Topic: Workers’ Compensation Providers

Obtaining North Carolina Workers’ Compensation Benefits Is Not As Hard As You (Or The Experts) May Think…

May 4, 2012, by Michael A. DeMayo
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Perhaps your employer promised to fight your claims; or maybe you’ve encountered resistance from an insurance company. Or maybe you’ve just been reading horror stories about claimants who’ve spent months or even years chasing North Carolina workers’ compensation benefits. In any event, you are gearing up for a big fight. But the path may not be as hard as you fear.

Secret of success: pretend your goals will be tough to reach (even if they won’t)

Researchers at Harvard found that, to set yourself up for success, you need to think effectively about your goals. According to the famous Pareto Principle – also known as the 80-20 rule – imbalances in life are basically everywhere. 20% of all people who get divorced account for 80% of divorces, for instance, amazingly. You wear 20% of your socks 80% of the time. This amazing, counterintuitive principle is at work in practically every facet of our lives, work, relationships, et cetera. Although it’s hard to find statistics to support this contention, it’s probably true that 80% of North Carolina workers’ compensation cases fall into the relatively simple and straightforward category. Only a slim minority of cases constitutes the difficult complex, “drag on in court for months or years” type cases.

Of course, it’s impossible to know whether your particular situation will merit a more robust and muscular response. And it’s always useful to prepare for the worse, even while you hope for the best. But if you’ve been putting off connecting with a North Carolina workers’ compensation law firm, like DeMayo Law, because you are worried about the complexity of your situation, avoid this kind of useless, worst case scenario thinking.

After all, you almost certainly face plenty of real challenges related to your injury or accident such as:

•    Educating yourself about your injury or illness;
•    Finding the right doctor and/or rehab specialist to get you maximum care;
•    Working with your spouse and family financial planner to devise an appropriate budget, given your new limitations;
•    Meeting your needs for resting and healing;
•    Enjoying the opportunity to reflect on your life and work and learning to grow as a person and employee;

So stop fretting about imagined obstacles to your case, find a good law firm, and get busy building the next chapter of your life.

More Web Resources:

Fearing Obstacles That Haven’t Yet Presented Themselves

Stop Worrying and Start Rebuilding Your Life

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Posted In: Medical Issues, Workers Comp Personal Struggles, Workers' Compensation Claims, Workers' Compensation Providers

What If You Find Out That Your Employer Does Not Have North Carolina Workers’ Compensation Insurance?

April 24, 2012, by Michael A. DeMayo
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Businesses that employ more than three or more people in North Carolina generally must carry North Carolina workers’ compensation insurance.

If they don’t, the owners can actually be hit with a felony charge and face jail time, among other punishments. Why does the state care so much about this issue? What’s the big deal?

If your employer lack proper insurance — and then you get sick or hurt on the job — how do you expect to collect benefits to pay for your lost wages, the time you spend off of work, and so on and so forth? Perhaps the business owner has personal assets to cover care. But probably not. And many workers’ comp cases in North Carolina can lead to damages in the range of hundreds of thousands of dollars.

If your employer is operating on a shoestring budget – and doesn’t have a lot of significant assets, and does not carry insurance – you may not have any recourse at all!

Then your burden becomes your family’s burden – and/or the state’s burden and/or the federal government’s burden. In other words, a simple lapse of judgment on the part of your employer can cascade to have massive impacts not just on your future and your family’s future but also on the economy in general. The rest of our civil society must pick up the tab for the incompetence.

There are a few lessons to be learned:

1. If you are an employer and you do not understand your obligations under North Carolina workers’ comp law — or if you do understand them and you still lack insurance — make it an urgent, top priority to take care of your insurance issue.

Do it not just to protect yourself from felony charges. Do it to secure the well being of the people on your teams who help you produce and also to help society at large.

2. If you are an employee, and you know that your employer has not met his insurance obligations– or other obligations with respect to your safety, financial well being, or welfare — speak up!

Don’t wait until you get hurt or sick to learn about your employer’s incompetence. It’s within your rights – and it’s commonsense – to find out whether you would be protected if something happened to you on the job. If you need more clarification, you can always connect with a resource like the North Carolina Industrial Commission or a qualified North Carolina workers’ compensation law firm.

More Web Resources:

The North Carolina Industrial Commission

North Carolina’s Laws Regarding Workers’ Comp Insurance

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Posted In: Workers Comp Personal Struggles, Workers' Compensation Benefits, Workers' Compensation Providers

ObamaCare and North Carolina Workers Compensation

April 15, 2012, by Michael A. DeMayo
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With the Supreme Court set to weigh in on the critical healthcare mandate aspect of ObamaCare, experts here in the North Carolina workers’ compensation system are already thinking through how the court’s decision might impact the rights of workers and employers here at home.

