chiropractor pled guilty last week to fraud and agreed to pay $104,000 in restitution payments as well as $5,000 to cover the cost of the investigation. Dr. Gary Berner took the plea deal to stop an impending trial. His Back and Spine Center had been at the center of a probe. Dr. Berner and three other employees of the Back and Spine Center faced multiple charges, including workers comp fraud, forgery (32 counts), theft, and racketeering. The other three employees have already been convicted of workers’ comp fraud – Dr. Berner’s trial will start up on March 29th. Dr. Berner, along with his partner, Dr. Bruce Holaday, allegedly developed a scheme to bill for services even after being banned to provide said services to hurt workers.

Obviously, in cases like this, unless you read the investigation very carefully and examine all the arguments that both sides make, you can’t really come to a clear determination. For instance, did the chiropractor and his co-workers harm their patients, or did they simple bend the rules in a relatively benign way? Hard to tell from a simple news account.

All that said, there is a “broken windows” aspect to consider. The “broken windows” theory of crime management suggests that, when a city, store, or other place winds up in disarray (e.g., lots of broken windows, trash on the floor, etc,) it becomes easier for people to “misbehave” and commit criminal acts. Likewise, when chiropractors get away with committing forgery, fraud, and theft, other doctors – who might be “on the fence” about whether to commit fraud or not – may take the plunge and commit illegal actions. Thus, as a precaution, it may be useful to severely punish those who skirt the law.

This debate aside, what’s important to remember is that the workers’ comp system should help injured workers heal and support them and their families. If you are having difficulties navigating the North Carolina workers’ compensation system, you don’t have to keep plugging away on your own.

Connect with a reputable and skilled North Carolina workers’ compensation law firm to go over potential solutions today.

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“Broken Windows” theory

Dr. Gary Berner workers’ comp case

One of the most talked about North Carolina workers’ compensation stories has come to a resolution that’s been widely celebrated. As this blog reported several months ago, an ex Illinois state trooper, Matt Mitchell, had sought workers’ comp benefits in Illinois for injuries he sustained in a Thanksgiving 2007 crash that left two young women dead. Last Friday, an arbitrator rejected Mitchell’s quest for benefits — in no uncertain terms.

Mitchell’s driving had been egregious by any standard. He had been travelling at 126 miles per hour (!) when he zipped across the median strip on I-64 and killed the girls. As arbitrator Jennifer Teague wrote, the officer “simultaneously drove at speeds in excess of 120 miles per hour on a highway replete with holiday traffic, wrote e-mails on his car computer, and took a personal call lasting almost 4 minutes long… [what he did created] a substantial and unjustifiable risk resulting in a gross deviation in the standard care in his duties as an Illinois state trooper… his conduct was egregiously outside the scope of employment.”

When Mitchell first sought workers’ comp benefits for the accident, unsurprisingly, his act elicited a chorus of angry rebukes — even from parties normally sympathetic to workers’ comp plaintiffs.

The fact is, when claimants make outrageous claims for benefits, all parties in the system suffer. Imagine you’re a hurt worker in Illinois. You tell a friend that you need workers’ comp to pay your family’s bills. Ordinarily, your friend might be sympathetic. But then say in his mind he associates you with this trooper who killed two girls and then begged the state for benefits. He might not be so inclined to see your claim in a positive light!

This is just one of the many challenges that people seeking North Carolina workers’ compensation benefits face. If you need assistance with your matter, get in touch with a reputable North Carolina workers’ compensation law firm at your earliest convenience to avoid making mistakes and to protect your rights as potential claimant.

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Matt Mitchell verdict

http://nl.newsbank.com/nl-search/we/Archives?p_multi=NWRB&p_product=SHNP8&p_theme=shnp8&p_action=search&p_maxdocs=200&p_field_label-0=title&p_text_label-0=Trooper%20hurt%20in%20deadly%20crash%20denied%20workers%27%20comp&s_dispstring=headline%28Trooper%20hurt%20in%20deadly%20crash%20denied%20workers%27%20comp%29&xcal_numdocs=20&p_perpage=10&p_sort=YMD_date:D&xcal_useweights=noInfo on the Thanksgiving 2007 crash

The experts who audit, debate, and refine the North Carolina workers’ compensation system spend a tremendous amount of time identifying the system’s inefficiencies. To maximize efficacy and minimize drag on the system as a whole, experts aim to identify:

• how insurance companies might be overcharging employers;
• how employers might be inadequately training their workers;
• how workers might not be engaging in proper safety, rehabilitation, self-care;
• etc

In this blog post, we will explore a novel approach to improving the North Carolina workers’ compensation system. This approach involves improving communication across all elements of the system, so that the feelings and needs of relevant parties get heard more clearly.

First principles: it’s clear that the participants in the system often feel like they are in opposition with one another. Employers strive to “protect” themselves from high premiums and workers who inflate their disability claims. Employees, on the other hand, “fight for every penny” and stay on guard to make sure that their employers and insurers treat them fairly. Insurance companies, meanwhile, watch their bottom lines. And the state strives to ensure order and fairness in the system.

So most people see these forces in opposition. But there may be another way of looking at our problems – a way suggested by Marshall Rosenberg, creator of the idea of “Nonviolent Communication.” According to Rosenberg, most individuals communicate in a violent language that he’s termed “jackal.” Most people – and most institutions – spend a great deal of time analyzing, judging, and labeling others. In Marshall’s alternative paradigm – what he calls “Giraffe” talk – the goal is not to see parties in opposition but rather to see them as each having feelings and needs. Once these feelings and needs get surfaced, it’s easy to find so-called “win-win” solutions. In other words, an employer and her employee may believe that they stand in opposition. But maybe that’s just because the employee doesn’t understand his employer’s feelings and needs. And vice versa. If both parties could only spend some time talking in the “giraffe” idiom, perhaps they could understand each other better and work together to develop more effective solutions.

In an event, employees who need help with their benefits claims often get confused about how to deal with recalcitrant or uncooperative insurers, employers, and other parties. A consultation with a proven North Carolina workers’ compensation law firm may help you significantly.

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Non-Violent Communication

Jackal vs. Giraffe

Many North Carolina workers’ compensation news stories involve subtle and arcane discussions about insurance rates, employment policy, and the state’s fiscal strategy. This blog wanted to take some time out to examine two more “down to earth” stories that should hopefully pique your interest and stir up discussion.

1. First on the docket: crazy workers’ comp fraud case.

On February 23rd, the Louisiana Workforce Commission reported an arrest for workers’ comp fraud. The owner of Streamline Framing Incorporated, Richard H. Woodle, allegedly engaged in “willful misrepresentations by an employer and unlawful practices” and was hit with felony charges. A local news outlet reported that the business owner made false reports to his workers’ comp insurer for three years to get out of paying his workers’ comp premiums. By lying to his insurer, “it is estimated that Woodle avoided paying hundreds of thousands of dollars in premiums.” The man could face a decade behind bars for felony workers’ comp fraud.

2. Story No. 2: KFC retaliation.

A KFC worker claims that his employers retaliated against him for filing for workers’ comp.

Most North Carolina workers’ compensation claims (and claims from other states) involve straightforward scenarios. An office worker gets carpel tunnel syndrome and then seeks benefits to pay for her hand surgery, for instance. Or a hurt dockworker struggles with an insurance company to get fair payment for his disability.

An Illinois worker at a KFC has filed suit in Madison County Circuit Court, alleging that his employers fired him for filing a claim. Michael Franklin managed a KFC on Johnson Road for more than 8 years. Last January, he reported an injury to his employer and made a claim pursuant to the Illinois Workers’ Compensation Act. 11 months later, his employer fired him. Franklin wants Morgan Foods to pay him $100,000 for compensatory and punitive damages.

If you or someone you love has been engaged in a fractious dispute with an employer or insurance company over your benefits or another workplace issue, it may behoove you to get a free consultation from a reputable North Carolina workers’ compensation law firm.

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Streamline Framing Incorporated workers’ comp fraud

KFC retaliation case

Last week, the Workers’ Compensation Research Institute (WCRI) released a study that found that North Carolina workers’ compensation costs were the highest per claim among 16 states. The WCRI report offers sobering news… but can it really be trusted?

Not according to the North Carolina Advocates for Justice (NCAJ). CEO Dick Taylor put out a scathing statement about the WCRI report, calling it “an unfortunate example of insurance companies and corporations seeking government subsidies by shifting their expenses to tax payers… WCRI is funded by insurances and big corporations and routinely issues reports that support “reforms” that would increase their contributors’ profits.”

The NCAJ rebuttal says that the WCRI charge about payment per claims being too high in NC just doesn’t hold water. North Carolina workers’ compensation “doesn’t cover many injuries sustained in normal work routine. North Carolina has fewer claims… and they are far more severe injuries. Naturally, our average payment per claim is higher.”

The NCAJ rebuttal also points out that the North Carolina workers’ compensation system tends to deliver good value per dollar spent… and at a relatively low cost to employers. NCAJ officials worry that corporate and insurance company interests may be tempted to leverage this WCRI study to slice into benefits for hurt workers. Indeed, business advocates are currently lobbying the North Carolina General Assembly to cut off workers’ comp benefits after 500 weeks. Such a proposal may not be popular – even with conservatives. According to an October poll conducted by Public Policy Polling (PPP), the idea of cutting off workers’ comp for hurt workers after 500 weeks is opposed by more than three quarters of liberals and 60% of conservatives.

The fracas over the WCRI report and the NCAJ counterclaims also illustrates a major problem when it comes to formulating public policy. Given enough “torturing” of any data, it can be pretty easy to support your point and/or refute your opponent’s point. For instance, the conclusions you draw may depend on how you look at trends. So it’s incredibly important that policymakers look to multiple perspectives before doing things like enacting major changes to legislation or cutting off benefits to large groups of people.

If someone you care about has been struggling with benefits, a North Carolina workers’ compensation law firm can be a tremendous ally in your battle to get fair payments and hold your employer and that employer’s insurer totally accountable.

More Web Resources

WCRI Report

NCAJ Rebuttal

In Part I on our series on hot button North Carolina workers’ compensation issues for 2011, we discussed how escalating health care costs, information overload online, and confusion over “independent contractor” status have redefined the national and local NC workers’ comp systems. In today’s post, we will examine other burning issues that insurers, analysts, employees, and employers will be debating this calendar year.

1. Confusion over Medicare Set-Aside Arrangements

The so-called Medicare Secondary Payer laws – MSP laws – can be overwhelming, even to people who have familiarity with the laws in theory and practice. A hurt worker can lose key Medicare benefits if he or she fails to deal with his or her MSP issues effectively during a settlement. Indeed, a scary number of experts remain confused about things like the best practices for dealing with Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA).

2. Is workers’ comp litigation helping or hurting?

Detractors of workers’ comp litigation point to the fact that institutions like the Equal Employment Opportunity Commission (EEOC) have ramped up their legal activity thanks to expansions of laws like the Genetic Information Nondiscrimination Act, the ADA, and the Ledbetter Fair Pay Act. With so many legal disputes in the works, some analysts fear a break down in employer-employee trust.

Obviously, litigation for litigation’s sake can clearly damage the economy and degrade trust. But critics of the EEOC should recognize that that group and others like it may merely be responding to longstanding unfair industry practices. It should be possible to work out “win-win” arrangements to simultaneously reduce litigation and improve conditions for both employees and employers. For instance, the strategic use of “social nudges” to prevent people from engaging in bad behavior and encouraging more generous employer-employee relationships could really help.

3. The frequency of workers’ comp claims may be reversing

Starting in the early 90s, the number of claims filed per company payroll began to decline. This reduced caseload helped to counterbalance the increase of medical and rehab costs. But the frequency of claims may be picking up again… adding yet another stressor to the North Carolina workers’ compensation system and other state systems.

4. The obesity and diabetes epidemics

Good data suggest that the increased prevalence of obesity and diabetes (sometimes known as “diabesity”) may be driving up health and medical care costs throughout North Carolina and other states. This epidemic not only creates additional cost control problems but also indirectly impacts the job market itself.

5. Bad advice at the beginning of your research can bias you and make you continue to make poor decisions

Social science findings show that the quality of the resources you initially tap into can have a dramatic influence on your long-term prospects for economic and medical recovery.

To that end, it may be helpful for you or your injured coworker to connect with a North Carolina workers’ compensation law firm that has the resources, track record, and wherewithal to deliver excellent service.

More Web Resources:

Medicare Secondary Payer

Ledbetter Fair Pay Act

From the corridors of the Research Triangle to rural parts of Western NC, North Carolina workers’ compensation specialists have been reviewing crucial trends in the industry and trying to identify the major issues that will shape the system in 2011. In a two-part blog post, we will be exploring pertinent studies and ideas weighing on the minds of physicians, employers, insurers, injured workers, and government policymakers.

1. OSHA bringing down the hammer

OSHA, the Occupational Safety and Health Administration, has stepped up its enforcement activity, according to the National Safety Council. The agency expects to collect $1 million this fiscal year for each of its 10 biggest penalties. A National Safety Council report indicates that, while the organization’s “Top 10” list of major workplace violations will remain the same, “the agency’s message of strong enforcement is clear.”

2. Medical costs continue to escalate: When and how will it all stop?

The National Council on Compensation Insurance (NCCI) has found that workers’ comp claims are skyrocketing – they now represent nearly 60% of all claims. A study in the January 2010 Journal of Occupational & Environmental Medicine reported that “injury types or diagnoses that don’t have clearly defined treatment pathways could easily lead to higher costs.”

Notably, fewer than 4% of all doctors are responsible for nearly three-quarters of workers’ comp costs. Perhaps by targeting those physicians and trying to help them treat patients more cost effectively, the North Carolina’s workers’ compensation system and other state systems could save some money without reducing care quality.

3. Hurt workers finding it harder than ever to get work

The “Great Recession” that stretched from 2008 to 2010 — and the relatively anemic recovery that’s followed — has meant that workers throughout the Atlantic region have found it difficult to earn effectively. That means hurt workers are finding it harder to get new work. This lag in reemployment stretches out temporary total disability benefit periods. This creates a drag on the system and a disincentive for hurt workers to find reemployment.

4. Murky definition of “independent contractors”

When should someone be considered an employee under workers’ comp law, and when should he or she be considered an independent contractor or freelancer? The answer may not be as clear cut as most employers and employees realize. The US Department of Labor, among other institutions, is cracking down. The DOL compelled employers to pay 5,200+ employees $6.5 million in back wages in 2010 – that’s more than double the 2009 numbers.

5. Information overload and confusion among workers’ comp beneficiaries… going WAY up

Despite the proliferation of websites, blogs, and other informational sources about workers’ comp (or maybe because of them), injured claimants are finding themselves more and more overwhelmed and confused by the sheer glut of often contradictory resources.

If you are struggling with a workers’ comp issue – or a friend or a family member is – get a free consultation from a qualified North Carolina workers’ compensation law firm.

More Web Resources:

About the Research Triangle

National Council on Compensation Insurance (NCCI)

Many high profile North Carolina workers’ compensation cases have major interstate elements. A recent case filed by the Texas Insurance Department’s Division of Workers’ Compensation demonstrates how interconnected states like North Carolina, Texas, and Pennsylvania can be when it comes to workers’ comp claims and insurance disputes.

A Philadelphia-based company called ACE American Insurance Company was fined $221,000 for failing to pay key medical costs and failing to comply with the Texas Workers’ Comp Commissioner’s rulings. According to local sources, ACE had to pay a $74,000 fine pursuant to the company’s failure to respond to preauthorization requests and failure to pay for certain key treatments, services, and emergency care. In a second case, the insurance company paid out $147,000 pursuant to its failure to pay indemnity and medical benefits and failure to comply with the Texas Commissioner’s orders. ACE also did not pay medical bills according to Texas’ medical fee guidelines.

While this kind of case is not exactly novel – insurance companies have been known to try every tactic and strategy in the book to get out of paying North Carolina workers’ compensation claims – the story does illustrate the truly interstate ramifications of workers’ comp disputes.

