North Carolina Workers' Compensation Lawyer Blog

No one would argue that the North Carolina workers’ compensation system is without flaws. But a breaking ruling out of Iowa shows that crazy cases and curious rulings are not merely the province of the “First in Flight” state.

The Iowa Supreme Court resolved a longstanding battle between Travelers Insurance Company and Grinnell Mutual Reinsurance over which company should compensate the family of a fallen volunteer firefighter, Justin Fauer. Brace yourself: the backstory is pretty weird.

A farmer named Dwight Johnson (of Johnson Valley Beef Farms) fell into a manure pit and got overwhelmed by methane gases. His employee, Fauer, noticed his boss’ plight and ran to tell Johnson’s wife to call the police. Fauer then returned to the pit and tried to help his boss out. But he, too, got overwhelmed by the methane and died in the pit.

So what led to the big workers’ comp battle? Well, Fauer was a volunteer fire fighter as well as a farmhand. So the farm’s insurance company as well as the volunteer firefighter’s insurance company have been duking it out in court (all the way up to the Iowa Supreme Court) over which firm should be liable for his family’s workers’ comp benefits.

Ultimately, Grinnell (which represented the farm) lost because of technical reasons pursuant to whether Fauer acted in the capacity of a volunteer firefighter or a farmhand. But without getting into too much detail about why, it’s important to recognize the broader implications. The length to which these two insurance companies went to avoid liability no doubt used up tremendous resources and court time. And this suggests a bigger problem – a broader problem – namely that North Carolina workers’ compensation cases (and similar cases throughout the US) can often get way too bogged down in the details at the expense of seeing that real justice gets done and that injured and needy claimants get their due.

The Moral: When the law gets overly technical, court battles drain much needed resources for no real justice-serving purpose.

Moving away from the abstract now… if you or someone you care about has been injured in an acute workplace accident or suffered an occupational disease or repetitive strain injury, you may want to seek guidance from a competent North Carolina workers’ compensation law firm. Understanding your rights is the key to reaching the best possible settlement.

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Travelers Insurance Company v. Grinnell Mutual Reinsurance

More about the Fauer tragedy

There is no doubt about it – North Carolina has faced some seriously hard times over the past two years (called by some the “Great Recession”). But North Carolina workers’ compensation and wage analysts have some good news to report -- finally. A new survey by the state’s Employment Security Commission has found that the average weekly wage has risen by $1.16 since 2009.

Since inflation is not a factor, this implies that the wage increase is real – much needed relief for the state’s beleaguered workforce. Analysts found that the average weekly wage in August 2009 was $758.44 – this year, the wage was $759.60. That may not sound much – and indeed it’s only a 0.15% increase – but it does augur well, particularly if you see the rise in the context of the state’s slowly improving unemployment numbers. Back in February, NC had double-digit unemployment topping out at over 11%. The latest statistics show that the unemployment rate has fallen for four months in a row and finally dropped back into single-digits.

While these numbers may be encouraging, they should by no means cause for celebration. Predicting the long-term success of the state’s economy is notoriously a tricky business. However, for workers who have been surviving on North Carolina workers’ compensation and unemployment benefits, this news may help to kindle a renewed sense of industry, entrepreneurial activity, and general hope.

All that said, if you or someone you care for has been waylaid by an injury or occupational disease, and you are struggling to make ends meet while battling your employer or/and an insurance company, all of these positive signs may be beside the point. What you need is actionable strategic help with your case. To that end, it almost certainly makes sense for you to consult with a result-proven and highly credentialed North Carolina workers’ compensation firm to protect your rights and benefits.

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Great Recession

Employment Security Commission survey

A few months ago, this North Carolina workers’ compensation blog reported about the case of Christina Gamble, a 43-year-old woman who got arrested on charges of workers’ comp fraud, after insurance investigators found that she had been stripping while collecting disability benefits, ostensibly because she had trouble “standing and changing positions.”

The 43-year-old Gamble waitressed at Red Robin Restaurant in 2007. She allegedly hurt her back at work. In 2008, a judge granted her disability benefits of $360 a week. All told, she collected $4,000+ in expenses and $23,000+ in disability payments. However, the restaurant’s insurance representatives hired private investigators to track down Ms. Gamble. They found her working as an exotic dancer at CR Fanny’s Gentleman’s Club in nearby Wilson. The PIs taped her stripping and used this evidence to prove that her workers’ comp claim was fraudulent.