The case before SCOTUS is monumentally complicated and highly politically charged. This is not the appropriate space to dissect the nuances of the arguments — and the predispositions of the various Justices. Some pundits believe that if Supreme Court scraps the mandate requirement, then much of “ObamaCare” would be hobbled. Others suggest that a Supreme Court smackdown might even ultimately help President Obama and fellow advocates.

We are obviously not going to get into the Supreme Court prognostication business here! But this case does hold interesting implications for North Carolina workers’ compensation. Not so much in how a ruling either way would impact healthcare. But rather… we can look at this cultural moment as an indicator of the interconnectedness of various governmental polices and initiatives.

Let’s make that a little less abstract.

The battle over ObamaCare has been a unique showdown involving the Executive, Congressional and Judicial branches of government. We tend to think about issues like health insurance or workers’ compensation in a vacuum. Indeed, experts in these fields can often get so interested in the subtleties and nuances and “10 levels deep” questions about their areas of focus that they lose the ability to explain what they are talking about in plain language to people who don’t know or don’t care what they do.

We can see some of this narrow-minded thinking with the whole healthcare debate. Practically no one who reports or analyzes healthcare stories has read the thousands and thousands of pages of documents that might be relevant to understand the implications for healthcare.

Let’s put this idea into context. What might it mean for people who are trying to simply understand what benefits they might be entitled to and why their employer or insurance company has given them a hard time?

First of all, understand that employers and insurance companies have an interest in protecting their companies and bottom lines. So, if you are encountering resistance, you shouldn’t necessarily be surprised. Second of all, when you’re traversing the gauntlet of the workers’ comp system, be aware that you will encounter many individuals who claim to be “experts” on the whole enchilada. In reality, the workers’ comp system is so complex, so byzantine, and so multifaceted that no one can “know it all.”

All that being said, a reputable workers’ comp law firm in North Carolina can help you make hugely substantial progress toward your goals.

More Web Resources:

Do the experts know anything?

Why people tend to oversimplify complex problems.

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Posted In: Medical Issues, Workers Comp Personal Struggles, Workers' Compensation Benefits, Workers' Compensation Providers

Employers and North Carolina Workers’ Compensation Insurance Cost: Part 2 – Possible Solutions

April 12, 2012, by Michael A. DeMayo
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In a blog post earlier this week, we discussed a piece in the Charlotte Observer about employer related struggles regarding North Carolina workers’ compensation insurance.

Although state law requires most companies to purchase workers’ comp insurance or at least certify that their businesses are flush enough to self insure, 30,000+ companies lack insurance, according to an analysis done by News & Observer.

This “underinsurance” problem creates a crisis for the entire North Carolina workers’ compensation system. Employers who break this law may get hit with a Class H felony charge, which can lead to jail time. Hurt workers, meanwhile, may wind up without recourse to pay for lost wages, time off of work, medical care, and beyond. And the underinsurance problem creates stresses on the entire system – upping the workload for the North Carolina Industrial Commission, causing insurance related headaches, and on and on.

It would be great if we could all sit down and try to figure out some solutions. To that end, here are some speculative ideas:

#1. Make it easier, less stressful, and less expensive for companies to purchase workers’ comp coverage.

Employers often claim that they simply lack the money or resources or time to shop and buy policies. If we can lower the bar for them (we can experiment with various mechanisms for doing so), then we can likely reduce some of the underinsurance problem.

#2. Improve employer education.

Most employers do not like to contemplate worst case scenarios: a worker getting sick at the shop or on the industrial floor, for instance. But employers need to understand not only the risks for themselves and for their businesses but also the risks to their employees.

#3. Employees need to investigate and speak up.

If you’re an employee, you want to be able to trust that your employer is doing the right thing and following proper procedures. And while legally, your employer is responsible, employers are human beings too, and they can make mistakes. As the old Cold War saying goes: trust, but verify. If you’re a new employee at a construction job, for instance, and your new boss tells you that he is bonded and insured and licensed and everything, why not go ahead and ask to see proof? The more informed you are about your own welfare, the more protected you will be, and the less likely you will need the services of a qualified North Carolina workers’ compensation law firm.