Here you have a Philadelphia-based company dealing with allegations drawn up by the Texas Workers’ Comp Commissioner. Although states do make independent decisions regarding their workers’ comp programs, this case illustrates the essential interconnectedness of the US workers’ comp systems. National and even transnational players, like insurance companies, funds, and big businesses, often get deeply embroiled in state-specific litigation.

Fortunately, most workers’ comp claimants don’t have to worry about these highly technical ramifications. If you have been recently injured at work – or if you know someone who has come down with an occupational disease, such as bronchitis or repetitive stress injury, from work related activities – you want a simple, clear and precise strategy to get your benefits as quickly as possible and reboot both your health and your career.

Talk to an experienced North Carolina workers’ compensation law firm to develop and execute a sound plan of action to get the help you need.

More Web Resources:

Texas Insurance Department’s Division of Workers’ Compensation

Case against ACE American

Often, debates about the efficacy and fairness of the North Carolina workers’ compensation system revolve around isolating an “at fault” constituency and punishing that constituency. For instance, there is the “insurance companies are to blame” school; there is the “stingy/unethical employers are to blame” school; there is the “lazy lying workers are to blame” school; and there is the “entire system is broken so there’s really nothing any well-intentioned person can do anymore” school.

Unfortunately, by dividing up the participants in the North Carolina’s workers’ compensation system into “good guys” and “bad guys” – irrespective of the rightness or wrongness of those categorizations – we may be overlooking some easy “win-win” solutions that could improve the system’s efficacy and effectiveness without causing pain to any participants.

One important strategy involves information sharing and information processing. Like most state workers’ comp systems, the North Carolina workers’ compensation system often finds itself gummed up by needless bureaucracy, long wait times, and paperwork. Almost all organizations – state run and privately run – find themselves overloaded with information these days. This overload makes it difficult to sort the wheat from the chaff — harder to make good decisions.

Practically speaking, this might mean that an injured woman who needs back pain medication may have to go through a grueling wait process to get approved. Or it might mean that an employer gets stuck dealing with tons of workers’ comp paperwork and has to spend dozens of man-hours dealing with claim forms instead of attending to his business. Even insurance companies suffer from the stifling bureaucracy. All of the paper shuffling and information mis-management that goes on at big insurers surely drains these companies’ bottom lines. Insurers may then end up passing these costs down to consumers.

So how can we go about in some systematic, industry-wide way cutting through the clutter and eliminating bureaucracy? Obviously, this is way too big a topic for one small blog post to handle. But consider these suggestions:

1. Solicit ideas from people “in the trenches” about how/where we can collectively save time, money and resources.

Talk to everybody involved, from the state insurance commissioner down to claims processors, injured workers, and small business employers, about their frustrations and innovations. There is no need to impose “top-down” solutions to cut through bureaucracy – often, the people “in the trenches” intuitively and immediately understand what needs to be done.

2. Simplify Simplify Simplify

Apply the “KISS” (Keep it Simple, Stupid) principle throughout the system to identify and do away with needless complications, paperwork, and restrictions.

3. Restrict the flow of information to find liberation.

Author Timothy Ferriss in The 4-Hour Work Week, talks about the benefits of a “low information diet.” By allowing information to pour into your environment, office, insurance company, or wherever, you set the stage for info overload and overwhelm. The easy fix is to turn down the informational faucet – to eliminate all but the most essential, need-to-know info from your life and business.

If you or someone you care about got hurt at work or suffered a job-related chronic illness, you may have lots of questions about how to handle your benefits case. Connect with a North Carolina workers’ compensation law firm today to explore methods for getting more out of your case.

More Web Resources:

Getting Things Done — Better information processing philosophy

Information Overload dangers

Steve Poizner, the outgoing Insurance Commissioner for the CA Department of Insurance, has slapped down a request to hike Califonia workers’ compensation rates up by 27.7% for 2011, a move that has North Carolina workers’ compensation analysts talking. The insurance industry, represented most vocally by the Workers’ Compensation Insurance Rating Bureau, is not exactly singing Poizner’s praises. Last year, the group asked for a 30% rate hike, but the Department of Insurance denied the hike. They claim that, since 2008, actual premiums have only increased by 3% – due perhaps to competition and employer adaptations.

The state compensation fund will hike up its rate by 5.2% starting first of the New Year – similar to the premium increase the fund adopted in 2010.

Poizner has been at loggerheads with insurers in the past. In 2009, he spelled out more than two dozen efficiencies that insurers could avail themselves of to cut costs. He struck a disappointed tone in a recent statement: “workers’ compensation insurers have failed to demonstrate that they have adopted procedures to control costs so that they are operating efficiently.”

Poizner aims to push through several reforms to improve the review process to make everything. Those in the North Carolina workers’ compensation system are paying attention. His proposed reforms include:

1. Come up with advisory premiums based on the real rates that insurers file as opposed to theoretical benchmarks.

2. Include clear tables to help employers classify their workers, so that they can understand how rate changes will impact their businesses.

3. Use better data monitoring and filing techniques to help consumers understand how insurance pricing actually works and to avoid getting lost in the details, which can often get quite byzantine (i.e. complicated), even for professionals in the field.

If you or someone you care about has been struggling with a benefits issue – maybe an insurance company has stalled on approving a claim; or maybe your employer claims you got hurt at a previous job and not at your current one – avail yourself of the resources of a quality North Carolina workers’ compensation law firm.

Don’t fight a complicated, technical legal battle on your own. Even if you school yourself on all applicable rules and regulations, you could still make small errors which could have catastrophic consequences for your benefits, and, more broadly, for your ability to return to full health and productivity.

The business of reforming North Carolina workers’ compensation – or any other state system – is a complicated and fraught one.

To wit, a monumental brouhaha is brewing in Seattle, Washington over a reform program championed by WA businesses. Theoretically, the reforms could save the Washington workers’ comp system upwards of $1.2 billion, including a one-time net savings of $730 million. Different entities within the Washington government have proposed wildly different estimates of the savings that the business backed plan would generate. Labor groups are vociferously protesting; they have put forward a different plan that may save the system approximately $450 million over the next several years.

According to the Seattle Times, WA governor Chris Gregoire is treading carefully, aiming to split the different between these two plans. The state’s Office of Financial Management believes that one quarter of all injury claims in WA (approximately 7,000 cases) will end up at settlement. The Chair of Washington state’s House Labor Committee, representative Mike Cells, doesn’t plan to give the bill a hearing, stalling its advance.

What bearing does this tug of war over Washington state’s potentially insolvent workers’ comp system have on the North Carolina workers’ compensation system?

Practically speaking, not a lot!

But although Washington is located literally thousands of miles away from North Carolina, it’s a mistake to underestimate the influence that out of state battles over benefits and entitlements can have on the timbre of debate here in NC. As we’ve explored in other posts, states around the union are desperate to get workers’ comp costs under control. (Witness the recent very public battles in both Illinois and California over similar issues.) As the national economy continues to stall and unemployment rates remain stubbornly high, political figures will look at entitlement programs like unemployment and workers’ comp to identify places to cut.

The problem is that indiscriminate, non-strategically optimized cutting may not necessarily save states. Slashing may also create longer term headaches — not just for hurt and injured workers, but also for the states’ fiscal health. Imagine, for instance, if the North Carolina General Assembly passed a draconian measure to chip away at workers’ comp. Say, for instance, the benefits period maxed out at 250 weeks. What might happen to all those hurt and sick workers? Where will they get money to support their families and to pay for rehab and medical bills? It’s not like these people will just disappear.

Obviously, there is no quick solution to these problems. And if you are personally struggling with an employer or insurance company, a consultation with a North Carolina workers’ compensation law firm can be crucial to making sure that you’re treated fairly and justly — and that you have the information you need to get your health back on track.

More Web Resources:

Can the Washington workers’ comp system be saved?

North Carolina General Assembly plan to reform NC workers’ comp

Last month, the North Carolina Court of Appeals upheld a decision in the North Carolina workers’ compensation case of Cardwell v. Jenkins Cleaner, Inc. The claimant slipped and fell on a stretch of black ice in the parking lot adjacent to her workplace (Jenkins Cleaner) and broke her wrist. She argued that, since she fell near the back door of her workplace, she should get workers’ comp. But the North Carolina Court of Appeals said that her broken wrist was not compensable because the parking lot in which she fell was not owned by her employer. In fact, her employer shared that lot with several other businesses. One judge dissented, saying that, since the entrance door to the cleaner’s was “in such proximity in relation” to the parking lot, the area where she slipped was “in practical effect on the employer’s premises.”

In general, a worker who gets hurt while on an employer’s property can get North Carolina workers’ compensation benefits. But as this case illustrates, subtle nuances and complexities can make the process complicated, if not impossible, for claimants.

Many potential claimants don’t understand their rights and/or don’t seek legal benefits in situations where a claim might be justified. For instance, a pizza delivery worker who gets hurt while driving to a delivery can get workers’ comp from his employer, even if the driver was far away from the restaurant when the traffic accident occurred. Many cases hinge on minor, seemingly irrelevant details. In this case, for instance, at issue was whether Cardwell’s fall happened on the employer’s premises or on a property that the employer did not control. Since she slipped in sort of a “grey zone,” the Court of Appeals ended up delivering a divided decision.

All this is to say that, if you or someone you care about has been dealing with a complicated claims issue, you should avail yourself of the most potent resources to defend your benefits. An experienced North Carolina workers’ compensation firm can provide a free case evaluation and advise you about the most efficient and practical steps to take to guarantee your claim and eliminate resistance from uncooperative employers or bad faith insurers.

More Web Resources:

Cardwell v. Jenkins Cleaner, Inc

Summary of Cardwell v. Jenkins Cleaner

A November 18th article in Wall Street Journal about the profitability of workers’ comp insurance has carriers who deal with North Carolina workers’ compensation policies buzzing. Liberty Mutual’s Chief Executive Officer was quoted in the article worrying about the threat of inflation to the workers’ comp industry. Edmund “Ted” Kelly hinted that his company would “willingly reduce our exposure” to the workers’ comp sector because of fears of inflation.

Across the industry – including here in North Carolina — workers’ comp coverage is sold at a loss. This means that insurers pay out more in claims than they collect through premiums. This isn’t to say that insurers don’t make money in this business. They take the premium money they collect and invest it to generate profit. But the CEO worries that the “time bomb” may soon go off – perhaps as early as 2014 – and cause serious tremors throughout the industry.

What might this all mean for employers and claimants here in North Carolina? It’s obviously too early to even begin to speculate how industry-wide policies could come back to alter employer practices or employee resources. But it’s important to recognize that there is a relationship here. Often, when employers and employees complain about the “unfairness” of this system, they are ultimately frustrated by macro level decisions made by the insurance industry or made by policy makers in Washington or in the NC state capital. Obviously, if you suffer from a lower back injury from work you did at a construction site in Raleigh, you don’t need to follow the latest AIG sales strategies. But the people who represent you with your claim should demonstrate a deep awareness of what’s going on in the industry – at both the state and national levels.

After all, North Carolina workers’ compensation claims can often get incredibly complicated and convoluted, even if they start out seeming simple. An employer may do a 180, for instance, and refuse to pay out a legitimate claim. Or an insurer may deny a claim based on bad data or an obscure provision written into a contract somewhere. Injured workers obviously don’t have the time, energy, or wherewithal to delve into all these legal details, and they often find the system to be tremendously inflexible and unresponsive. These people need advocates who can help make the system work for them – and most importantly, to make things simpler, easier, and faster, so that they can focus on healing, being with their families, plotting out their financial strategies, and getting back to work.

A North Carolina workers’ compensation firm can provide you with the strategic know-how and guidance you need to manage your claim productively and eliminate the enduring stresses associated with it.

More Web Resources:

Edmund “Ted” Kelly

Liberty Mutual CEO predictions for insurance industry

North Carolina workers’ compensation experts along with media analysts across the country are all talking about a momentous sentencing decision out of California. A Laguna Hills man convicted of perpetrating the biggest California workers’ comp premium fraud in history has been sentenced to a decade in state prison.

51-year-old Michael Vincent Petronella was ordered by the court to pay $500,000 in restitution to the CA State Compensation Insurance Fund on top of fines of equaling $550,000. In February, Petronella was found guilty of an unbelievable 33 felony counts of insurance fraud. According to an AP report, Petronella and his wife “fraudulently submitted 42 claims for uninsured workers and unreported $29 million in pay roll to avoid paying insurance premiums.” As a result of their scheme, the state lost millions in insurance premiums and over $250,000 in uncovered worker claims. At the same time, Petronella and his wife apparently lived a life of opulence. They owned 2 Ferraris, jewelry worth hundreds of thousands of dollars, and closets upon closets of apparel from luxury designers like Burberry, Chanel, and Gucci.

Petronella’s ex employees and the local Deputy District Attorney complained that the judge did not order even more forced restitution. The Deputy DA, who had asked that Petronella pay $35 million to California, said that “the court’s ruling establishes that it pays to commit fraud.” The DA wanted Petronella to spend 37 years in jail. She expressed contempt for the judge’s decisio: “[Petronella] has taken no responsibility for his conduct… when he gets out, he will do it again.”

North Carolina workers’ compensation policymakers pay attention to out of state fraud cases to understand potential industry-wide implications. Since this case against the Laguna Hills roofer may be the biggest in California’s history, the decision could indirectly inform future debates over the correct punishment for workers’ comp fraud.

Pulling back from the abstract, for a second, what might this case tell us about the rights and responsibilities of individual claimants? The biggest takeaway is that a claimant needs to be mindful of adhering closely to the rules. Even if you don’t “intend” to cheat the system, you can still be flagged for problems with your claim if, for instance, you shortcut your paperwork or miss a deadline.

If you’ve been dealing with issues regarding your claim, consult with a reputable and highly credentialed North Carolina workers’ compensation firm to strategize about the most efficient ways to eliminate the constraints on your benefits.

More Web Resources

Michael Vincent Petronella sent to prison

Roofing contractor gets 10 years for workers’ comp fraud scheme

The State of North Carolina and the North Carolina Rate Bureau (NCRB) reached an agreement over North Carolina workers’ compensation rates for next spring. The 2010 filings – which will go into effect on the 1st of April, 2011 – should save businesses approximately $7 million over what they might have had to pay, had the North Carolina Rate Bureau completely gotten its way. Wayne Goodwin, the State’s Insurance Commissioner, agreed that the “slight increase” in North Carolina workers’ compensation employers costs (0.6% for voluntary market loss costs and just a little more than 4% for assigned risk markets) was justified.

The Rate Bureau had hoped for slightly higher increases – 1.2% for the voluntary market costs and 5.5% for the assigned risk markets. The industry argued that it needed a hike in rates because of rising medical costs across the state. But opponents of large increases argued that the number of workers’ comp claims in NC has declined; therefore, rates shouldn’t be bumped too much. The Rate Bureau’s director speculated that the number of claims may have declined because:

A) High risk manufacturing jobs preferentially disappeared during the recent recession.
B) Employers have made strides in making their workplaces safer.

The Rate Bureau believes that employers across North Carolina will pay approximately $1.16 billion in 2011 in premiums alone. While a spokesperson for the NCRB claimed to be “a little bit disappointed” with the final decision, the Bureau didn’t seem too frustrated by the final outcome.

These macroscopic changes to the system may be interesting to policy analysts. But what if you are a worker who has recently been diagnosed with a chronic disease or who just got into a serious accident on the job? Will these rate changes affect you? And if so, how?

The trickle-down effect of major policy changes can be very difficult to detect and to quantify. Rather than getting distracted by macroscopic state rate politics, focus instead on what you need to do maximize your claim and speed up your recovery. If you’ve been having trouble with an employer or an insurance company – for instance, an employer unreasonably denying your benefit request or an insurance company acting in “bad faith” and refusing to pay money owed – consult with a North Carolina workers’ compensation law firm to figure out your best next steps.