Obviously, any North Carolina workers’ compensation fraud case hurts everyone else in the system. When people fake disabilities or play up injuries to get benefits, this not only drains resources that could otherwise be used to help people who really are injured – but it also creates a sense of mutual distrust. When insurers and employers lose trust, they tend to crack down by making the process more difficult and the investigations more probing, personal, and annoying.

All that said, in the case of Ms. Gamble, you have to feel some sympathy for this woman. It sounds like she has had a very hard go of it. It’s obviously impossible to know her full story just from a news report. But it is important to remember that North Carolina workers’ compensation fraud comes in many flavors – some people purposely bilk the system to take advantage of loopholes; other people just get into desperate straits and do desperate and stupid things.

If you or a family member faces problems collecting benefits, your focus is 100% on getting these issues resolved ASAP. To that end, you might be well advised to set up a free consultation with a local North Carolina workers’ compensation firm to explore your rights, build a strategy to get your benefits and to resolve any agita associated with your claim, and work towards building a sustainable financial future for you and your family.

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CR Fanny’s Gentleman’s Club

Bucks woman to stand trial in workers' comp case

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

North Carolina workers’ compensation policy experts have largely been absent from the debate over how the Obama administration and BP’s $100 million workers’ compensation fund will be dispersed to rig workers rendered temporarily unemployed (or underemployed) by the recently imposed moratorium on off-shore drilling (due to end in November). That said, local pundits, fisherman, and policy wonks have been keeping a close eye on the unfolding story. This article can give you some background and introduce you to key points being discussed.

Background

Pursuant to the massive BP oil well spill – which this blog actually covered just weeks after the explosion happened – the Obama administration imposed a moratorium on offshore drilling to prevent additional catastrophes similar to what happened to the Deepwater Horizon. Unfortunately, by imposing this moratorium, the administration essentially put thousands of oil rig workers on a forced hiatus. To compensate these workers and others harmed by the spill, the White House assigned Ken Feinberg to administer a $20 billion Oil Spill Fund. (In case you don’t recall, Feinberg was the same man who administered the reparation fund for the 9/11 terrorist attacks.) Although Feinberg has promised to be very lenient as to the proof that he and his team will require to grant compensation, many industry workers are confused. And employers and workers in peripheral industries – even way up here in North Carolina – also must contend with uncertainty and work slowdowns associated indirectly with the BP spill.

In short, North Carolina workers’ compensation experts are busy trying to figure out whether -- if at all -- the BP spill money will translate to compensation for NC employees and others glancingly impacted. One school of thought – the predominant one – says that the oil spill will have a negligible effect, since it’s so far away. Another theory suggests that the spill will have a domino effect, essentially ricocheting through the economy of states that touch the Gulf and Mid Atlantic. In either case, unless you are directly working on a rig or directly impacted by this spill, it’s unlikely that you will be able to collect from the nationally established fund. But this doesn’t mean that the spill won’t affect you in indirect ways.

The key is to figure out what’s in your circle of control and influence. What can you personally do to improve your chances of collecting North Carolina workers’ compensation benefits in a timely fashion and to work around obstacles thrown up by your employer, the North Carolina Industrial Commission or an insurance company?

To that end, you will likely need legal guidance. Trust your case to a veteran North Carolina workers’ compensation attorney – one who has handled many similar kinds of cases in the past successfully.

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North Carolina Industrial Commission

BP’s $100 million workers’ compensation fund

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

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

North Carolina workers’ compensation and unemployment benefits recipients have been scrambling to prepare themselves financially for the end of some government protections. Since the beginning of June, according to the Rocky Mount Telegram, probably 20,000 NC residents have been dropped from unemployment compensation -- every week!

Last week, the U.S. House of Representatives voted 270 to 153 to extend some unemployment benefits for people who have been long out of work; however, the US Senate has thus far refused to pass that measure – or any like it – into law. This dispiriting news comes on the heels of a grim jobs report in June that has prompted economists – including many traditionally chipper analysts – to voice fears that the US may be plunging into a “double dip” recession – a dangerous circumstance that could put even more pressure on workers who rely on unemployment benefits and North Carolina workers’ compensation to provide for themselves and their children.

On the upside, the North Carolina unemployment rate appears to be dropping in some key counties. Edgecombe County saw its unemployment rate fall from a high of 17.2% in January to 14.8% in May. Both the Twin Cities and Nash Counties saw better job markets – and, all told, 86 North Carolina counties saw better numbers in May. So this might be a silver lining to an otherwise grim cloud of North Carolina workers’ compensation news.