More Web Resources:

Charlotte Observer’s Piece on the Consequences of When Employers Dodge Workers’ Comp Costs

Speaking up for yourself as an employee

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Posted In: Legal Issues, Workers' Compensation Benefits, Workers' Compensation Fraud, Workers' Compensation Providers

North Carolina Workers Compensation: A Powerful Tool, But Only One Asset in Your Arsenal

April 5, 2012, by Michael A. DeMayo
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Whether your husband dislocated his knee working a construction job in Raleigh, your son broke his back in a fork lift accident, or you got exposed to hazardous chemicals at an industrial job site, you need North Carolina workers’ compensation benefits to pay for your treatment, time off, rehab, and other costs. And, certainly, workers’ comp benefits can go a long way towards helping you and your family meet expenses and keep your budget in the black.

However, hurt workers – and their families – need to think about their benefits in the context of the larger financial picture. Yes, it would be great if your employer and/or insurance company co-operated fully with you and compensated you fairly and immediately. And yes, it will be a tragedy if you have to struggle for months or years to get treated fairly by the system. But your benefits – even in a best case scenario – only constitute one thread in the tapestry of your financial life.

Being financially prudent can mean two things: penny pinching and expanding your assets.

Penny pinching and income boosting, in and of themselves, are less useful alone than they are together. To that end, here are a few ideas to help you boost your revenue stream and cut costs to stay in the black, no matter what happens with your North Carolina workers’ compensation case.

•    Ask your spouse to create more of an income stream;

•    Cut out extravagant entertainment options, such as pricy TV packages and cell phone/video streaming packages;

•    Go over your budget with a fine toothed comb for a month to see where you and your family are spending “too much” – the more granular your audit, the more you can see ultra specifically where you are spending (and potentially wasting) your money.

•    Consider downsizing. Instead of driving down to Florida for spring break, consider creating a fun stay at home “staycation.” If your mortgage payments are getting out of control, consider moving to a smaller home or even an apartment, while your family gets its financial balance.

•    Avoid racking up too much credit card debt by limiting impulse purchases. Some families even find it useful to make purchases only in cash (to avoid getting into credit card trouble), although that kind of system creates its own accounting headaches and also leaves you more vulnerable to problems like theft, etc.

•    Get help immediately with any benefits questions by connecting with an experienced and client trusted North Carolina workers compensation law firm.

More Web Resources:

How to increase your revenue stream

How to clip your home budget

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Posted In: Legal Issues, Overuse Injuries, Workers' Compensation Claims, Workers' Compensation Providers

The North Carolina Workers’ Compensation Downward Spiral

March 24, 2012, by Michael A. DeMayo
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A hurt worker who gets on North Carolina workers’ compensation can inadvertently wind up on a rapid treadmill to disaster.

It has been said that those who are not moving towards success are moving towards failure. There is no such thing as “standing still” in your life. If you are not making progress towards a goal – towards a better life, or more fulfilling life, a healthier body, etc., then you are in effect moving the other way. This may be a hard pill to swallow. But it’s a subtle idea. Moving towards bigger goals in life – healing from a North Carolina workers’ compensation accident, for instance, does not mean that every step along the way must be positive. You can (and will) experience setbacks. But a setback is different from a wrong direction.

Think about hiking from the North Carolina coast to the mountains. Sure, there might be ups and downs along the way in either direction. But in one case, you are methodically headed towards a higher point, and in the other case you are methodically headed towards a lower point. The trouble is that, if you just look at where you are now — or where you are going in the immediate future or where you’ve come from in the immediate past — you might be mistaken about your overall trajectory. It might look like you are headed towards the proverbial mountains when you are actually headed towards the ocean but just going over a bump. And vice versa.

So how do you know which trajectory you are on? How do you know whether you are moving towards recovering from your injury, stabilizing yourself financially and emotionally, rebuilding your career… or doing the opposite?

The short answer is: “your perspective is limited, so you cannot ever really know for sure.”

But this doesn’t mean you can’t do intelligence gathering and find more objective perspectives. A North Carolina workers’ compensation law firm, for instance, can keep you on a positive trajectory as far as your compensation quest goes and can also connect you with other resources to deal with the other problems in your life, such as financial planning for your family, coping with the emotional ramifications of the injury or the loss of your productivity, and so forth.

Get on and stay on a positive trajectory.

One key is to simply acknowledge the reality that we are either moving towards success or moving towards failure in every area of our lives. Just that epiphany – held in the mind – alone is often enough to kick start people towards adopting behaviors and habits — and connect with resources they need — to halt the downward spiral and get their lives back on track.

More Web Resources:

You are Either Moving towards Success or Failure

The Difference between Short-Term Pain and Long-Term Gain

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Posted In: Workers' Compensation Benefits, Workers' Compensation Claims, Workers' Compensation Providers

Simple Causes, Complex Problems (A Guide for North Carolina Workers’ Compensation Applicants)

March 2, 2012, by Michael A. DeMayo
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Disaster has struck at your workplace. You now need North Carolina Workman’s Compensation to pay staggeringly high medical bills, supplement your family’s income during your time off (and who knows how long that will last), and generally keep you moving (perhaps limping) towards your long-term financial goals.