More Web Resources

North Carolina Rate Bureau (NCRB)

More about the rate hike

Last week, LAPD Officer Robert Yanez got arrested at police headquarters in downtown L.A. for workers’ comp fraud – provoking a lively debate among policy analysts and other North Carolina workers’ compensation experts. The 38-year-old officer got hurt in October 2008 on the job. After being ordered back to work by his doctor, he allegedly switched physicians and forged/altered his doctor’s notes to continue getting payments.

All told, the 11-year-veteran LAPD officer allegedly did this multiple times – he got charged with six total counts – and cost his department around $7,000. Officer Yanez was held at the Men’s Central Jail in downtown L.A. on $30,000 bail. If convicted, he could face seven years behind bars. According to a statement from the LA County DA’s Division of Healthcare Fraud, investigators discovered “probable cause to believe that Officer Yanez had received benefits to which he was not entitled.” According to news reports, the LA Police Officers Union is not representing him in this case, and Officer Yanez is on home duty until the investigation finishes.

North Carolina workers’ compensation fraud – and workers’ comp fraud throughout the US – drains millions of dollars from the system and creates problems not only for insurance companies and employers but also for employees who have legitimate claims. The workers’ comp system is designed to help legitimately hurt or ill people make ends meet until they can recover. Unfortunately, a few bad apples do take advantage of the system and even resort to explicitly fraudulent activities (such as doctoring a doctor’s note) to avoid having to go back to work.

In response to fraud cases like this one, insurance companies may put in place more cumbersome screening procedures; employers may get more suspicious of workers who make any claims; and injured employees may find it more challenging to make the system work for them.

If you have been unfairly charged with fraud – or if you are dealing with some other issue with your benefits – such as an employer not paying a legitimate claim or an insurance company gumming up your claim by stalling or using bullying tactics – you may benefit significantly from a free consultation with a North Carolina workers’ compensation law firm. Smart attorneys and their associates – who understand the system and the law – can reduce your level of uncertainty and stress and steer you on a course to maximize your recovery and maximize your benefits.

More Web Resources

Veteran LAPD officer accused of workers’ compensation fraud

LAPD officer accused of workers’ comp fraud

The North Carolina Industrial Commission is sponsoring the 15th Annual North Carolina Workers’ Compensation Educational Conference next week from October 13 through 15. The event – which will take place at the Raleigh Convention Center – aims to educate people involved in all different aspects of the state’s workers’ comp system about:

• Policies
• Forms
• Procedures
• Rules

The conference also aims to allow diverse participants to discuss key issues about the system. The NCIC website says that the following participants may gain useful info from this conference:

• Employers
• HR managers
• Attorneys
• Medical providers
• Mediators
• Rehab providers
• Paralegals
• Self-insurers
• Administrators
• Claims adjusters
• Safety managers

Both the Raleigh Marriott City Center and Sheraton Raleigh hotels offer discount conference rates just half a block away from the Raleigh Convention Center (where the conference will be held). According to the NCIC website, the following people will be speaking at the North Carolina Workers’ Compensation Educational Conference:

October 13:

• Pamela Young, the Chair of the NCIC
• Martha Dealy, the President of Kids’ Chance of North Carolina
• Denise Thomas, Consultant
• Kirk Leggott, the NCIC’s Chief Information Officer
• Adolfo Arsuaga, a speaker on Multicultural Issues
• Tracey Weaver, David Gantt, and Henry Byrum, who will talk about Professional Ethics

October 14 (Thursday) two breakout sessions will occur in the morning – one on Rehab Dilemmas and one on “The Workers’ Knee – A Medical Assessment”

In the afternoon, two other breakout sessions will occur: one on “Hot Topics in Claims Administration” and one on “I Know I Can Do It, I Just Don’t Remember How!” held by the NCIC Deputy Commissioners.

October 15 (Friday) you will get to hear more speakers, including:

• Pamela Young, the NCIC Chair
• Wanda Taylor, Keischa Lovelace, and John Schafer, who will talk about Industrial Commission Rule Changes
• Dr. T. Kern Carlton III will talk about Controversies in Chronic Pain
• Johnny Lee will talk about Workplace Violence
• Maggie Bennington and Bruce Hamilton will talk about Case Law Updates

If you or someone you care about has gotten injured or sick at work – and your employer, or relevant insurance company, or another party has not treated you fairly, it may behoove you to discuss what steps to take with a qualified North Carolina workers’ compensation law firm.

More Web Resources

more about the North Carolina Workers’ Compensation Educational Conference

North Carolina Industrial Commission

North Carolina workers’ compensation policy — as it pertains to longshore and harbor workers — could face radical reshaping. According to new regulations proposed by the US Department of Labor, ocean workers – such as boat repairers and builders – may soon be able to avail themselves of more comprehensive workers’ compensation benefits.

The National Marine Manufacturers Association (NMMA) has voiced concerns about the regulation changes. According to the new definitions proposed, workers who dismantle or repair or build a boat that’s less than 65 feet in length will now be entitled to benefits above and beyond what they get now. The NMMA worries that manufacturers may not know how their boat products will eventually be used – whether they will be passenger, commercial, or recreational, e.g.. The DOL says that boat workers who do “qualifying maritime” labor as well as “excluded work” should be covered. The NMMA has asked for a 60-day extension to examine the regulations and comment on them.

Given that North Carolina sustains a large and thriving maritime industry – with many boat builders, repairers, and dismantlers – these new DOL regulations may have a deep and broad impact on NC’s maritime economy as well as on the manufacturing industry’s schedule.

The debate over the nuances of these new regulations illustrates how complicated even relatively simple sounding North Carolina workers’ compensation cases can become. This modification to the law – to essentially make boating employers more responsible for their workers – will no doubt stir a lively debate among that industry’s community about the fundamental responsibilities a manufacturer has to employees who build and repair.

Are you struggling with a similarly nuanced and complicated issue pertaining to your benefits? Is your employer refusing to pay you? Or is a liable insurance company balking at paying your full benefits? If you need any kind of help, discuss your problems with a North Carolina workers’ compensation law firm. By getting good upfront advice, you can avoid the pitfalls that often cause cases to drag on for months (if not years), and you can hopefully expedite your pursuit of a fair and complete settlement.

More Web Resources

National Marine Manufacturers Association (NMMA)

NMMA: Workers’ comp changes could affect boatbuilders

Last year, this North Carolina workers’ compensation blog reported, North Carolina Insurance Commissioner Wayne Goodwin ordered a 9.6% decrease in voluntary loss costs for the state’s workers’ comp – a move that Goodwin claimed saved companies in the state nearly $120 million. But 2010 has seen a reversal of strategy. The North Carolina Rate Bureau – an organization that represents the interests of NC workers’ comp insurance companies – seeks increases in loss costs of 1.2% as well as an average increase of 5.5% in assigned risk markets (in 2009, there was zero change to the assigned risk markets).

The North Carolina Department of Insurance will have 60 days to look-over these rate adjustments to determine whether they are warranted or not. If you are interested in examining the nitty-gritty details, head to this website: http://pserff.ncdoi.net/pc.html.

The manipulation of North Carolina workers’ compensation insurance rates numbers may seem irrelevant to you, if you are in the process of filing a claim. But these kinds of “big picture” changes to state insurance policies can have serious trickledown effects. It’s very difficult to calculate exactly how rate increases (or decreases) will translate into costs/benefits for businesses and claimants. It’s not a “one-to-one” thing. Indeed, literature abounds with examples of market interventions actually yielding completely contradictory – even paradoxical – results.

So, if you are a business owner or a claimant, what should you make of these potential rate adjustments? In short, don’t make too much of them! If you are a business owner, focus on building your business, managing costs, and dealing with rate changes as they emerge. If you are a claimant, focus on processing your paperwork effectively and on time – and on dealing with any roadblocks, such as uncooperative or bad faith insurers or employers. Also, focus on your rehab/recovery so you can return to the workforce in good spirits and in a productive capacity.

Do you need help dealing with a claims-related issue? If so, get in touch with a North Carolina workers’ compensation law firm to explore your rights and obligations under state law. Even if you have a relatively simple and seemingly straightforward case, it never hurts to speak with representatives of a solid and well-established law firm about the do’s and don’ts of filing.

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North Carolina Rate Bureau

More info about the proposed rate increase

Although this North Carolina workers’ compensation blog typically covers regional (and, occasionally, interstate) stories, we almost never focus on international cases because they are usually not that germane to our readers. But a fascinating international case – pertaining to a longstanding debate between Japan and China – has us breaking our rule.

A battle extending nearly 80 years

In World War II, approximately 40,000 Chinese people got conscripted as forced laborers in Japan. Around 7,000 conscripts died. But many survivors – all of whom are now over 80 years old – remain unsatisfied with the reparations they collected from Japan under the 1972 Japan/China joint statement. Since the ‘72 arrangement, which ostensibly finalized reparations, courts in Japan have rejected 15 different lawsuits filed by Chinese workers to collect benefits pertaining to what was essentially their conscription and enslavement. Undaunted, a group of around 100 laborers from Shandong have launched a legal action to collect around $15,000 per worker in reparations from the Mitsubishi Materials Company, which employed over 2,700 Chinese conscripts in mining activities following Japan’s invasion 79 years ago. The case has warranted the attention of China’s foreign ministry spokesman, Qin Gang, who petitioned the Japanese government to make good on the reparations because, China asserts, the 1972 joint statement did not fully resolve all relevant questions.

So how does this all tie back to now parochial seeming debates over North Carolina workers’ compensation? It ties back in a number of ways. First, it illustrates that debates over how to redress employment related injuries and diseases can fester for years and even decades. Second, it illustrates just how complicated and political the process of compensation can get – particularly when companies, employees, and insurers wrestle with questions of severe injury/death and high payout amounts.

All this is to say that, if you or a loved one has been struggling with an employer or an insurance company about your claim, you are not alone. It’s common to encounter friction and even outright bad faith in negotiations for compensation. To that end, it’s always a good idea for claimants to avail themselves of a free and confidential consultation with a North Carolina workers’ compensation firm. Better educated and well represented claimants tend to resolve their claims faster and more effectively.

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More on the Mitsubishi Materials Company saga

1972 Japan/China joint statement

On August 3rd, the entire country (including the normally provincial North Carolina workers’ compensation community) was shocked by a series of brutal workplace slayings in Manchester, Connecticut. An employee of Hartford Distributors, who claimed that he had been racially discriminated against, opened fire on his co-workers and shot and killed eight of them before he committed suicide at the scene.

The tragedy shocked central Connecticut. The employees and owners of Hartford Distributors (along with the company’s insurer, Hanover Insurance) must still be reeling from the disaster. Since the eight deaths occurred at work, the families of the slain employees should be eligible to collect death benefits through workers’ compensation. The families will have until next August 3rd to file claims, and analysts believe they will likely be able to secure hefty settlements given the grisly and very public nature of the deaths.

Interestingly, some industry analysts believe that the implications of this workers’ comp case could go well beyond Manchester and reverberate throughout the entire beverage manufacturing industry. After all, insurance companies set their rates by calculating risk probabilities. And this Manchester shooting and the (likely) large workers’ comp settlements it will yield will put pressure on insurers to revise how they appraise the risk of insuring beverage companies. So, in a very indirect way, the shooting could have ultimate implications for North Carolina workers’ compensation insurance.

If you or a coworker or a family member has suffered serious injuries at work, you likely need savvy guidance about how to proceed. Often, injured workers who don’t understand this system wind up with inadequate compensation for their disabilities. This makes the process of getting rehabilitated and returning to work that much more difficult – particularly in today’s testing economy. For help now with your case, get in touch with a creditable and results-proven North Carolina workers’ compensation law firm.

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Hartford Distributors

More about the Manchester shootings

The last thing most employees want to do is have to go on North Carolina workers’ compensation. No one wants to be injured. Few enjoy the hassle of filing claims and dealing with less than cooperative insurance companies and employers. Some on the job accidents and illnesses are unavoidable. For instance, say your delivery van gets sideswiped by a semi-truck, and the resulting accident gives you serious whiplash. There is no way you could possibly anticipate that kind of accident. But other at-work accidents can be more easily avoided:

1. Typing Injuries

Warning Signs: You feel numbness and tingling in your fingers, your arms ache or throb at the end of the day, you notice that you are adopting “crutches” such as typing with your non-dominant hand or intentionally “slacking off” so that you don’t have to type as much.

Solution: Talk to your employer about a better ergonomic set-up. Improve your posture and muscular conditioning. Take frequent breaks. See a physical therapist to treat your “trigger points” with modalities like acupuncture, massage, and microstretching.

2. Slip and Falls Waiting to Happen

Warning Signs: “Near misses” in which you and or other employees “almost” get into serious injuries, jokes around the office that a piece of equipment is an “accident waiting to happen” or a “fire trap.”

Solution: As quickly as possible, bring the problem to the attention of your boss and/or manager. Document any or all attempts you make to get the problems fixed. If your immediate manager won’t help, consider going up the chain of command to complain.

3. Exposure to Chronic Toxins

Warning Signs: If you work with chemicals, and you come home with a headache or being unable to breathe; if you notice that you are getting a rash or other allergic reaction to chemicals, glass, plastics, or other materials used at your work; if you get dizzy or feel sick at work when you use a certain piece of equipment or a certain kind of chemical or material.

Solution: Report the problem to your manager as soon as possible. You might be able to solve this by wearing better safety equipment, such as a ventilator or mask. Alternatively, you may need to stop using whatever product or material is causing the allergic or toxic reaction.

If it’s too late – and you’ve already been injured or gotten an occupational disease – and you need assistance with a North Carolina workers’ compensation issue, it behooves you to consult with an experienced law firm that specializes in North Carolina workers’ compensation. The faster you get professional legal assistance, the easier it will likely be to start collecting benefits.

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All about trigger points

Common Workplace Toxins

North Carolina workers’ compensation experts have been following a bizarre breaking story out of Chenango County, NY.

According to the Associated Press, a 53-year-old New York woman named Susan Tansosch has been ordered to pay over $60,000 in restitution to the United States Postal Service for workers’ comp fraud, pursuant to charges that she falsely claimed that she had no additional income streams – when she had been making significant money selling goats.

Last Wednesday, Judge Thomas McAvoy sentenced Tansosch to four years probation and forced restitution to the USPS for making untrue statements to collect workers’ comp benefits from the federal government. The Department of Labor abruptly ended Tansosch’s benefits – all because she sold goats on the side.

This story drives home a point that many North Carolina workers’ compensation claimants often forget. Namely, that you need to read and understand the fine print of your benefits arrangement. If you fail to abide by the terms stipulated, you could wind up in court, in trouble, and in debt to the agency or insurer that provided the benefits to you.

There is no way to tell from this AP story whether or not Ms. Tansosch knew that selling goats would violate her workers’ comp arrangement. But don’t think that, just because you settle your North Carolina workers’ compensation case, that the situation will be permanently resolved. Insurance carriers are businesses. They investigate claims — even after they have settled! — to make sure that claimants are/were telling the truth about their injuries.

Managing the legal complications of a debate over your benefits can be a draining chore – one that you likely do not have the training to handle adroitly. That’s why, even if your case is relatively simple-seeming now, you might benefit from a consultation with a reputable and proven North Carolina workers’ compensation law firm. As the old adage goes, an ounce of prevention is equal to a pound of cure. Smart planning can mean the world for your workers’ comp case.

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NY goat-seller must pay back workers’ comp

Woman sentenced after conviction

North Carolina workers’ compensation experts are all talking about the case of an Ewa Beach man, who got convicted in Honolulu last week for workers’ comp theft.

Jacob Belaski allegedly hurt himself while operating his Teixeira Trucking business. He fought for benefits from his insurance company, HEMIC. At the same time, he continued (on the sly) hauling materials to and from a cement factory. In the process, he earned over $100,000 – all while collecting benefits compensating him from being unable to work.