Given all the dodgy financial news, injured and sick workers more than ever need to follow up their North Carolina workers’ compensation cases carefully. Recalcitrant employers, uncooperative insurance companies and paperwork-related snafus can result in your not getting timely benefits. All sorts of secondary consequences can come off of that – including missed credit card payments and mortgage payments.

If you or a loved one has any questions or concerns about how to get benefits or keep them coming, get in touch today with a creditable and experienced North Carolina workers’ compensation attorney. Don’t wait until the electric company turns out your lights and you lose all sources of income. Protect yourself by doing due diligence and coming up with a budget and get-back-to-work plan that’s plausible and robust.

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US lawmakers extend jobless benefits

Unemployment signs look better

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

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

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

Last Wednesday, the multinational bank Wells Fargo was ordered to pay out $30 million to four non-profit entities, pursuant to a jury’s verdict that the bank participated in fraud. North Carolina workers’ compensation policy analysts have been reviewing the case to see whether it may have interstate implications.

The four non-profit entities -- the Minnesota Workers’ Compensation Reinsurance Association, the Robins, Kaplan, Miller and Ciresi Foundation for Children, the Minnesota Medical Foundation, and the Minneapolis Foundation -- all alleged that Wells Fargo essentially tricked them into believing that they were investing in low risk options, when in actuality the bank had been funneling their money into risky investments which blew up during the recent credit collapse. The jury found that the bank violated the Minnesota Consumer Fraud Act (and other laws). Punitive damages have yet to be assessed against Wells Fargo.

Representatives for the bank expressed disappointment about the decision, although it could have been worse for Wells Fargo. The non-profits asked for $400 million -- more than ten times what the jury returned.

The litigation over punitive damages (and the potential Wells Fargo appeal) could stretch on for years – a not uncommon phenomenon in North Carolina workers’ compensation cases in which millions of dollars hang in the balance.

Most individual workers’ comp cases involving occupational diseases, injuries at work, and conflicts with insurers do not take as long to resolve and do not get nearly as complicated as the Wells Fargo case. Nevertheless, if you or a loved one faces friction getting benefits, dealing with an insurer, or managing the deadlines associated with your claim, connect at once with a reputable and experienced North Carolina workers’ compensation attorney to review your strategic options and make sure that you’ve dotted all your I’s and crossed all your T’s.

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Wells Fargo vs the non-profits

Minnesota Workers’ Compensation Reinsurance Association

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

Many North Carolina workers’ compensation cases wind up being dry and technical, requiring attorneys to develop nuanced arguments based on subtle interpretations of the law. But a new case out of Montana has engendered lots of laughs and some raised eyebrows. Below are the deets.

On June 7, a judge found in favor of a 23-year old plaintiff, Brock Hopkins, who was mauled by a bear he had been feeding while high on marijuana. Brock had been volunteering at Great Bear Adventures in Montana. One day, he smoked a pipe of marijuana and came in to do his job when the bear attacked him, dislocating his knee cap, and leading to $70,000 in medical expenses.

The park’s owner, Russell Kilpatrick, argued that Hopkins’ marijuana use was the major cause of the attack – had he not been high, the bear would not have attacked. But although the judge found Hopkins behavior to be “ill advised to say the least and mind bogglingly stupid to say the most,” he also found that Kilpatrick’s testimony that he paid Hopkins “out of my heart” to be laughably disingenuous. Since Hopkins should have been considered an employee of the park, he deserved workers comp benefits.

We have to throw in this pretty amazing quote from Kilpatrick about the event: “Brock could not resist one last time of harassing the bear with his habit of blowing smoke in their faces for God only knows what reason in direct defiance of my telling him not to disturb them!!!”

Hopkins is clearly lucky to have survived the encounter and hopefully has learned his lesson. If you or another family member has been hurt at work (even if you don’t work at a Grizzly Park), your employer or the state could be liable for your medical bills, time off work and other costs. Filing out a North Carolina workers’ compensation claim is not easy. You can find more information about how to do so at the official North Carolina Industrial Commission website.

If you encounter any problems with your insurer, employer, or any other party, it may make sense to connect ASAP with a top caliber North Carolina workers’ compensation attorney to review your rights and make sure the legal system treats you fairly.

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Bear Attack Victim Eligible for Workers' Comp Despite Marijuana Use

Pot not to blame for bear mauling, judge rules

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)

Pursuant to North Carolina worker’s compensation laws as of the beginning 2006, here are some brief answers to FAQs you may have about worker’s compensation benefits and restrictions. Please speak with an attorney before making any decisions about your claim and coverage.