How did you end up here?

Two classes of events can lead people to get hurt or sick at work: Acute and chronic.

Acute Workplace Injuries

These are the more “obvious” injuries. They include things like:

•    You fall off a loading dock and break your leg in three places;
•    You inhale aerosolized toxic chemicals while working in a chemical refinery and suffer immediate burning and lung damage;
•    You suffer a massive concussion and blood loss after a careless driver t-bones your delivery truck or rental car while you are en route to a conference;
•    You get into an altercation with a co-worker, and he beans you with a rock or a fist.

Acute accidents/illnesses are relatively easy to trace. In other words, you can identify the cause of the illness/injury pretty easily and with great certainty. The injury also happens across a very short span of time (seconds, minutes).

Chronic Workplace Injuries

Examples might include:

•    You develop carpal tunnel syndrome or another typing injury after working as a secretary for 13 years for a bank in the Research Triangle;
•    You develop fibromyalgia or type II diabetes or some other ailment which degrades your performance at work and, possibly, ultimately, prevents you from doing your job at all;
•    You suffer a lung ailment, skin problem, or some other medical concern after being exposed to environmentally dubious conditions at your workplace.

Chronic ailments are far difficult to “trace.” In other words, it’s harder to put together an argument or a story that connects workplace exposure or conditions with your illness/injury. Chronic problems by definition develop over long swaths of time. As a result, you cannot as easily connect the “causative event” with your injury, since so many different factors might have contributed to your problems.

That being said, many workplace injuries – even chronic, complicated ones – stem from simple causes done repeatedly over time. If someone hit you over the head with a hammer, you would develop a fractured skull, contusion, bleeding, swelling, etc. You could clearly say “the hammer blow caused all these problems.” But if someone taps your head with a hammer softly, repeatedly for a few weeks, and you suffer subtle, long term neuronal damage, now your case is harder. You can no longer say “the cause is still simple. All of my injuries and woe stem from the simple cause of the hammer blow.”

The moral here is: Your problems may seem complicated and not interrelated. But don’t be so sure. Even if you have a host of ailments right now, a single prominent chronic stressor in your life or at work might be responsible for a vast number of them.

A North Carolina Workers’ Compensation law firm can help you drill down to discover the root cause (or causes) of your problems and help you get compensated.

More Web Resources:

Example of a Simple Cause Leading to a Complex Problem.

Chronic Versus Acute Injuries

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Posted In: Medical Issues, Workers' Compensation Benefits, Workers' Compensation Fraud, Workers' Compensation Providers

Depressed by the State of Your North Carolina Workers’ Compensation Case?

January 28, 2012, by Michael A. DeMayo
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You have been struggling long and mightily with your North Carolina workers’ compensation case.

•    Perhaps you suffered a slip and fall at a machining plant facility in Raleigh a year-and-a-half ago, and you’re still managing a “bum” leg and knee.
•    Maybe your spouse suffered a traumatic brain injury after he inhaled residue of an explosive fire in his North Carolina car crash.
•    As if the accident or event wasn’t disturbing enough, you have since had to deal with insurance company shenanigans, bureaucratic incompetence, and a totally uncooperative employer.
•    Meanwhile, you need to sustain your focus on getting adequate compensation while dealing with all of life’s other challenges, such as raising your family, managing your dwindling finances, and dealing with the personal drama in your life.

It’s not surprising that many people in the throes of North Carolina workers’ compensation struggle also suffer from depression, anxiety, and fatigue.

There is no easy fix. However, probably just hearing all of your problems laid out like this makes you feel a little bit relieved. In other words, now you know that that sense of depression and overwhelm has a real source: there are real-world, root causes of your discontent.

On the other hand, just labeling the problem is not going to dispatch it!

To that end, here are three tools useful for wrangling with life’s uncertainties, meeting financial and organizational challenges, and cultivating the inner resources necessary to see your case to a positive conclusion:

1. Check out David Allen’s book Getting Things Done

Widely hailed as the most respected “productivity guru” of the twenty-first century (by the likes of Time magazine, Wired, and other big publications), Allen teaches a philosophy of personal management that involves identifying “what’s true now” in your life. GTD uses sophisticated processes to help you manage everything from clearing your email inboxes to codifying and reviewing your purpose on the planet.