Investigators from the Honolulu Police Department’s White Collar Crime Unit discovered the scam and realized that Belaski had misrepresented his injury to his physicians, insurance company, and others. Mr. Belaski even testified under oath to being hurt. Mr. Belaski’s conviction of theft and perjury charges may dissuade others in the Aloha State from similarly trying to take advantage of the claims process to collect benefits illegally.

This blog has investigated a number of cases of workers’ comp fraud lately to try to highlight the shades and nuances of the law – and of the individuals who commit these crimes. It’s important not to paint these defendants with a broad brush. As we have seen recently, practically anyone can wind up as a defendant in a North Carolina workers’ compensation fraud case – from strippers to goat sellers to truckers.

If you cannot collect benefits, cannot deal efficiently with your employer or insurance company, or cannot figure out how to put your life and budget back together again after a significant injury or illness, you need good help. In particular, a qualified North Carolina workers’ compensation law firm can guide you towards good resources and ensure that you stay within the bounds of your benefits arrangement. A good attorney can also help you deal with uncooperative bosses or insurance companies.

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Case of Jacob Belaski

Honolulu Man Convicted in Hawaii’s First Workers’ Compensation Theft Related Case

On July 19, the Obama administration laid out a four-year path for state agencies to improve safety standards and limit North Carolina workers’ compensation cases (and cases in the other 49 states, as well!). Obama’s memo noted that in 2009, 79,000+ claims were filed and $1.6 billion in payments were handed out. The President said “many of these work-related injuries and illnesses are preventable, and executive departments can and should do even more to improve work place safety and health.”

The President’s initiative, Protecting Our Workers and Ensuring Reemployment (POWER) compels agencies to improve in 7 categories of performance by the close of FY 2014. These include reducing total injury/illness rates, reducing lost time and illness rates, analyzing lost time data, increasing the timely filing of wage loss and workers’ comp claims, reducing loss production rates, and speeding employees’ return to their jobs. On Wednesday, the House Committee will further explore how to deal with federal workplace injuries.

How will POWER impact the North Carolina’s workers’ compensation system? At this point, it’s obviously too early to tell. Clearly, if relevant agencies can impose stricter standards to simultaneously promote better care, better service, and faster re-employment, this would be a win-win-win for all parties concerned. But some critics worry that, in their rush to comply with POWER, agencies might accidentally (or purposefully) disempower some claimants. For instance, by trying to enforce point number 7 of POWER’s Plan (speeding employees back to work), agencies might inadvertently compel seriously injured or sick people to take on work that they are not ready for yet. Of course, it’s obviously way too early to weigh in on the merits of this order, but it is certain to change the playing field.

Do you or a loved one need help with your workers’ comp case? Have you been having trouble with your insurance company, employer, or provider? If so, consider getting the advice of a respected and credentialed North Carolina workers’ compensation attorney today.

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Protecting Our Workers and Ensuring Reemployment

WaPo opinion on POWER

Initiative 1082 — way up in Washington State — has sparked a firestorm of debate and controversy among North Carolina workers’ compensation analysts. Ordinarily, a statewide initiative in a far off part of the country would not rile up insurers, business owners, injured workers, and state bureaucrats. But the vocal debate out of Washington has served as a touchtone for a number of issues hotly being discussed right here in NC.

Facts about the Initiative, and Implications for North Carolina Workers’ Compensation Politics

The Building Industry Association of Washington – regarded as a politically conservative group – sponsored I-1082 to crack the state monopoly on workers’ comp. To qualify for the ballot, the measure needed 241,000 signatures – allegedly, it got nearly 100,000 signatures above that mark. Clearly, many Washingtonians are fired up. Sponsors argue that the current system sticks business owners with high insurance premiums and allows injured workers to enjoy overly-plump benefits. Opponents of I-1082 say that introducing a for-profit component into the workers’ comp system could degrade benefits and lead to claims being delayed or denied.

Both opponents and proponents of the initiative claim that the implications of I-1082’s passage for the state could be profound. Currently, Washington is one of only four states that does not allow companies to privately compete with a state-run workers’ comp system.

The North Carolina workers’ compensation system allows private insurers to compete – so the WA debate can be relevant only indirectly. However, the growing frustration among business owners regarding workers’ comp costs – and the simultaneous growing health problems among workers, including chronic occupational diseases and medical conditions like obesity and diabetes – may well portend a sea-change in the next few years, economically speaking.

Can small businesses survive a clunky economy and potentially a double dip recession? Can hurt employees – many of whom may soon start to lose their unemployment benefits – survive if their benefits get curtailed or restricted?

If you or a coworker or a family member has been experiencing difficulties collecting your benefits, connect ASAP with an attorney to advise you. A free and confidential consultation with a North Carolina workers’ compensation lawyer can help protect your rights and ensure your family’s financial stability.

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Initiative 1082

Workers comp initiative steps closer to ballot

The California Department of Insurance made a decision in early July to earmark $1.25 million to battle workers’ comp insurance fraud. Steve Poizner, the often-in-the-news CA Insurance Commissioner, remarked that “fraud creates costs that burden our economy at a time it can least sustain it.”

Those in the North Carolina workers’ compensation community have reacted strongly to California’s decision. Advocates of similar measures here at home argue that funneling money into fraud control can help the system be more functional and protect benefits to attend to the needs of truly injured workers. Opponents of stronger fraud control worry that antifraud dragnets might accidentally sweep up legitimate claims. For instance, take someone who ordinarily would qualify for North Carolina workers’ compensation for a hurt lower back. She might wrongly be denied benefits — or at the very least given an overly hard time to qualify for them.

If you or a loved one or a coworker has experienced problems collecting benefits from a non-cooperating employer or bad faith insurance company, you may have rights and legal means at your disposal that you may not even be aware of. To find out how to protect your interests optimally, connect with an experienced North Carolina workers’ compensation attorney ASAP. Whether you have been improperly identified as trying to defraud the system, or you are having a simple vexing issue with your workers’ comp, get good help now before it’s too late for you and your family.

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California Department of Insurance

County tentatively slated to receive $1.25 million for worker’s comp fraud

Kenneth Bullock, a St. Regis, New York man, has been charged with fraud in conjunction with a scheme that he allegedly had perpetrated since the early 1990s. North Carolina workers’ compensation blogs and analysts are closely following the story.

Background

Bullock worked as a mechanic in New York in the 1990s. While executing his duties, he hurt his back — or so he claimed. Bullock said that his at-work accident rendered him unable to keep servicing cars, and he was put on workers’ comp. While collecting benefits, he moved to Florida and took another mechanic’s job – in direct violation of his workers’ comp arrangement.

If convicted of scamming the system, Bullock could face seven years imprisonment for illegally collecting $39,000 in benefits. Allegedly, surveillance caught Bullock working at a shop – investigators were tipped off when his claims arrived with Florida postage. The Onondaga County Insurance Fraud office will handle the matter, since that location processed Bullock’s claims.

North Carolina workers’ compensation fraud drains hundreds of thousands (if not millions) of dollars of funds from an already over-milked system every year. It’s obviously in the interest of all parties concerned – from trial attorneys to insurers to employers to injured workers – to clamp down on scams and schemes. Unfortunately, many injured workers with very legitimate claims wind up under investigation for fraud simply because they fail to file paperwork correctly or because they engage in activities to “stretch” themselves – such as aggressive physical rehab.

If you or a family member or a coworker has been wrongfully targeted for North Carolina workers’ compensation fraud, and you need guidance to make sure that you can collect benefits (and not get punished for making an illegitimate claim); or if you simply need basic FAQs answered about how to deal with a difficult employer or how to fight back against a recalcitrant insurance company, get in touch with a credentialed and experienced North Carolina workers’ compensation attorney ASAP. Get good guidance upfront, so you don’t wind up in a protracted battle over your benefits.

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St. Regis man charged in alleged workers’ comp scam

Franklin County native charged with fraud

Appalachian State University will host a symposium on North Carolina workers’ compensation from August 1st to August 2nd in Winston-Salem, NC at the Embassy Suites Hotel. The symposium offers an opportunity for insurance professionals, lawmakers, employers, attorneys, regulators, and economists to get together to discuss critical issues about the state’s workers’ comp system.

For more information, go to http://insurance.appstate.edu// — you can also register online there. The price is $129 if you register by the 10th of July and $149 after that. The symposium is titled: “North Carolina’s Workers’ Compensation System: is the “compensation bargain” still working for both employers and employees in our state?”

The conference aims to take a deeper and more levelheaded look at the so-called North Carolina workers’ compensation bargain – the idea that injured workers should be covered for medical care and missed wages in exchange for not filing negligence claims or debating questions of fault. Ideally, the system should move cases through faster because establishing fault is not the key issue. In practice, however, many North Carolina workers’ compensation claims end up tied up in court, potentially creating a drag on the system and even on the economy as a whole.

Some of the brightest minds and luminaries in the arena of North Carolina workers’ compensation will attend this conference. Special speakers include Nicole Coomer, an economist at the Workers’ Compensation Research Institute, Jay Norris, the President of the North Carolina Association of Self Insurers, Carol Telles, an analyst at the Workers’ Compensation Research Institute, and Pamela Young, the Chair of the North Carolina Industrial Commission.

If you or a loved one faces an intractable problem with your benefits or insurer; or if you need help understanding anything about the process, connect today with a knowledgeable and a results-proven North Carolina workers’ compensation attorney.

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Appalachian State University

“North Carolina’s Workers’ Compensation System: is the “compensation bargain” still working for both employers and employees in our state?”

Breaking news in a key North Carolina workers compensation case: The North Carolina Court of Appeals upheld an award in the case of Hatley v. Continental General Tire, stipulating that the claimant (Hatley) was entitled to temporary total disability benefits pursuant to an injury he suffered while repairing a tire.

Background

Hatley was a tire inspector who hurt his hand during a blowout accident at work. After he got treated, his physician put him on light duty restriction. Following this rest, he tried to go back to work but found that he could not perform his duties because of continued problems with his injured hand. His employer told him that he had to continue working or retire. The inspector chose to retire and take a new position as a teacher’s assistant, six months after the fact. His employer sought to get out of paying for disability claims; he alleged that not all of Hatley’s symptoms could be traced back to the at-work accident. (Pursuant to the North Carolina Workers’ Compensation Act, an injured worker must be able to show that a workplace injury caused a disability that resulted in impairment.)

The employer’s argument fell short, according to the Court of Appeals, because no doctor testified precisely how much of the injury resulted from work place trauma and how much resulted from other factors. Without good medical testimony to this point, the Court concluded that “any attempt to apportion plaintiff’s injury would have been speculative and improper.”

Although the plaintiff in this case managed to hold on to his temporary total disability benefits, many other workers with legitimate claims are not so lucky. They can find their benefits retroactively stripped from them. If you have questions or concerns about how to handle a difficult employer or a non-cooperative insurance company, it’s probably in your best interest to discuss your case in confidence with an experienced North Carolina workers’ compensation attorney.

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Hatley v. Continental General Tire

The North Carolina Court of Appeals

On June 15th, regulators announced that South Carolina workers’ compensation rates would fall to 9.8% — news that has sent ripples of interest and concern across the North Carolina workers’ compensation community. According to SC Insurance Director, Scott Richardson, 2009 marked the second year in a row in which regulators approved a decrease. He argued that “this trend [implies] an improved economic climate, and [we] hope to see this continue into next year.”

SC insurers will be able to use the new 9.8% rate in just 30 days. Richardson cited multiple reasons for the decline in rates, including enhanced employee safety programs, a reduction in the frequency of claims, and changes to the nature of claims themselves. In South Carolina, more than 40% of benefit costs can be directly attributed to payments for medical services. Most SC workers’ comp costs go to indemnity payments – that is, benefits to replace wages lost. As Richardson and others have noted, the extent to which the rate change will impact policy regarding medical costs in the state remains to be seen. Richardson noted that the state “will continue to monitor and assess the impact these reforms have on workers’ compensation rates…as it will take several years to realize the full impact.”

Meanwhile, north of the border, North Carolina workers’ compensation experts have been feverishly debating whether and how these rate changes might influence the playing field up here. So many unbalancing factors are at play – both at the state level (see our earlier blog entry about the ongoing devastation at the last year’s Slim Jim plant in the town of Garner, for instance) and at the national level (see our past blog entries on the local implications of the Gulf oil spill, for instance).

It’s important to recognize the limits of our collective power to influence the interactions of the dynamic elements that comprise the ecology of the North Carolina workers’ compensation system. Even among key players — who include but are not limited to insurance adjusters, attorneys, judges, economists, employers, employees, and their families — debate about how to set rates rages.

Getting away from generalities and down to brass tacks… if you or a loved one has a clear and present concern about North Carolina workers’ compensation benefits, insurance, or coverage, consider connecting today with a top caliber attorney to discuss your needs and responsibilities.

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South Carolina Workers’ Compensation Rates to Drop 9.8%

South Carolina Regulators Approve 9.8% Cut in Workers’ Comp Rates

Most news coverage about the 2010 BP Gulf oil spill has focused, understandably, on states like Louisiana, Mississippi, and Texas because they are “in the line of fire” of the spillage. But North Carolina workers’ compensation experts and other local observers have expressed a plethora of concerns over how the spill might ultimately impact the economy of North Carolina. In particular, what might happen to local workers and employers injured by the environmental and economic fallout? Will North Carolina fishing industries suffer? If so, by how much? What about the state’s oil and gas industry — how will the BP disaster impact it and all those who depend on that industry for employment and income? And so on.

These questions about the relevance to North Carolina workers compensation remain unanswered. But a White House fact sheet released last Wednesday outlines some critical specifics regarding victim compensation for the oil spill. Per this fact sheet:

1. An independent claims facility will be established to ensure that those with recoverable claims (e.g. businesses and individuals) will be paid in a quick and transparent manner. Kenneth Feinberg – the former administrator of the September 11th Fund – will be the head administrator.

2. BP will establish an escrow account and contribute $20 billion to it to make sure that funds exist to pay injured workers, businesses, and others. BP has stated that it will not hide under the protection of the Oil Pollution Act to cap its liability.

3. BP will additionally contribute $100 million to provide support for workers rendered jobless by the oil rig disaster, and the payouts will be handled by the Disaster Unemployment Assistance Program.

4. BP will contribute another $0.5 billion to the Gulf of Mexico Research Initiative, which will explore ways and means to mitigate the environmental and economic fallout of the oil pollution and set in place long-term monitoring stations along the Gulf Coast (and presumably elsewhere – if the spill trickles out to places like North Carolina).

Although many environmental activists and Gulf Coast politicos have welcomed these concrete steps that the White House and BP have taken, some worry that they may be too little, too late.

If you or a co-worker or a family member has encountered problems with your benefits, insurer, or even the North Carolina Industrial Commission itself, it may be in your interest to connect with a trusted North Carolina workers’ compensation attorney to get a free and no obligation consultation.

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Kenneth Feinberg

White House fact sheet about BP fund

The ongoing oil well gusher in the Gulf of Mexico may have a profound impact on North Carolina workers’ compensation claims, even though at present the residue remains hundreds of miles away from North Carolina shores.

With President Obama, Coast Guard Admiral Thad Allen and thousands of other federal, state, and local officials and engineers “on the case” to get the deep sea oil well capped and to resolve the environmental and human health fallout, one might think that North Carolina would be spared significant damage. But a recent ABC News analysis of how the potential spill may evolve over the coming months suggests that tarballs and other oil spill related environmental problems may come to haunt North Carolina shores, cause injuries to fisherman and workers here and lead to a host of North Carolina workers’ compensation claims.

All sorts of indirect problems may be in the offing. Consider that, in May, the Obama administration ordered BP to stop using a chemical called Corexit (a dispersant) because of its potentially toxic effects on ocean life and on engineers who disperse it. The spill may also have tertiary and quaternary impacts on the North Carolina workers’ compensation system. If, as many analysts fear, the spill drives the US into a double dip recession or at least slows down growth, business owners and insurers in NC will come under intense pressure to downsize and cut corners. As any half aware watcher of the North Carolina workers’ compensation scene knows, when business owners cut corners, people get hurt at work. It would be very difficult to trace any resultant injuries back to the BP spill (after all, it’s tough enough to isolate secondary consequences of a disaster like this – much less tertiary and quaternary consequences), but an historical analysis might indeed suggest that the thesis proposed here has merit.

Of course, though the press, environmental activists, and Federal civil engineers may be apoplectic about the spill, you as an injured state worker don’t care as much about the national implications. You just want to know how to get your benefits, deal with frustrating insurance companies and negotiate with uncooperative employers.

To that end, don’t replicate the kinds of mistakes that BP has made over the past few months. Get help sooner to understand your personal financial situation better, and talk to a creditable and experienced North Carolina workers’ compensation attorney to explore how to get fair benefits quickly and cut through red tape.

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Corexit

Politico Story about BP Spill Workers Comp Issues

Here are more solid answers to questions about the North Carolina worker’s compensation process (pursuant to laws in effect as of 2006). Consult a reputable NC worker’s comp attorney for details about your case.

What forms can you use to notify your employer that you have been hurt at work or that you have come down with an occupational disease?

Three different forms may be used:

1. The NC Workers’ Compensation program has a form called SGWCP-2 that you can get from your direct supervisor or from a workers’ comp administrator. This form lets you talk about the injury or accident and fill out different leave options.
2. Form 18 from the North Carolina Industrial Commission. You can get this from your workers’ comp administrator or directly from the NCIC. You can use Form 18 even if your employer does not want to accept responsibility for paying your claim.
3. Other forms (usually internal to your company). Talk to your HR department about how to get this form or speak with an official workers’ comp administrator.

How do employers report employee injuries?

Typically, they use Form 19, which they can get through the NCIC.

Can employers opt out of covering people for workers’ compensation?

No. North Carolina is a compulsory state. With some exceptions — waivers not being one of them! — employers must provide workers’ comp insurance either through self insurance or through a private carrier.

What are the exceptions?

• If an employer has three employees or fewer
• If a saw mill and or logging operator has 10 workers or fewer
• If an agricultural, non-seasonal employer has fewer than 10 full time workers

How does Temporary Total Disability work for North Carolina Workers’ Compensation?

Temporary Total Disability, also known as TTD, can be paid for the length of the disability. TTD is calculated by taking into account the working wage. Benefits are capped at both a maximum and minimum pay out.

What payment rules govern Permanent Partial Disability (PPD)?

PPD is also calculated based on the employee’s wage and capped for maximum payouts. Injured workers can collect PPD for as long as 300 weeks – that’s nearly six years. In certain cases, such as permanent disfigurement or complete incapacitation, disabilities can obviously be extended.

What rehabilitation benefits are available under North Carolina Workers Compensation law?

Physical rehab is compensable but occupational rehab is not provided for in the current law. If you lose your hearing as a result of an occupational injury, you may be able to collect compensation for this, though strict filing protocols apply.

How do NC workers’ comp death benefits work?

State law requires that the spouse and/or children of an employee will collect death benefits calculated by looking at the employee’s wage and estimating a percentage from that. Death benefits include funeral allowances and insure a minimum payout no matter what the employee made.

How can you get more specific information what to do about your North Carolina workers’ compensation claim?

Given all the legal complexities that go into these claims, it may behoove you to retain a pre-qualified and experienced North Carolina workers’ compensation attorney. Most attorneys will provide free consultations (in confidence) to give you a better idea of how they might be able to serve you.

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Permanent Partial Disability (PPD)

Temporary Total Disability (TTD)

Those who follow North Carolina workers’ compensation policy debates often closely analyze minor court cases because these cases inform the broader discussion. To that end, we will review the implications of a recent US District Judge’s decision to sentence a former US Navy employee for workers’ comp fraud by sending him to prison for 21 months and compelling him to pay nearly $0.25 million in restitution to the Department of Labor.

Background

Mark Correnti worked for the US Navy for years as a civilian employee. In 1989, he hurt his back. Starting in the year 2000, he began collecting $2,000 a month from the Department of Labor in federal workers’ compensation for his back injury. These payments continued through 2008, during which time he accrued over $0.25 million.

According to prosecutors, Correnti violated the Federal Employees Compensation Act by starting up a small business, Safe & Sound Storage, and collecting income from this business. At seven different times, Correnti denied that he was bringing in money from this business. (These false statements allowed him to keep collecting federal workers’ comp.) After being caught, Correnti pled guilty last November to charges of making false statements, and the US District Judge sentenced him in late April to the harsh terms outlined above.

Now, obviously, most North Carolina workers’ compensation claimants work hard to understand their obligations and to avoid putting up red flags that might indicate fraud or non-compliance.

Nevertheless, claimant errors and omissions can torpedo otherwise valid North Carolina workers’ compensation claims. In other words, even if you did legitimately hurt your back lifting an object at work, for instance, your claim could be invalidated or downgraded if you don’t follow the correct protocol.

Fortunately, you don’t have to go through the rigmarole of applying for and securing workers’ comp benefits on your own. By connecting with a vetted, strategically focused, and experienced North Carolina workers’ compensation legal team, you can save yourself a lot of hassle and increase the likelihood of collecting the maximum benefits.

More Web Resources:

Federal Employees Compensation Act

Mark Correnti case

Most North Carolina workers’ compensation fraud cases pale in comparison with two breaking stories out of California.

The first involves a San Jose man named Daniel Nelson, who allegedly bilked the CA State Compensation Insurance Fund out of nearly $60,000 by failing to report $600,000 in payroll for his businesses (Monster Magic LLC and Worldwide Attraction). According to the DA’s office in Santa Clara County, an investigation began shortly after it was discovered that Monster Magic and Worldwide Attractions had failed to report nearly $80,000 in payroll for the 2006 calendar year. But the amount of underreporting turned out to be nearly 10 times that much — all told, investigators found over $614,000 in underreported payroll. Nelson was arrested by deputies in Alameda County and held on a $50,000 bail. If convicted of California workers’ compensation fraud, he could face a $50,000 fine and a jail sentence of up to five years.

Meanwhile, in a separate matter, a man named Mitchell Zogob faces a decade in California prison for collecting nearly $5 million in fraudulent California workers’ compensation insurance premiums. Zogob pled guilty to a gamut of offenses. Experts who followed the case interpreted the sentence to be a shot across the bow to other would-be workers’ comp defrauders.

How does North Carolina workers’ compensation fraud impact employees, employers, insurance companies, and the economy as a whole?

When someone bilks the NC workers’ comp system, everyone ultimately pays. Fraud does two things. First, it removes money from the system that could (and should) go to deserving claims. Second, it encourages insurers and watchdog agencies to vet claims more thoroughly. Thus, claimants with legitimate grievances often must go through extensive hurdles to collect their (rightly-owed) benefits.

Indeed, occasionally, legitimate claims get flagged as “false positives” for fraud. If you or a family member has been wrongfully accused of North Carolina workers’ compensation fraud, or if you need help with anything else regarding your workers’ comp matter, look to an established and peer-reviewed NC workers’ comp law firm near you to get strategic advice.

More Web Resources:

San Jose Man Arrested for Workers’ Comp Insurance Fraud

OC man gets 10 years for $4.6m insurance fraud

Most North Carolina workers’ compensation cases that this blog covers pertain to local events — debates about insurance coverage, fraud schemes, and occupational disease and injuries that relate specifically to North Carolina industries, such as tobacco (covered in a recent post), or tech (e.g. incidents out of the Research Triangle). But for this week and next week, we’re going to do a two-part investigation into a breaking story out California that may have serious implications for North Carolina workers’ compensation policy.

As reported in the New York Times last week, the National Football League and its insurers have been embroiled in a dispute over whether ageing football players should be entitled to California workers’ compensation for dementia. Already, due to California’s peculiar laws, several hundred former NFL players have filed for comp in CA. An NFL player who played even one game in California can file a claim for cumulative damage… even for injuries sustained years or even decades ago.

Point is, California has become a battleground for the NFL workers’ comp debate.

The newest wrinkle involves a dispute over the cause of dementia in NFL players. The New York Times story discussed the case of Dr. Eleanor Perfetto, the wife of Ralph Wenzel, an NFL lineman who played in the 1960s and ‘70s and who’s been hospitalized with severe dementia. Dr. Perfetto and her supporters contend that Wenzel and other NFL players in his generation (and afterwards) sustained cumulative damage playing football and that this damage caused (or at the very least exacerbated) the dementia.

If Dr. Perfetto’s claim on Mr. Wenzel’s behalf leads to a ruling in her favor–experts guess it would be about a $1 million settlement–it would open the door to dozens of similar claims. The Times’ story suggests that, all told, this could lead to over $100 million in claims. This money would not come from state coffers; it would come from the NFL and its insurers. Given that the NFL rakes in more $8.5 billion a year, this might seem like “a drop in the bucket,” but $100 million is $100 million, and experts expect a significant battle over this.

Dr. Perfetto claims that her husband’s care costs over $100,000 a year and that evidence significantly supports the theory that playing in the NFL increases the likelihood of getting dementia. For instance, in a recently conducted NFL commissioned study (published last September), players between the ages of 30 and 49 reported memory related problems at more than 19 times the normal rate for their age group. In addition, West Virginia University and Boston University researchers have discovered “traumatic encephalopathy” in the brains of diseased former NFL players — a telltale sign that cumulative football-related head trauma can in fact lead to dementia.

If you or a loved one has been suffering from an occupational disease or an injury sustained at work, it may behoove you to talk with a North Carolina workers’ compensation lawyer ASAP to develop a strategy for how to collect money owed to you. Take proactive action today to ensure that you collect the benefits that you and your family need to move forward and level your budget.

More Web Resources:

In N.F.L. Fight, Women Lead the Way

Ex-NFL Players Pursue Workers’ Comp

North Carolina workers’ compensation policy analysts and lawyers have been closely following a breaking story out of Butte, Montana involving a Homeland Security worker who attempted to rob Montana’s workers’ compensation out of almost $30,000.

40-year-old Richard Hannum pled guilty last Wednesday, according to the AP, of pretending to have injured his back while working as Transportation Security Administration (TSA) officer at a Montana airport. Hannum had claimed that he wrenched his back while lifting luggage and that this had caused him to be permanently disabled. But one of his workers’ compensation doctors saw him walking around a mall normally and without pain. The doctor alerted authorities, who followed him and ultimately videotaped him engaging in normal activities – which belied his claim that he was bedridden.

Hannum’s case is interesting, in particular, because it falls under federal jurisdiction. He didn’t collect his money from the Montana workers’ compensation system – he collected directly from the Department of Labor and Homeland Security.

Some North Carolina workers’ compensation fraud cases involve the defrauding of federal coffers as well. But these cases are rarer, and they can be legally more significant.

As this blog has discussed many times, North Carolina workers’ compensation fraud hurts not only the state system, insurers, and employers, but also beneficiaries. When someone steals money from the limited North Carolina workers’ compensation benefit funds, it has a ripple effect. With less money to go around, insurers, employers, and even state and federal overseers of workers’ compensation claims will be more dubious in the future of all claims. This means more invasive investigations and longer wait times before claimants can collect their benefits. So cracking down on North Carolina workers’ compensation fraud is ultimately in everyone’s interest.

That said, if you have been accused of North Carolina workers’ compensation fraud – and you are legitimately hurt – or if you are having trouble with other aspects of your claim, it’s probably a wise move to retain a reliable NC workers’ comp attorney as quickly as possible. A good representative can help you strategize and explain what to do and what not to do when confronting parties like your employer and the responsible insurance company.

More Web Resources:

Richard Hannum

Butte, Montana

Last year, an explosion at a Garner, NC Slim Jim plant killed 3 and injured many more. The slew of North Carolina workers’ compensation suits that followed in the disaster’s wake created a bureaucratic maze that the legal system is still trying to untangle.

A similar situation may be unfolding in Connecticut, following a February 7th explosion in the town of Middletown. In that case, 6 people died, and 26 more were injured after a welder accidentally set fire to a gas line. The enormous explosion was felt 30 miles away.

Already, plaintiffs seem to coalescing around a major and complicated workers’ compensation action. Diverse injuries abound. Some workers allegedly suffered posttraumatic stress syndrome from the blast. Others endured physical injuries, such as burns and lacerations. Still others died (their spouses are gearing up to take legal action). On top of that, three separate defendants have (thusfar) been mentioned in the suits: Keystone Construction, Ducci Electrical and O&G Industries.

Sources close to the case believe that the Connecticut workers’ compensation system may try to consolidate the claims — perhaps by holding them in front of a single judge, so that a unifying logic can underpin the compensation arrangements worked out.

Filing a North Carolina workers’ compensation claim stemming from a catastrophic incident (like the Slim Jim plant or the Connecticut plant explosions) can be quite complicated and confusing. To that end, if you or a friend or family member has been injured at work — whether catastrophically injured or hurt in a more “mundane” fashion (for instance, by a repetitive stress injury brought about by too much typing), consider connecting today with a qualified and well credentialed North Carolina workers’ compensation attorney.

More Web Resources

Slim Jim plant explosion

Connecticut power plant explosion

According to the Chicago Sun-Times, three individuals have been indicted for perpetrating a healthcare fraud in excess of a million dollars – the case has North Carolina workers’ compensation experts buzzing.

Details of the Crime

According to allegations, three individuals – Dr. Jacob Solomon, a chiropractor named Darwin Minnis, and a biller named Gary Strauss — collaborated from 2004 to 2007 to falsely bill over a million dollars worth of claims at a West Chicago doctor’s office. Strauss and Solomon have been slapped with one count of healthcare fraud. Minnis, who owned and ran the Maywood Spine and Joint Rehabilitation Center, faces 18 separate counts of fraud. The three inflated claims for insurance payments and workers’ compensation. They are due to be arraigned in federal court.

Many North Carolina workers’ compensation cases “rhyme” with this Chicago case. Often, one (or a handful) of individuals collaborate over a long period of time to slowly but surely bilk the workers’ comp system. In the short-term, the amount of money stolen is usually not enough to send up red flags. But over the long-term, this money can add up to something substantial. (This blog reported only few months ago about a local woman who netted tens of thousands of dollars before being busted for North Carolina workers’ compensation fraud.)

How do these fraud cases debilitate the system?

• First of all, any time someone drains money from the system, that shortfall must be made up through higher premiums, poorer care, and thinner benefits.
• Second, North Carolina workers’ compensation fraud creates an atmosphere of distrust. If doctors, insurers, employers, and employees cannot count on the system to be fairly run, they may choose to go around it or choose to ignore other pertinent and important rules of protocol.
• Finally, fraud cases – whether perpetrated by employers, insurers, or employees – create pressure on the parties that payout North Carolina workers’ compensation benefits to vet claimants more closely. Unfortunately, this enhanced vetting often snares innocent parties. For instance, someone who may have legitimately hurt his back in a work related lifting accident may come under close scrutiny by his insurance company. Many a legitimate claim has been denied because of this kind of irrationally strict vetting.

If you or a loved one has been battling over benefits, it is a good idea to speak with a knowledgeable North Carolina workers’ compensation lawyer as soon as possible. Good, strategic legal advice can help you compel an insurer to pay out a full claim and can end annoying and potentially illegal harassment. The more knowledgeable you are about your rights under the system, the easier time you will have of collecting benefits owed and recuperating from your injuries.

More Web Resources:

Maywood Spine and Joint Rehabilitation Center

Maywood Clinic Linked to Fraud

High profile North Carolina workers’ compensation experts have been vigorously debating last week’s settlement arrangement regarding compensation for 10,000+ plaintiffs who were exposed to toxic contaminants while cleaning up the rubble at the World Trade Center subsequent to the September 11, 2001 attacks.