2. Practice mindfulness meditation

Powerful scientific research now shows that regular meditators (30 to 45 minutes a day) experience a profound reduction in stress, increase their general level of happiness, and enjoy other health and wellness improvements.

3. Connect with a North Carolina workers’ compensation law firm.

Your workers’ comp case will almost certainly be less overwhelming and terrifying if you have the appropriate team to guide you, help you make the right choices, and avoid the mishaps and false beliefs that hamper so many hurt and sick workers out there.

More Web Resources:

Summary of Research on the Benefits of Meditation

How to Get Started with Getting Things Done

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Posted In: Medical Issues, Overuse Injuries, Workers Comp Personal Struggles, Workers' Compensation Providers

Your Office Vending Machine: The Source of Your North Carolina Workers’ Compensation Woes?

May 3, 2011, by Michael A. DeMayo
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Experts who study North Carolina workers’ compensation issues are constantly trying to puzzle out why accidents, injuries, and illnesses happen at work and how these catastrophes can be prevented. The thinking is, if policy analysts can suss out the root causes, we can collectively reduce injury rates and sickness rates everywhere from the Research Triangle to the far West of NC.

So what ARE the major root causes of workplace related injuries and illnesses, and can they be effectively treated with smart policy?

Typically, we focus on improving safety of equipment and machinery; limiting number of hours worked (too many hours leads to fatigue and worker error); boosting worker education (poor training leads to safety catastrophes); and limiting repetitive work (repetitive labor leads to soft tissue injuries, like carpal tunnel syndrome).

But sometimes it helps to think out “outside the box” and look at other potential root causes of worker pain. According to a very provocative article in the April 19 issue of the New York Times magazine, the sugary snacks and beverages in your local office vending machine may be causing far more problems than you, your employers, and most North Carolina workers’ compensation experts realize. Taking his cue from pediatric obesity specialist Robert Lustig, science writer Gary Taubes argues that refined sugars – particularly sugars taken in liquid form (such as the Cokes and Pepsis in your local vending machine – as well as the fruit juices) may be making many, many people not only overweight but also sick.

What Lustig says is that, when you eat sugars – particularly when you drink them – your liver gets essentially biochemically “punched” and injured. Fatty deposits form in the liver, and this process may stimulate a condition known as insulin resistance, which appears to be the common denominator in many diseases of civilization, including obesity, diabetes and heart disease as well as many types of cancer.

If this supposition is correct, that means that one (albeit indirect) way to seriously reform our entitlement system is to get people to stop eating so many sugary snacks – particularly sugary beverages. Even a slight decrease in our sugar consumption might lead to a collective boost in our national health and lend some genuine relief to over stressed and under supplied healthcare providers.

On a more personal note, if you or a family member or someone at work is struggling with benefits issues, a North Carolina workers’ compensation law firm can provide the essential services you want and deserve.

More Web Resources:

Is Sugar Toxic?

Lustig’s YouTube video

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Posted In: Uncategorized, Workers' Compensation Benefits, Workers' Compensation Providers

Texas-Sized Mess Serves as a Cautionary Tale for the North Carolina Workers’ Compensation System

December 9, 2010, by Michael A. DeMayo
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Analysts often get mired in the details of internal state policy, spending time reviewing in-state cases and poring over announcements from individuals like Insurance Commissioner Steve Poizner to understand factors shaping the North Carolina workers’ compensation system.

But sometimes it’s instructive to attend to the trials and tribulation of other state’s workers’ comp programs. To wit, a November 23 report out of Austin, Texas highlights a slew of nagging problems with that state’s Division of Workers’ Compensation (DWC). The report identified four serious problems that “significantly inhibit” the DWC’s ability to offer benefits and care for workers hurt on the job. The points get technical and dry, but they are worth quickly reviewing:

1. The Texas DWC allegedly does not process complaints about medical practitioners well, so system auditors cannot evaluate the consistency and appropriateness of any disciplinary actions.
2. The complaint process the DWC uses fails to comply with the Texas Labor Code.
3. The way healthcare providers get chosen creates major inefficiencies and results in the “overutilization” of healthcare.
4. DWC also has problems in engaging in sanctions and enforcing its decisions.

Texas professionals plan to meet on December 14 in Austin to discuss how to rehabilitate the Division of Workers’ Compensation. But the ongoing struggles in the Lonestar State should alert analysts and policymakers who focus on North Carolina workers’ compensation to the sheer size and scope of some of the crises we face.

One major theme that emerges here is the idea that failure to process information effectively can have serious systemic consequences. State bureaucracies are not exactly known for being efficient. But lack of a structured set of processes and systems gums-up the whole system. It forces people to engage in extra paperwork. It drains resources from already resource-strapped and time-strapped individuals.