According to the New York Times, US District Court Judge Alvin Hellerstein met with lawyers for the city and for the plaintiffs last week to go over the terms of the payout. Assuming 95% of the plaintiffs sign on to the agreement, the settlement will go forward. If only 95% agree, the settlement pot will be $575 million. If 100% of claimants agree, the pot will be raised to $657.5 million.

The New York Times quoted NYC Mayor Bloomberg saying that the arrangement was “a fair and reasonable resolution to a complex set of circumstances.” Both city lawyers and lawyers for the plaintiffs seem pleased by the arrangement. Under the terms, a special claims administrator will evaluate plaintiff claims, determine whether specific plaintiffs can participate in the compensation, and allot moneys to be paid out. Some people will likely be awarded only a few thousands of dollars. Others may qualify for over a million dollars.

Many plaintiffs fear that they might develop cancer or another chronic condition that might not manifest for a while due to their exposure, so the settlement stipulates that a special fund of over $23 million will be set aside to pay for their insurance policy costs.

The legal battle over how and whether to compensate victims who got exposed to chemical contaminants, particulate debris, and other hazards at the World Trade Center cleanup site has taken years to resolve. According to the NY Times, the battle cost the city over $200 million in legal fees.

A claims administrator is scheduled to start hearing cases in the middle of May. He or she will look at factors such as the severity of illness/injury suffered, whether the patient had any pre-existing conditions prior to working at Ground Zero, how long it took the patient to develop/report/diagnose his or her illness, and whether the patient has a history of smoking.

Judge Hellerstein also made an unusual decision to have “fairness hearings” about the reasonability of the settlement – fairness hearings are usually only held in class action lawsuits.

North Carolina Workers’ Compensation policy wonks have been blogging about this decision since it came down last week. On the one hand, the settlement does unclog the court system, and it provides a measure of significant recompense to injured victims. It also appears to be relatively balanced, and the extra measures to prevent fraud make a lot of sense, especially in light of the legal brouhaha over the September 11 Victim Compensation Fund.

That being said, the settlement is far from perfect, according to numerous North Carolina workers’ compensation experts. It took way too long to resolve this issue. One initial claimant actually died while waiting for the case to resolve, for instance. And the case consumed fantastic amounts of media oxygen and court time.

What should you do if you or a family member is struggling with a compensation case?

Rather than “going it alone,” connect with a qualified North Carolina workers’ compensation attorney to discuss potential remedies. The logistics regarding even simple worker claims can get extraordinarily complex, and small clerical errors can result in major problems with collecting benefits down the line.

More Web Resources:

Terms of the $657.5 9/11 settlement

Diseases of Ground Zero

According to local station WECT (based out of Wilmington, North Carolina), almost 100 people who ordinarily collect North Carolina workers’ compensation and unemployment benefits did not get them this week due to a computer glitch. Officials believe that the problem can be traced back to an order of President Obama himself. In retooling a piece of legislation called the Emergency Unemployment Compensation Act, President extended a deadline. This indirectly resulted in a short-term glitch in the North Carolina unemployment compensation system. Some state bank accounts went temporarily empty due to the delay caused by the transfer.

WECT quoted an unemployed man named John Crawford: “I have been hungry many nights…I have been lying in my bed, crying many nights.”

Officials at the North Carolina Employment Commission have been working double time to see that everyone who is owed North Carolina workers’ compensation and unemployment claims will get their paychecks. The disbursal is being prioritized, and a manager for the NCIC (per WECT) said: “once we get it processed, and we get it cleared up, within 72 hours of us getting it fixed they should have their money.”

Temporary computer glitches and shortfalls impact North Carolina workers’ compensation claimants differently. For people living paycheck to paycheck, shortfalls can devastate and lead to an almost Rube-Goldberg-esque cascade of financial problems. For other people, who have more savings and a bigger safety net, a payment delay might not much, if anything at all.

If you or a family member has been struggling with a North Carolina workers’ compensation issue – be it a computer glitch, a dispute with your employer, a frustrating series of negotiations with your insurance company, or a feeling of overwhelm from dealing with the mountains of paperwork you must file with the NCIC – a solid North Carolina workers’ compensation attorney may be able to give you good guidance.

More Web Resources:

Emergency Unemployment Compensation Act

WECT story about the glitch

Pundits and policymakers who debate North Carolina workers’ compensation are abuzz about the latest news out of Canada’s Supreme Court regarding a 16-year old workers’ compensation dispute that followed a deadly mine explosion.

Here is the background.

In 1992, a bitter labor dispute at Yellowknife Giant Mine led to riots. One of the rioting miners, Roger Warren, was so distraught that he planted an explosive in one of the mines and detonated it via a trip wire. The explosion killed nine miners. Although Warren himself was quickly convicted and is now serving a life sentence in prison, his action set off a legal dispute between the widows of the miners killed and organizations that they alleged were indirectly responsible (and thus liable) for Warren’s actions.

The miners’ widows sued the Canadian Auto Workers, Royal Oak Mines, and the security firm that was supposed to protect the site, Pinkerton’s of Canada, as well as the Government of Canada’s Northwest Territories. In a lower court decision, the widows won a payout of $10.7 million in 2004. But the Supreme Court overturned the lower court’s decision, citing the fact that the parties named did not have sufficient control over the actions of Roger Warren and could not have anticipated that he would commit such a destructive act.

How might the Canadian Supreme Court’s rejection of these miner widows’ claims impact North Carolina workers’ compensation legislation?

Peripherally at best. However, the case does raise some interesting points of law that have international implications.

For one, it re-raises the long running debate over the definition of indirect liability. If someone else causes significant damage (that merits, for instance, a North Carolina workers’ compensation claim), and a third party could theoretically be indirectly implicated in the primary agitators’ actions, what is correct legal remedy? Obviously, in the abstract, you simply can’t answer that question. In this case in Canada, the Supreme Court found that parties like Pinkerton’s and the Government of Northwest Territory could not be liable for the actions of the renegade angry miner. But you can certainly find analogous cases in Canada and in the United States, in which a third party can be held significantly liable for damages that a subordinate party causes.

For instance, let’s say a trucking company hires a driver and fails to vet the drivers’ safety record effectively. The driver then goes out and causes a car accident, which causes permanent spinal damage to a passenger in another vehicle. Although the truck driver who caused the accident was primarily responsible, the injured victim could probably make a great case against the truck company itself for providing the dangerous driver with a truck to drive in the first place.

If you or a family member has been involved in any kind of North Carolina workers’ compensation dispute, you may want to speak with a veteran, highly credentialed North Carolina workers’ compensation attorney ASAP to get a better understanding of your rights and strategic possibilities moving forward.

More Web Resources:

Yellowknife Giant Mine – original verdict

Widows Lose Appeal

Military personnel injured by exposure to carcinogenic elements at Camp Lejeune in North Carolina may soon be able to cash in on North Carolina workers’ compensation claims, thanks to a new bill under consideration in the Senate called the “Examination of Exposures to Environmental Hazards during Military Service Act of 2010,” also known as TRICARE. Since January 28th, the Senate Veterans Affairs Committee has held hearings about how to compensate injured military personnel for damages related to exposure to environmental hazards, such as benzene-based solvents like trichloroethylene.

The Senate bill is designed to respond to complaints at 130 military bases around the nation. These are all listed on something called The Environmental Protection Agency Superfund’s National Priority List. Thousands of military personnel may be impacted by the legislation.

At Camp Lejeune in North Carolina, officers and other personnel came into regular contact with trichloroethylene (TCE) during the course of cleaning airplane parts. This harsh solvent seeped into the ground and local water supply, and many personnel thus indirectly drank it, got it on their skin and inhaled the aromatic compound.

Assuming the proposed Senate bill becomes law, the Department of Defense will have 90 days to create a list “Of individuals exposed to environmental hazards at Camp Lejeune, during the period… in which the water at Camp Lejeune was contaminated with volatile organic compounds, including known and probable human carcinogens.”

To collect North Carolina workers’ compensation benefits from the DOD, potential beneficiaries will likely have to jump through many logistical hoops. If you or a family member suffered exposure to chemicals at Camp Lejeune, it may behoove you to speak with a qualified and highly credentialed North Carolina workers’ compensation attorney to protect your interests and to ensure that you get fair payment for injuries, medical costs, wages lost, and other damages.

More Web Resources:

Examination of Exposures to Environmental Hazards during Military Service Act of 2010

Camp Lejeune

Most first time North Carolina Workers’ Compensation claimants find themselves ovewhelmed by the Byzantine claims process. To make things easier for you, we’ve put together this quick guide to explain the basic players who deal with North Carolina Workers’ Compensation claims and injury management.

1. Employee

This is you. A worker who gets injured while executing a job related duty can be eligible for North Carolina Workers’ Compensation.

2. Employer

Your boss or your company is technically be known as the “employer.” If you work for yourself, and you have Self Employment Workers’ Compensation Insurance, you may be both the employee and the employer. Many employers are required by law to carry North Carolina Workers’ Compensation policies. These policies pay out to injured claimants; thus, the money does not come directly from the employers/company’s pockets. Another technical name for the employer is the “Insured.”

3. Insurance Company

The insurance company issues policies to employers to cover them in the event that an employee (such as you or a co-worker) gets injured on the job and requires money to pay for medical services, rehabilitation, and time off of work. Different states have different laws regarding Workers’ Comp Insurance Coverage. If you have specific questions regarding how North Carolina Workers’ Compensation Insurance companies must behave, speak with a veteran attorney or call the North Carolina Industrial Commission (NCIC).

4. Insurance Broker/Agent

A Broker or Agent acts as a liaison between the Insurance Company and the Employer. A broker typically tries to sell services to employers. The Broker can also act as a consultant and risk benefit analyst for employers.

5. Claims Administrator

A third party administrator, also known as a TPA, manages claims, adjusting them per settlement arrangements. Some insurance companies outsource their work to these independent agencies. TPAs also must act in accordance with North Carolina laws.

6. Doctor/Rehabilitation Specialist

The Physician and/or Rehab Specialist play critical roles in the injury management process. Obviously, if you are hurt on the job, a medical doctor must examine you and attest to your state and degree of injury before you can collect North Carolina Workers’ Compensation benefits.

7. Attorney

A North Carolina Workers’ Compensation Attorney can help you resolve questions you have regarding eligibility, benefits, settlement arrangements, insurance negotiations, and so forth. Most good attorneys will provide free, confidential consultations to answer your questions and concerns. Take advantage of this opportunity to learn more about the lawyer’s services, fee structure, track record, and credentials.

More Web Resources:

Third Party Administrator (TPA)

More about parties involved in workers compensation claims

Elevated North Carolina Workers’ Compensation costs concern everyone in the “employment ecosystem” – small business owners, employees, government agencies, insurance companies, and physicians alike. To bring down costs across the board, however, requires a holistic approach to problem solving. In this article, we will speculate about remedies that could be applied throughout this “ecosystem” – at little to no cost to employers, insurers, or employees.

1. Put in place systematic solutions to common workplace ergonomic problems.
How many North Carolina workers’ compensation cases begin at the keyboard? Carpel tunnel syndrome, repetitive stress injuries, and other soft tissue injuries abound in North Carolina – many of them no doubt due to bad workstation ergonomics. An employer can mitigate against risk of repetitive stress injuries by investing in more economic keyboards, for instance, more tailored workstations, and a program of regular breaks and stressing. The cost of such a proactive “war” against repetitive stress injuries would be minimal, and the benefits would no doubt be long lasting. Workers who are not exhausted from keyboarding and other repetitive tasks can work longer hours (thus making up any theoretical costs of ergonomic modifications). Fewer injuries would mean lower North Carolina Workers’ Compensation insurance premiums.

2. Better Alert and Response System to Control North Carolina Workers’ Compensation Fraud.
As the old saying goes, a few bad apples can spoil the bunch. Everyone loses when people cheat the system. But how do you get people the stop cheating? This is the $64,000 question. Better monitoring of claims might be a theoretically good solution, but when you incentivize insurance companies to look for fraud, these companies inevitably will turn up “false positives.” I.e., they will harass people who are legitimately injured – trying to get them to admit that they are not actually hurt. This is obviously terrible, and it results in many tragedies, some of which we have reported on this blog.

A better solution might be to build in a more robust tracking system to make sure that claimants stay honest. In addition, insurance companies and employers must recognize and respect the claimants who are actually hurt and go the extra mile to help them.

3. Involve physicians in more holistic patient care.
The fractured approach to patient healthcare no doubt exacerbates many medical problems. If a patient sees four doctors, chances are that each physician will require separate paperwork, and that the doctors will not communicate with one another about the patient. This needs to change. Implement across the board holistic treatment for injured patients, and we will see much better health care. This is obviously an enormous task. But if we really want to bring down North Carolina Workers’ Compensation costs, we need to start treating patients as whole people — and not just as carriers of individual symptoms they present with.

4. Better, more thorough and more regular data analysis of North Carolina Workers’ Compensation cases.

Organizations like the North Carolina Industrial Commission (NCIC) and other government agencies do track serious injuries and deaths at NC workplaces. But the amount of data that’s mined and shared about these accidents is extremely small, maybe even negligible, compared with what could be mined. We need to gather much more information – much more detailed analyses of various injuries and incidents. We must be able to share that information not only with government agencies, insurance companies, and fellow employers, but also with employees.
Do this kind of analysis, and we will no doubt be amazed at the kind of improvisations and “band-aid” solutions that emerge.

If you or somebody you love has been hurt or needs help with North Carolina Workers’ Compensation issues, connect with a qualified veteran attorney near you for a confidential consultation.

A recent report released by the California Workers’ Compensation Institute has many experts and consultants who specialize in North Carolina workers’ compensation quite concerned. The CWCI found that just 3% of doctors who treat workers’ comp patients in the Golden State prescribe over 55% of the “Schedule II” medications, which include potentially addictive drugs like methadone, codeine, and fentanyl. The report, Prescribing Patterns of Schedule II Opioids in California Workers’ Compensation, found a variety of disturbing findings, including:

• The top one percent of hurt workers ingested 25 times more medication than did the average workers’ compensation patient.
• 279 physician prescribers drove two-thirds of all drug-related payments
• Over 50% of Schedule II drug claims involved minor back pain – certainly a troubling issue, but not an issue that necessarily requires strong medications.
• Schedule II drugs prescribed in CA skyrocketed from just 1.4% in 2005 to 7.2% by 2009.
• Payment for Schedule II drugs also increased by over 500%.

Dr. Arnold Milstein, the leader of Stanford University’s Clinical Excellence Research Center, explained why regulatory agencies may not be putting the brakes on what’s clearly an over-prescription problem: “The State Medical Licensing Board is horribly underfunded in terms of stopping these obviously crazy prescribing patterns by a small percentage of doctors.”

Another expert, Joe Paduda of Health Strategy Associates, explained why physicians might take unfair advantage of the system: “The workers’ comp industry is a very soft target for healthcare providers and other people who want to take advantage of regulatory or other loopholes.”

The California system, apparently, is set up in such a way that patients get encouraged to go the prescription med route instead of trying alternative, non-medication related modalities, such as physical therapy and strength training.

In any case, what might this CWCI report mean for the North Carolina workers’ compensation system?

States differ tremendously in their workers’ comp programs. And no North Carolina institution has done a similarly thorough study on Schedule II workers’ comp prescriptions. But it shouldn’t come as that much of a surprise that a minority of doctors causes the most abuse. The so-called “Pareto principle” – also known as the 80-20 Rule – is a well-established economic principle. It suggests that, in any given population, a minority of participants will drive the majority of results. For instance, if you own a small business, 20% of your clients will yield 80% of your work. 20% of your clients will also yield 80% of your problems. And so forth. So the fact that a small minority of doctors caused the majority of the Schedule II drug abuse shouldn’t be too much of a surprise. Indeed, data should find a similar pattern here in North Carolina.

If you or someone you care about needs help with a benefits issue or help with a recalcitrant employer or insurer, connect immediately with a North Carolina workers’ compensation law firm.