New developments in information processing theory may be useful. For instance — and this may sound silly at first — but imagine if everyone in the system adopted the “K.I.S.S. principle” (keep it simple, stupid) when developing their systems and procedures. A return to simplicity could make regulations and restrictions clearer, allow employers and hurt workers to make better decisions and foster a more genial overall spirit.

Stepping back from these global and philosophical implications…

If you’ve recently been put out of work by an injury or occupational disease, or if your family has been struggling to collect benefits from an insurance carrier, you are probably less concerned with what’s going on in Texas and much more concerned with questions like: “How am I going to feed my family if my benefits run out?” and “What can I do to heal faster so I can get back to work?”

To tackle all your concerns, you may benefit greatly from a free consultation with a North Carolina workers’ compensation law firm.

More Web Resources

Division of Workers’ Compensation (DWC)

Texas’ workers comp agency’s oversight faulted: Auditor

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Posted In: Legal Issues, Medical Issues, Uncategorized, Workers' Compensation Benefits, Workers' Compensation Providers

Conference on North Carolina Workers’ Compensation Slated for Next Week

October 7, 2010, by Michael A. DeMayo
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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

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Posted In: Medical Issues, Uncategorized, Workers' Compensation Claims, Workers' Compensation Providers

North Carolina Workers’ Compensation Bloggers Weigh in on Octomom’s Lawsuit Settlement

June 16, 2010, by Michael A. DeMayo
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Although her saga does not technically pertain directly to North Carolina workers’ compensation matters, Octomom Nadya Suleman quest for workers’ comp has riveted the attention of the nation. According to breaking reports, the Southern California mom of 8 has finally settled a long standing lawsuit for workers comp for just a little over $23,000.

Background

In 1999, Suleman sustained an injury at the Metropolitan State Hospital while working as a psychiatric technician (hurt her back). For this, she subsequently received around $170,000, which she used in part to fund the in vitro fertilization that led to her becoming the mother of octuplets last January. The California Division of Workers’ Compensation reported that her original settlement of $40,000 was diminished by nearly half because of attorney’s fees and advance payments.

Suleman has been roasted widely in the press for feeding her children with food stamps, selling pictures of herself clad in a bikini to the tabloids, and taking $5,000 from People for the Ethical Treatment of Animals in exchange for putting a sign in her window that reads “don’t let your dog or cat become an Octomom – Always spay or neuter.”

The workers’ comp drama may not be over for Ms. Suleman, given that some of her medical providers have a lien against her, claiming that she owes them around $800.

Are there lessons here for would be North Carolina workers’ compensation claimants? Likely not. Ms. Suleman’s case is fairly unique, and not just because she has octuplets and has behaved in fairly idiosyncratic manner. California has special laws in place that may not be applicable to North Carolina workers’ compensation cases.

For instance as this blog recently reported, an NFL player who hurts himself in a game in California can theoretically claim workers’ comp benefits from the state for the rest of his life – CA is unique in the nation regarding this kind of liberal policy.

If you or a family member faces difficulties collecting benefits, wrangling with insurance companies, or even processing paperwork to meet critical deadlines, it may behoove you to speak with a reputable and battle proven North Carolina workers’ compensation attorney. As the case of Octomom illustrates, workers’ comp – whether you succeed in getting appropriate payments or not – may not be a complete solution for your financial woes.

Speak with a financial planner to draw up a battle plan for you and your family to get on a more even financial keel.

More Web Resources

Octuplets mom Nadya Suleman settles her workers’ comp case

Octuplet mom settles disability claim for $23,000

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Posted In: Medical Issues, Out Of State Workers Comp News, Uncategorized, Workers' Compensation Benefits, Workers' Compensation Providers

Could North Carolina Workers' Compensation Doctors be Overprescribing “Schedule II” Drugs?

January 19, 2010, by Michael A. DeMayo
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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

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Posted In: Medical Issues, Uncategorized, Workers' Compensation Benefits, Workers' Compensation Claims, Workers' Compensation Providers

Understanding North Carolina Workers’ Compensation Fraud

January 3, 2010, by Michael A. DeMayo
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Here is a brief primer on North Carolina workers’ compensation fraud — including relevant laws passed by the North Carolina General Assembly as well as information, implications, and a toll-free hotline for fraud investigation.

Laws
In 1994, the state assembly passed the Workers’ Compensation Reform Act, which included statute 97-88.2 (outlining punishments for misrepresentation in a North Carolina workers’ compensation filing) as well as statute 97-88.3 (outlining punishments for healthcare providers who fail to follow the law.)

The following year, the state assembly changed statute 97-88.2 and empowered the North Carolina Industrial Commission (NCIC) to look into fraud violations of the 1994 WCRA.

In 1997, the North Carolina Assembly passed House Bill 618, which further amended two key statutes – 97-88.2 and 97-94 — to spell out increased penalties for fraud and misrepresentation under the Workers’ Compensation Act.

Today, the NCIC operates a hotline at (888) 891-4895 from Monday through Friday during normal business hours.

Who can be accused of conducting fraud? Parties including but not limited to:
• employees/claimants
• employers/managers
• corporate officers
• administrators of third party services
• insurance adjusters/agents
• lawyers
• providers of healthcare services
• rehabilitation providers

Individuals who commit North Carolina workers’ compensation fraud imperil the whole system. Fraud drains millions of dollars that would otherwise go to claimants with legitimate problems. That being said, not all cases are cut and dried. Some individuals may accidentally commit North Carolina workers’ compensation fraud simply because they fail to fill out paperwork properly or fail to follow bureaucratic protocol. It’s not that they try to cheat the system, in other words; it’s that they do not understand how to operate within it effectively.

This isn’t to say that there are not some bad eggs out there who intentionally game the system. However, if you or a family member has been accused of this crime — or if you’re in need of other kinds of assistance filing or moving forward with your North Carolina workers’ compensation claim — it may behoove you to connect with a knowledgeable attorney right away to discuss your concerns in confidence. A free consultation with a reputable attorney can put you on a strategic path to maximize your benefits and minimize your hassle.

More Web Resources:

NC Workers’ Compensation Reform Act

More about Workers Comp Fraud in NC

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Posted In: Uncategorized, Workers' Compensation Benefits, Workers' Compensation Fraud, Workers' Compensation Providers

5 Common Mistakes Made By North Carolina Workers’ Compensation Claimants

September 17, 2009, by Michael A. DeMayo
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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

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Posted In: Uncategorized, Workers' Compensation Benefits, Workers' Compensation Claims, Workers' Compensation Providers

Changes to PEO Act Offer New Options for North Carolina Workers’ Compensation Providers

September 16, 2009, by Michael A. DeMayo
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On September 15th, Governor Perdue signed amendments to the North Carolina Professional Employer Organization Act intended to aid businesses who use PEOs to handle their North Carolina workers’ compensation and other benefits.

The NC Senate and House passed SB 1029 unanimously. The bill’s passage may hold implications for businesses associated with the state’s more than 143 professional employee organizations (PEOs), which function (ideally) to free up employer resources, expand opportunities, and improve both the quality and cost efficiency of benefits packages.

How might the legislation impact day to day North Carolina workers’ compensation claims? At this moment, it’s too early to predict. On the one hand, if the bill helps employers reduce costs and improve/expand benefits, obviously workers stand to gain. In addition, theoretically, the more that small and medium sized business owners outsource their administrative and other work relating to North Carolina workers’ compensation to PEOs, the more uniform the state’s standards will be; this uniformity, too, should benefit workers.

On the other hand, as with any piece of legislation, hidden problems may lurk. For instance, the expanded power of PEOs may disincentivize some employers from obtaining higher caliber private North Carolina workers’ compensation benefits packages. Also, if PEOs gain too much power, argue some, than they can make self-interested decisions that could have less than ideal downstream consequences for workers.

All that said, given the general enthusiasm for the bill — advocates for employers and advocates for workers who might need North Carolina workers’ compensation alike seem relatively pleased by the legislation — industry watchers seem cautiously optimistic that it could succeed in reducing costs, cutting red tape, and generally improving benefits.

Reuters, North Carolina Passes Professional Employer Organization Act, September 15, 2009

Insurance Journal, North Carolina Updates Professional Employer Organization Requirements, September 15, 2009

More Web Resources

What is a PEO?

NAPEO

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Posted In: Uncategorized, Workers' Compensation Benefits, Workers' Compensation Claims, Workers' Compensation Providers

Raleigh Convention Center to Host North Carolina Workers' Compensation Educational Conference

August 11, 2009, by Michael A. DeMayo
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Per a news bulletin on the NC Industrial Commission’s website, the fourteenth annual North Carolina Workers’ Compensation Educational Conference will be held this year from October 7th through 9th at the Raleigh Convention Center on South Salisbury Street. According to the conference brochure, the purpose of the symposium is to “educate those who participate in the North Carolina workers’ compensation system regarding current rules, procedures, policies, and forms, and to provide an opportunity for dialogue among these participants.”