More Web Resources:

Prescribing Patterns of Schedule II Opioids in California Workers’ Compensation

California Workers’ Compensation Institute

Most North Carolina workers’ compensation matters never wind up at trial. Usually, if there’s a dispute between a claimant and his or her employer or his or her insurance company, an arrangement can be ironed out.

However, in some cases, an insurance company or employer can act so egregiously that the only recourse is to pursue recompense in court. Here are some things to consider when debating whether or not to go to trial over your North Carolina workers’ compensation matter.

1. The process can be time consuming.

The judicial process is slow, sometimes aggravatingly so. You may be called into the courtroom multiple times over the course of months. You and your attorney alike may have a lot of logistical work to do to prepare. It can be months before a judge weighs in. So prepare yourself for a lot of starts and stops — and budget your time and patience accordingly.

2. Prepare for potentially brutal tactics.

Insurance companies can be quite aggressive — and even nasty — when defending decisions to deny coverage or to refuse to pay out a policy. In some cases, companies have actually videotaped plaintiffs on the sly in the hopes of catching them “acting uninjured.” These companies argue that they do this to prevent fraudulent claims, but if you are legitimately injured, this can seem to be quite a heartless tactic. Be prepared for assaults on your word and character, and work closely with your North Carolina workers’ compensation attorney to anticipate these tactics and defend against them accordingly.

3. How you dress and act in the courtroom counts.

In a perfect world, a trial would deal specifically with issues of law and nothing else. But human beings are susceptible to persuasion. How you conduct yourself in the courtroom, how you dress, how you articulate your stance, and how prompt you are to court proceedings can all dramatically influence a judge’s decision. To give yourself the best chances, dress appropriately (and soberly), be polite and attentive to everyone, think through your thoughts before speaking them out loud – particularly when you’re addressing the judge, and mentally rehearse your trial prior to the date, so you can envision the best possible outcomes.

4. Prepare both for victory and for loss.

To make the waiting period less excruciatingly stressful, anticipate both victory and defeat scenarios, and focus on tasks immediately at hand to avoid getting caught up in needless speculation. The judge’s decision will come, and when it does come, you (along with your lawyer) can piece together your best next steps of action.

5. Even if a verdict goes your way, the insurance company may still watch you.

Many North Carolina workers’ compensation claimants win at trial only to find themselves in hot water months or even years later. Insurance companies can follow you to make sure that you are as injured as you say you are. If you give an opening, companies may retroactively attack your claim. Again, there have been instances of insurance companies videotaping claimants to try to catch them in the act of “being healthy” in order to negate a claim retroactively.

All this being said, one of the best strategies to ensure victory is to connect with a reputable, trial proven, and results driven North Carolina workers’ compensation lawyer as quickly as possible to create a prepared and proactive strategy.

More Web Resources:

Preparing for Trial

Dealing with Insurance Companies who Videotape People

According to a December 19 article in the Herald Sun, around 200,000 unemployed North Carolina workers could see their benefits ended unless the US Congress re-ups its Emergency Unemployment Compensation program (part of a nearly $800 billion package entitled the American Reinvestment & Recovery Act).

While jobless employees can still collect North Carolina workers’ compensation, this funding shortfall could further destabilize the state’s already stagnant economy. The Byzantine nature of the Emergency Unemployment Compensation program does not seem to be helping matters, either. Consider:

The initial program was to be funded equally by the federal government and the state government. Now, due to technicalities regarding the EUC, it’s funded 100 percent by the federal government. A spokesperson for a consultancy based out of Chapel Hill noted that one of the biggest problems is the so-called trigger system. Filers are sorted into one of four tiers. Once you exhaust the weeks of benefits within your tier, you can apply to file under a different tier. All this bureaucracy appears to jam the system and make filing vastly more complicated.

Adding to the headache is North Carolina’s rate of unemployment, which tipped double digits in the fall and now stands at around 11 percent (although the Research Triangle has a slightly lower rate).

So what’s the bottom line in terms of North Carolina workers’ compensation policy? First of all, the impacts of the 2007-2008 Recession will surely reverberate into 2010 and beyond. Second, according to the North Carolina Employment Security Commission’s Deputy Chairman, if the US Congress fails to extend unemployment benefits, the ramifications for workers on unemployment and workers’ comp could be devastating. Third of all, the disappointing numbers might inspire more innovative policy approaches. Think tanks and policy groups are already coordinating about how to rejigger the system to keep unemployed, underemployed and disabled workers financially afloat as the state economy stabilizes.

If you’re worried about unemployment or workers’ comp benefits running out due to the vagaries of the Emergency Unemployment Compensation program, it may behoove you to connect ASAP with a qualified and experienced North Carolina workers’ compensation attorney.

More Web Resources:

Added jobless benefits program set to expire

North Carolina record unemployment rate

North Carolina workers’ compensation policy wonks generally spend the lion’s share of their time doing things like analyzing insurance tables, parsing changes to state regulations, and tracking growth trends in state-specific industries. However, abundant research suggests that policymakers might want to focus more attention on simple workstation ergonomics.

Consider that a British research company (The Work Foundation) recently found that 100 million Europeans endure serious musculoskeletal problems every year, and that these problems eat up around two percent of the entire EU GDP — a staggering $400 billion. There’s no reason to doubt that work-related musculoskeletal injuries enact a similarly devastating toll on workers here in the United States and in North Carolina.

To that end, it seems that fixing whatever is causing these musculoskeletal problems should be a top priority for our policymakers. The question is: how? One theory is that many — if not the majority — of North Carolina workers’ compensation cases stem from chronic damage caused by overuse of certain muscle groups and poor ergonomics. For instance, a stenographer who spends ten hours a day typing up court transcripts can seriously hurt himself if he doesn’t employ excellent technique, take frequent breaks, and use well-designed equipment.

Repetitive stress injuries and other chronic musculoskeletal problems can occur in practically any industry — they are not specific to traditional office work. A painter, for instance, can develop adhesions in her shoulder from doing repetitive brush stroking day in and day out. A truck driver can develop sciatica and lower back strains from sitting in a cab for eight to ten hours a day. Even professional athletes can get quite hurt from doing repetitive actions, even actions not normally associated with acute dangers. Indeed, any job that requires that you bend, lift, type, walk, stand, sit, or talk for extended periods without appropriate rest and ergonomic support can create the conditions for injury.

What’s baffling is that simple and cheap ergonomic solutions to many chronic overuse problems abound. The installation of more ergonomic workstations across North Carolina, for instance, might be very useful at cutting down the rate of typing injuries. The installation of lumbar supports in truck cabs should be useful at reducing sciatica and lower back pain and so forth.

To summarize, North Carolina workers’ compensation policymakers should analyze simple, cost effective, and easily instituted ergonomic fixes post haste. This should not only lead to happier and healthier workers but also to a reduced number of claims, and thus to many other indirect benefits to employers and to the state as a whole.

More Web Resources:

The Work Foundation

Sorehand

North Carolina workers’ compensation experts are constantly on the lookout for ways to protect workers better, reduce claim costs, and speed up recovery times. A new study out of Copenhagen, Denmark could provide fresh new policy ideas for how to protect state workers from lower back injuries — by challenging what are known as “fear-avoidance beliefs.”

According to a journal called BMC Musculoskeletal Disorders, European National Research Center researchers studied over 2,600 healthcare workers to determine whether fear of lower back pain increased or decreased risk of actually developing musculoskeletal problems in the lower back area. In other words, could an anti-placebo effect develop? Could worry about hurting oneself in and of itself lead to injury?

The researchers apparently found a correlation between “fear-avoidance beliefs” and increased likelihood for getting hurt. So does this association prove that thinking fatalistic thoughts causes injury? Or could something else be driving the association?

If indeed it can be determined that thinking negative thoughts — that is, being afraid of going to work or doing certain on-the-job tasks — could cause injury, policymakers could work from this concept to develop a battery of solutions that could help drive down North Carolina workers’ compensation claims and costs. For instance, perhaps human resources managers could identify particularly pessimistic workers or workers who are otherwise afraid of certain pieces of machinery and retrain them to be less afraid and more “ergonomically ready” to tackle tasks.

If, on the other hand, the association between the development of musculoskeletal problems at work and fear of injury stems from some other root cause, then maybe modifications in worker thinking might not yield much benefit. For instance, let’s say that individuals who are more fearful of doing certain tasks are also in some other way more vulnerable to getting injured. Perhaps these individuals are malnourished, depressed/anxious or less self-confident than are individuals who demonstrate less of a fear-avoidance reaction. Perhaps one of these other factors is the key. In this scenario, the goal would be to help workers become more self confident, optimistic, etc. — rather than help them limit their fear avoidance.

If you’ve had the misfortune of developing lower back injury on the job, help is available. To navigate the system, consult a competent and battle proven North Carolina workers’ compensation attorney to discuss your situation in confidence.

More Web Resources:

BMC Musculoskeletal Disorders Study

fear-avoidance beliefs

Thanks to the efforts of the North Carolina Rate Bureau, North Carolina workers’ compensation insurance policy rates will plunge nearly 10% for 2010. Wayne Goodman, the state’s Insurance Commissioner, announced the rate slash this week, which government statisticians believe will help NC employers save around $120 million in 2010. An Insurance Department spokeswoman argued that the rate slash would drive down the cost of doing business in the state and thus spur growth. Insiders believe that the rate slash was made possible in part by a dramatic decline in the number of North Carolina workers’ compensation claims filed. This is the second year in a row that there has been a significant decrease in NC workers’ comp insurance rates. Last year, rates were slashed 4.4% over 2008 numbers.

The rate decrease won’t help every employer. Almost all North Carolina state employers won’t be impacted. And many private employers — for instance, those employers who have to pay insurance for high risk jobs — will likely not see the benefits of these insurance rate slashes.

The rate slash does nothing to change fundamental laws and rules governing North Carolina workers’ compensation. In general, businesses that employ three or more people must pay for insurance in case an employee suffers disability, requires medical care, or requires compensation for lost wages.

Whether the motion will spur renewed business commitments in the state is an entirely different debate. The recession has hit North Carolina relatively hard, notwithstanding the state’s diverse economy and relatively resilient tech sector in the Research Triangle. Perhaps these rate decreases will incentivize businesses to take on new projects, hire new employees, and attract contracts to the state. Still, some skeptics worry that the rate slash may have a dampening effect on growth and that it will destabilize the ‘playing field’ in certain industries, artificially favoring businesses which benefit from the rate cut and hurting businesses that don’t qualify.

More Web Resources:

North Carolina Rate Bureau

Workers’ comp rates falling in N.C., Charlotte Observer, Nov 5, 2009

According to the Charlotte Observer, a recent report released by the United States Government Accountability Office (GAO) confirmed that many North Carolina workers’ compensation injuries are going unreported. The GAO found that company doctors and nurses often feel pressure from their employers not to report employee injuries.

The Observer cited the following extremely disturbing statistics:

Over a third of practitioners — in a survey of over 500 healthcare workers — were asked by employers to provide ‘insufficient treatment’ to injured workers so that injuries would not appear on company logs.

Over half of those surveyed were encouraged by their employers to ‘downplay injuries or illnesses.’

Over two-thirds reported that they knew that many employees fear that they would be disciplined if they reported getting injured.

The GAO report also found that many plants actively discouraged workers from reporting their injuries by sponsoring ‘prizes or bonuses’ for plants/branches that went for long stretches without recording injuries in their log books.

The Charlotte Observer article quoted the executive director of the National Council for Occupational Safety and Health (OSHA) saying that: ‘If healthcare professionals are being asked to not record injuries properly, then we have a pretty broken system.’

Could this systemic non-reporting of injuries be responsible for why the state has seen a dramatic decrease in claims over the past two years? And, if so, could this under-reporting also explain why employers were able to achieve a nearly 10% slash in their workers’ comp insurance rates for 2010.

As this blog reported in a separate entry, the state’s insurance commission recently approved a slash of 9.6% for North Carolina workers’ compensation insurance policies — a decision that’s projected to yield savings to employers of around $120 million annually. If these savings came as an indirect result of denying/ignoring legitimate injury claims, then the individuals charged with maintaining a fair benefits program need to make adjustments to the system to ensure equality and transparency.

If you got hurt at work — and you failed to report the injury out of fear of retaliation; or if the company doctor or nurse did not take your injury seriously — you may greatly benefit from a free consultation with a respected North Carolina workers’ compensation attorney.

More Web Resources:

OSHA

GAO

Charlotte Observer, Study: Workplace injuries are going hidden; Nov 17, 2009

If you have been injured at work — or hurt while on the way to or from a work function or while otherwise engaged in company business — you may be entitled to a wealth of North Carolina workers’ compensation benefits, including replacement for lost wages, vocational training and placement, help with medical bills, and compensation for pain and suffering. Unfortunately, if you mishandle your claim, you can miss out on these benefits.

So what are some of the common ways in which claimants ‘self-destruct’ their cases?

1. Ignoring the injury/accident.

Obviously, a claimant who falls off a ladder and breaks her leg is not likely to ignore her injury; however, not all job injuries are acute. Some are chronic. For instance, repetitive stress injuries — such as carpal tunnel syndrome, cubital tunnel syndrome, and thoracic outlet syndrome — can all significantly impair your quality of life, make job duties harder, and lead to thousands of dollars in medical bills and therapies. If you don’t report a claim in time, you may miss out on key workers’ comp benefits.

2. Failing to get appropriate treatment.

Not only can delaying your treatment lead to a worsening of your health problems or injuries, but neglecting to take proper care of yourself can provide insurance companies leverage to deny your claim. Delaying can also make it more difficult to demonstrate that the injury sustained was a direct result of your on the job accident.

3. Failing to realize that the insurance company will continue to investigate your situation even after your claim has been approved.

This shouldn’t be a problem as long as your claim is real (ongoing investigations are designed to probe for instances of North Carolina workers’ compensations fraud). But insurance companies generally do all they can to avoid paying long term claims. They may look for any loophole to deny your claim and/or reduce your coverage — even retroactively. Insurers have gone as far as to secretly videotape claimants to look for evidence to deny claims.

4. Trusting employers or insurance companies to ‘do right.’

As the old adage goes: trust, but verify. As we just discussed, insurers and employers may have sympathy for you. Some individuals may even go out of their way to help you figure out your rights and fill out paperwork. But make no mistake. These companies are in business to make money — and that means they have a strong motivation to deny claims and/or to limit them as much as possible. Thus, if you disclose too much information — or the wrong kind of information — to an insurance company investigating your claim, you could significantly impair your chances of collecting of a good settlement.

5. Settling for far too less.

Many claimants are desperate for any money to pay for medical bills, lost wages, and therapies. They thus will often quickly settle with insurance companies to get some active cash flow. However, usually an insurance company’s first offer is not the best offer. A reputable and time-proven North Carolina workers’ compensation attorney can likely help you get much more for your claim.

6. Waiting too long to consult/retain an attorney.

The longer you wait to speak with an experienced attorney about your injury/accident on the job, the greater the likelihood that you will make some error of omission that could damage your claim or cause it to be dismissed altogether. The laws governing workers’ comp benefits and payouts can be extremely complicated; thus, your case may require delicate finesse to get you the most compensation and in the fairest possible terms. Furthermore, a qualified and creditable workers’ compensation attorney can help you develop a plan of action that will reduce your anxiety and uncertainty.

More Web Resources

North Carolina Industrial Commission

North Carolina Office of Economic Opportunity

Repetitive stress injuries (RSIs) cause hundreds of thousands — if not millions — of American workers chronic problems and may account for a sizable percentage of a North Carolina workers’ compensation claims. But what are RSIs? And how can workers prevent and treat them most effectively?

Theories abound to explain how workers develop conditions like carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, and tendonitis. Obviously, the etiology is complex and this blog is not prepared to offer medical advice in any way; however, a look at the dominant theories reveals much.