Various commissioners, attorneys, insurance representatives, and medical professionals will present, and individuals can attend specialized break out sessions during the conference. Registration fees range from $275.00 per person for registrants who pay before 08/15/09 to $350.00 per person after 09/15/09. The proceeds from the conference will be given to the International Workers’ Compensation Foundation, a non-for-profit group that assists with education and research. Certain individuals, such as attorneys, providers, and carriers may be able to collect continuing education credits for attending the conference. (Insurance adjusters may want to discuss any credit issues with the Department of Insurance, which can be reached at (919) 807 6800.)

The North Carolina Workers’ Compensation Education Conference generally boasts a diverse guest list, and discounted rates for groups are available. Attendees often include administrators, employers, HR professionals, attorneys, healthcare analysts and providers, and vocational therapists. This conference is a joint venture put together by the International Workers’ Compensation Foundation and the NC Industrial Commission.

More Web Resources

NC Industrial Commission

International Workers’ Compensation Foundation

Raleigh Convention Center

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Posted In: Medical Issues, Uncategorized, Workers' Compensation Providers

North Carolina Workers’ Compensation Survey Reveals That the State Has Exceptionally High Payment Per Claim Costs

July 31, 2009, by Michael A. DeMayo
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According to a study conducted by the non-partisan Workers’ Compensation Research Institute (WCRI), North Carolina’s workers’ compensation payment per claim costs are significantly higher than average when compared to similar costs in other states. The study, CompScope TM Medical Benchmarks, revealed that North Carolina workers’ compensation payments per claim exceeded the average of a group of 13 states by 13%. State lawmakers have already reacted to the problem by imposing fee schedule changes; these began taking effect in July 2009. Various policy groups have also proposed initiatives to reduce payouts for certain hospital costs, physical medicine, and outpatient services. The Office of State Budget and Management has calculated that the fee schedule changes for 2009 should save the state over $35 million.

What was driving the abnormally high payments per claim in the state?

The CompScope survey points to many culprits. For one, the state has a higher surgery rate than other states surveyed. In addition, both outpatient and inpatient payments per claim and payments to providers are much higher than the median for the states studied. Bear in mind that these figures don’t mean that North Carolina workers’ compensation claimants are necessarily getting more money or a better deal on their medical services. The costs have gone up for almost every party within the healthcare system across the board.

Workers` Compensation Payments Per Claim to North Carolina Hospitals Higher Than Typical of 14 States and Growing, Says WCRI Study, Reuters, Fri Jul 10, 2009

North Carolina: Study finds payments per claim growing rapidly, Risk and Insurance.com, July 30, 2009

More Web Resources

CompScope

Workers’ Compensation Research Institute

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Posted In: Medical Issues, Uncategorized, Workers' Compensation Providers

Answers to Your FAQS about North Carolina Workers’ Compensation Benefits and Rules (Part II)

July 22, 2009, by Michael A. DeMayo
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Who is in charge of directing your medical care?

In general, your employer or the employer’s insurance company is in charge of offering and directing your course of treatment. If you don’t like the physician that your employer commends you to, it’s up to you to petition the North Carolina Industrial Commission to compel your employer to find another doctor. Be sure to get any changes in writing prior to receiving treatment, or you may not get reimbursed. In some cases, in which your employer or your employer’s insurance company does not behave fairly, the Commission may mandate certain terms of treatment. In the event that you need emergency medical assistance, obviously you should get it. If your employer or the insurance company subsequently refuses to pay for that treatment, you should contact the NCIC as quickly as possible within reason to discuss your situation.

Is it true that you can’t collect compensation for the first week you’re off of work?

In general, the first seven days you miss work due to your disability will not be covered by so called “Lost Wage Compensation.” However, if your disability lasts longer than 21 days, you will be able to start collecting — just not for days 1 through 7.

Are compensation payments always made weekly?

Under most circumstances. However, the NCIC can in some situations mandate that you get monthly checks instead.

How much money should you expect in terms of benefits?

In general, you should expect two thirds of your weekly wage with a maximum of $816 per week (according to 2009 rules).

Can you continue receiving benefits after you return to your job?

In general, no. Once an employee is able to go back to work, his or her benefits end.

How can you find out your North Carolina Workers’ Compensation claim number and the insurance carrier that your employer uses?

The North Carolina Industrial Commission maintains a statistics hotline at (919) 807-2506 to answer these questions.

What should you do if your employer does not acknowledge or otherwise refuses to honor your claim?

In general, it’s a good idea to connect with a North Carolina workers compensation attorney ASAP. You also should notify the NCIC and all relevant healthcare providers.

More Web Resources

North Carolina Industrial Commission


NC Workers Compensation Act

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Posted In: Uncategorized, Workers' Compensation Providers