One school of thought considers and treats the different manifestations of repetitive stress induced trauma. For instance, a worker who complains of neck pain resulting from a typing injury may get treatment directly at the source of the pain — for instance, massage, cortisone injections, or doses of non-steroidal anti-inflammatory drugs to relieve the pain.

Another school of thought suggests that many RSI injuries result from systemic damage to the musculoskeletal system and that repairing the damage requires a broader approach. In other words, a pain in the neck that results from a typing injury may represent essentially the tip of the iceberg. The injury/insult may in fact be to the entire upper thoracic region, including perhaps the arms, chest, upper back, lower back, hands, and so forth. Moreover, the insult is not simply to muscle or nerve tissue but ultimately to the entire musculoskeletal apparatus, including connective tissues, such as tendons, ligaments, and fascia. Treatment thus focuses on a variety of modalities, including massage, trigger point therapy, stretching, resting, chiropractic, and improved posture and ergonomic practices.

Many occupations predispose to repetitive stress injuries. These include,

• Computer work
• Assembly line work
• Sewing
• Hairstyling
• Office/managerial work
• Any job that involves lifting or sorting (e.g. Postal Service work)
• Design work
• Craft work
• Any job that requires an employee to hold a position for many hours at a time — including waitressing (standing), truck driving (sitting), and athletic employment (running, twisting, etc).

Perhaps a majority of the working population in North Carolina and throughout the country may be subjected to repetitive work related traumas that can result in injury. Corrective measures can include workstation changes (to make a computer station more ergonomic, for instance); institutionalized massage therapy; better education about posture and relaxation techniques; reduced hours; enforced break times; and regular continuing education about the dangers and treatment methodologies for RSI.

If you have suffered traumatic injuries due to repetitious work, you may be entitled to significant North Carolina workers’ compensation benefits. It may behoove you to speak with a knowledgeable NC workers’ comp attorney ASAP to learn about your rights and options.

More Web Resources

Sorehand

Deborah Quilter’s RSI book

Mission Hospital — which employs about 6,000 people and has been under the gun for mishandling numerous North Carolina workers’ compensation cases — has been ordered by the NC Industrial Commission to pay penalties for botching employee claims.

North Carolina’s Deputy Commissioner ordered the hospital to remunerate Terry Cawthorn for attorney’s fees and to pay for a sizable percentage of her benefits. Mission has come under fire for violating North Carolina workers’ compensation rules in separate cases. The Court of Appeals and other arbitrators found that Mission had done things like:

• Denied benefits despite ‘overwhelming evidence’ that money should have been paid out to a claimant;
• Failed to authorize payments for medicines for a woman who was so depressed that she had to be sent to a psychiatric ward;
• Hid evidence of an employee who cried at work after returning to her job following an injury;
• Contradicted the findings of the hospital’s own expert in order to deny a claim of psychological trauma.

Mission Hospital released a statement to the effect that the Commission’s sanctions don’t necessarily imply that the hospital admitted fault. However, notably, the hospital has yet to deny allegations that it tried to stop real and valid claims from going through.

More Web Resources:

Asheville CItizen-Times, Mission Hospital audit to look at workers’ compensation program, November 9, 2009

Asheville Citizen-Times, Asheville Mission Hospital workers comp sanctions ‘unusual’, October 31, 2009

Whether you got hurt at a processing plant or developed carpal tunnel syndrome while working as an executive for one of the big banks of the Research Triangle, you may need significant North Carolina workers’ compensation benefits to pay for medical care and support your budget while you recuperate. Unfortunately, a fair number of claims get denied every year because applicants don’t take the time to learn about best practices for filing. Here are some common mistakes that claimants make – along with suggestions for how to avoid these problems:

1. Waiting too long between the time of the injury/ incident and the time that you file a claim – Wait two or three months between getting hurt at work and reporting the accident, and not only might your employer be less sympathetic, but you also may lose some legal leverage. The longer you wait before investigating North Carolina workers’ comp, the harder it will be to collect evidence and statements to support your claim.

2. Saying the wrong things to your employer / and or insurance company representative –Candor is generally a sound ethical strategy. But you might be advised not to discuss your case at all with insurance company representatives, for instance, before speaking with an experience North Carolina workers’ compensation attorney. After all, your employer and your employer’s proxies may not have your financial interests in mind. And making even “innocent” statements can jeopardize your claim.

3. Changing your story – when you do give a statement to an employer or an insurance company representative, if you later revise the facts of the incident, your claim may come under significant suspicion, particularly if it’s a large claim or a claim for benefits that might last years or even decades.

4. Failure to keep a paper trail and to track witness statements – just because you ‘know’ you should be entitled to workers’ compensation benefits doesn’t mean that your employer, an insurance company, or even an objective judge will agree. Fortify your contentions by collecting statements from employees who saw you get hurt, by keeping track of any paperwork your doctor or employer provides, and so forth. Do this spade work, and your North Carolina workers’ compensation attorney should be able to dispatch your case more quickly, efficiently, and effectively.

On June 9th, 2009, an explosion at a Slim Jim plant in Garner, North Carolina killed three and injured dozens. A spate of North Carolina workers’ compensation claims were filed in the wake of the disaster, which authorities at the U.S Bureau of Alcohol, Tobacco, Firearms and Explosives now believe was caused by a defect in the natural gas piping system.

The Garner plant rebooted its operations shortly after investigators completed their work there and safety inspections had been performed. That said, the plant was hobbled and could only produce at half its former capacity. Since the Garner plant was the sole manufacturer of Slim Jim products in the U.S., the incident impacted the entire country’s dried meat industry.

The burden of paying 750 full time employees as well as North Carolina workers’ compensation benefits for the injured led management to take defensive action. On Friday September 18th, ConAgra announced that the company will slash 321 jobs at the plant. Layoffs will begin in November and will be based on seniority and experience with the company, according to reports. Workers currently receiving benefits will be forced to look to the state to provide their North Carolina workers’ compensation payments.

In addition to these cost saving measures, ConAgra has committed other resources to shoring up the plant, such as outsourcing some of its manufacturing to third parties and paying factory workers per hour worked (as opposed to per a standard forty hour workweek).

ConAgra to cut 321 at Slim Jim plant, Omaha World Tribune, Sept 18, 2009

Slim Jim plant lays off 300 after blast, UPI.com, Sept 17, 2009

More Web Resources:

U.S Bureau of Alcohol, Tobacco, Firearms and Explosives

ConAgra

How can you determine whether you, a family member, or a co worker may be eligible for North Carolina workers’ compensation benefits?

State law construes eligibility broadly. The law gives claimants significant leeway to make claims for benefits to cover lost wages and medical bills. As long as you suffered an injury on the job and as long as your sickness or injury was not caused by gross misconduct on your part, chances are you will qualify. (Of course, you must have sustained your injury/illness while working for your present employer to collect benefits from that company or from its insurers.)

If you got injured on the way to work or while travelling on a work function, will you qualify?

In most cases. As long as you were engaged in a work related activity, you should be eligible for North Carolina workers’ compensation benefits. Moreover, if your employer (through intentional misconduct or gross negligence) caused or aggravated your injury or illness, you may be entitled to extra benefits, such as double payments.

What kind of injury might constitute an actionable damage?

In general, the injury or illness must be significant. For instance, bruises, contusions, fractures, repetitive stress injuries, mental/emotional trauma, and back problems such as sciatica can all be grounds.

Will your eligibility last indefinitely?

No. You must file a claim within a designated time limit or your claim may be denied, or your benefits may be slashed or reduced. Moreover, just because you qualify for benefits now doesn’t mean that the employer or insurer will cooperate for the life of the claim. And, of course, each North Carolina workers’ compensation case is different and thus requires nuanced handling.

Given all these factors, it generally makes sense for claimants (or even potential claimants) to discuss their issues with a qualified North Carolina workers’ compensation attorney.

Web Resources:

North Carolina Industrial Commission

Who is covered under Workers’ Compensation

Since the early 1900s, North Carolina workers’ compensation benefits have provided injured workers with money for missed wages, medical bills and retraining. Unfortunately, abuses of the workers’ comp system have reached epidemic proportions, according to the National Insurance Crime Bureau, which surveyed the industry and found that this crime costs America around five billion dollars a year.

Workers who feign injury to collect benefits pass the costs of these payouts onto insurance companies, employers, and the federal government, resulting in higher premiums for everyone and stealing focus from legitimate workers’ comp claims. Insurance company advocacy groups and federal and state regulators claim that perpetrators of North Carolina workers’ compensation fraud do systemic harm, in other words.

No doubt many people do take advantage of the system by intentionally misreporting or mischaracterizing aspects of their conditions, and so forth. At the same time, however, the insurance companies cannot fairly claim to be pure victims of this fraud. Companies are generally free to hike up rates. And by investigating — and in some cases harassing — legitimate North Carolina workers’ compensation policy claimants, insurers often exacerbate the stresses on these individuals, thus indirectly causing more health problems for them and thus straining healthcare resources further and hurting the economy.

It’s also debatable whether at least some of the fraud that’s been going on constitutes a “gray market” as opposed to a “black market.” Consider: many injured workers don’t get a fair shake when it comes to their benefits. Some then rebel against a system that they perceive to be (and objectively may be) biased against them by committing fraud. Thus some attempts to siphon money from insurance companies could theoretically be justified. (That said, the law is the law.)

The deeper issue that needs to be addressed may be more global in nature. In other words, perhaps neither the perpetrators of fraud, nor the insurance companies are at the root of this epidemic. Maybe the problem is that American workers do not get adequate safety training. Alternately, maybe some massive as-of-yet-fully-acknowledged problem (such as poor workstation ergonomics) is injuring a vast number of workers and thus draining the resources of insurance companies (who in turn must bully policyholders to survive financially; and in turn policyholders must
perpetrate small scale fraud to be able to pay their bills.)

The Cost of Fraud, NYSIF

The Myth of Workers Compensation Fraud, PBS, May 29, 2000

More Web Resources:

National Insurance Crime Bureau

1. Waiting too long to go to a doctor.

The longer a claimant waits before seeing a physician about his or her North Carolina workers’ compensation injury, the more dubious his or her claim may be perceived to be. After all, an employer or an insurer can always argue that the injury or impairment occurred after the fact (e.g. when the claimant was not at work) and therefore that the claim should not be allowed. Moreover, delaying treatment can result in exacerbation of the underlying problem. For instance, if you suffer a wrist sprain and fail to treat it, the favoring that results from that injury can lead to secondary “downstream” injuries.

2. Failing to read fine print of your North Carolina workers’ compensation benefits agreement.

Insurance companies are cagey. They can stipulate that claimants meet with rehabilitation specialists, job search consultants, and other intermediaries as a condition of receiving benefits. Claimants may also be required to make themselves available at certain hours, check in with agents, and deal with what can be overwhelming logistical requirements. That’s why it’s so important to vet the fine print. Ideally, this process should fall to an experienced North Carolina workers’ compensation attorney.

3. Speaking with an adjuster or other insurance company representative before speaking with a North Carolina workers’ compensation lawyer.

In the wake of your injury or illness, you may want to “get through” the paperwork as quickly as possible, so you can rest and heal. However, comments made to insurance company representatives can jeopardize your potential settlement. Don’t jump the gun.

4. Playing down an injury or illness.

Good employees don’t like to complain. They want to appear tough, persistent, and diligent in the face of adversity. There is something to this philosophy. But if you’ve been seriously or even mildly injured at work and you fail to attend to it, an array of problems can follow. First of all, mild problems can get worse. For instance, carpal tunnel syndrome or thoracic outlet syndrome can cripple people, notwithstanding mild initial symptoms, such as tingling in the fingertips and soreness in the forearms.

5. Conflating workers’ compensation claims with lawsuits.

A lawsuit and a North Carolina workers’ compensation claim are not the same thing. You can file a claim even if your employer did nothing wrong (i.e. wasn’t negligent, careless, et cetera). The burden of proof required to collect a claim is much lower than the burden of proof you’d need to win a lawsuit.

Web Resources

thoracic outlet syndrome

what is a North Carolina workers’ compensation “claimant”?

It’s no secret that North Carolina workers’ compensation claims have decreased precipitously over the past three years. In 2006, claims dropped 2%. In 2007, claims dropped another 2%. And in 2008, claims dropped a whopping 4.4% — on top of those declines. This rapid drop coupled with sobering projections put out by the North Carolina Rate Bureau has inspired insurance companies to request a 9.6% decrease in North Carolina workers’ compensation premiums. Employers in the state and government overseers of benefits programs alike appear pleased with this request. One survey estimates that in-state businesses could save nearly $120 million if the Department of Insurance allows the decrease. The burden of setting the final rate falls to State Commissioner Wayne Goodwin. A spokesperson for the DOI applauded the request, saying “that’s a good thing for businesses in North Carolina.”

An NC state representative, Sherry Melton, also approved. “There isn’t much bad to say,” said Rep. Melton, about a decrease in North Carolina’s workers’ compensation rates. Notwithstanding, she argued that the system could be further refined to bring “costs and rates down even lower.”

North Carolina employers currently pay out over $1.4 billion annually in premiums, and both workers and employers alike have complained in the past that these excessively high premiums stunt growth and lead to less effective and efficient care for injured workers. The insurance rate request will not impact all employers in the state. State and Federal government employees, for instance, won’t be impacted, nor will about 25% of small and medium sized businesses that self insure.

Charlotte Observer, Workers’ comp rate may fall, September 3, 2009

WRAL, Workers comp insurance rates could drop, September 2, 2009

More Web Resources

North Carolina Rate Bureau

Wayne Goodwin

1. Settling a North Carolina workers’ compensation claim without assessing the true value of that claim.

Even if a claimant has sustained a relatively minor injury, such as soft tissue damage to the pad of the thumb or shin splints from lifting heavy objects, he/she may be ultimately entitled to collect North Carolina workers’ compensation benefits for an entire lifetime. It’s a fact of human psychology that people tend to over-emphasize the difficulties associated with acute injuries and underestimate the difficulties associated with chronic injuries. Thus, particularly when it comes to chromic injuries, claimants tend to undervalue their claims.

2. Thinking that the insurance company is on your side.

Insurance companies are in business for one reason and one only reason only — to make money. To stay competitive, insurers go through rigorous processes to shave costs and minimize payouts to policyholders. In other words, the insurance company exists in large part to DENY as many claims as it can get away with. This isn’t to say the insurers are malicious. But they are most assuredly NOT working for you (even if individual associates appear sympathetic and helpful.) To that end, if you volunteer information about your condition — even by saying relatively innocuous things like “I’m feeling better this week” — your statements can be manipulated, taken out of context, and leveraged against you in the future.

3. Signing an incomplete agreement within the insurance company.

Let’s say the insurance company agrees to settle. If so, the claimant will receive what’s known as an “agreement to pay” from an adjuster. This agreement can be quite complicated, so it’s often in claimants’ interest to have it examined by a competent North Carolina workers’ compensation attorney. Not all of your injuries may be included on the form. For instance, perhaps you hurt your arm AND suffered a finger sprain. If the agreement only stipulates that your arm was injured and you do not correct the form, you may not be able to recoup any costs associated with the treatment of your hand.

4. Even after your claim has been accepted and approved, insurers can still investigate you.

Often North Carolina workers’ compensation claimants feel that they are “in the clear” after settling successfully with insurers. However, this can be a serious mistake. Insurance companies often reserve the right to investigate claims even after they have been processed and paid out, particularly claims for chronic disabilities. Indeed, insurers have gone to incredible lengths to retract, amend, or otherwise renegotiate claims, including, for instance, secretly videotaping claimants.

5. Believing that you can choose from an indefinite number of healthcare providers.

North Carolina workers’ compensation rules limit your choice of providers. An employer or an insurance company may offer you a choice of physicians from a pre-selected list. Once you choose a doctor, it can be very difficult and time consuming to “deselect” that doctor and find someone else… without risking your benefits.

Web Resources

North Carolina Industrial Commission

workers’ comp insurance adjuster