How long can you wait after you get hurt before filing for benefits?

One full week (seven days).

How long do you have to be out of work for an injury before you get retroactive North Carolina worker’s compensation benefits?

Three full weeks (21 days).

Who decides what physician you can see?

Your employer does, in general. But the North Carolina Industrial Commission can change your physician selection in certain cases.

What employees do North Carolina worker’s compensation laws cover?

• NC government workers
• Officers and employees of universities
• Elected officials of North Carolina
• Most temporary, part time, and full time employees

What does the North Carolina Worker’s Compensation Act say?

A worker hurt by accident that occurred during the course of or out of employment can get compensations. Not all work injuries will be compensable. Some event had to cause the harm. One exception: hernias and back injuries may be compensable even if the claimant cannot identify a specific traumatic event stemming from work that caused the problem.

The Act also says that so-called occupational diseases can be compensable. These are diseases or illnesses that occur more frequently in a particular occupation. For instance, stenographers tend to suffer higher rates of typing injuries than do people in other professions. So, carpal tunnel syndrome may be classified as an occupational injury for a stenographer. However, say a stenographer comes down with diabetes. That may not be a compensable occupational disease, since being a stenographer does not typically predispose to getting diabetes.

What must an injured employee do to get compensation?

First, you must tell your employer as quickly as possible after the injury happens. If you wait 30 days or more, the employer may be able to refuse to pay out North Carolina worker’s compensation benefits. The injured party must also file a claim with the North Carolina Industrial Commission within two years from the injury or from the time that the injury was recognized.

Should you get legal help for your claim?

It never hurts to discuss your matter for free and in confidence with a qualified and proven North Carolina Worker’s compensation attorney. A free consultation is non-binding, meaning that you don’t have to pay for any services if you choose not to retain the lawyer after speaking with her.

More Web Resouces:

North Carolina Industrial Commission

North Carolina Worker’s Compensation Act

A sad and disturbing fraud case out of Pennsylvania has North Carolina workers’ compensation policy makers and analysts furiously debating a number of moral and ethical quandaries.

Background

On April 29, authorities arrested 43-year-old Christina Gamble for workers’ comp and insurance fraud stemming from a claim she made in November 2007 that she allegedly made under false pretences.

The PA Attorney General’s office alleges the following:

Gamble had been working for the restaurant Red Robin, when she fell on November 9, 2007 and hurt her back. The restaurant alerted its insurance carrier. In November 2008, a judge awarded her benefits for workers’ compensation. She collected over $22,700 in disability benefits and $4,100 in medical expenses before being caught working in a new capacity – as an exotic dancer for C.R. Fanny’s Gentlemen’s Club and Sports Bar. A private investigator tipped off an agent of Highmark Insurance, which had been representing Red Robin. Since Gamble made her claim on the basis that she could barely move her back, her work as a dancer for hire obviously completely undermined her claim.

Gamble is due in court on May 7. If she is convicted of both accounts of insurance fraud and theft, she could face 14 years in jail and $30,000 in fines.

Workers’ comp and insurance fraud are obviously reprehensible. Enforcement of North Carolina workers’ compensation laws must be strict to ensure that people who do play by the rules get treated fairly and that system-wide costs don’t get out of control. Nevertheless, this case illustrates – or at least implies – how difficult it can be for some people to recover from bad injuries or occupational diseases. Here is a story of a waitress who presumably hurt herself and then did a wrong thing by stealing from her employer’s insurance carrier. But (likely) the news story does not give us the full human dimensions of Gamble’s struggle. As anyone who has personally dealt with North Carolina workers’ compensation issues can tell you, it’s not easy to handle insurance companies or to figure out how to correctly and efficiently get your life back on financially solid ground.

To that end, before you or a family member does something dumb like try to defraud an insurance company or misreport numbers on your workers’ compensation form, connect with an ethical, reliable, and results-proven North Carolina workers’ compensation attorney to discuss your situation in confidence. A free consultation can give you the strategic guidance you need to make wise and ethical decisions about how to move forward and recover from an injury, both medically and financially.

More Web Resources:

Christina Gamble fraud saga

Strip club no cure for her bad back

A relatively small felony case is turning the heads of top North Carolina workers’ compensation specialists. According to news sources, a 48-year old man named Richard Scepkowski pled guilty to felony workers’ compensation fraud after being caught working at an auto repair center. Scepkowski worked for the Transportation Security Administration (TSA) at Albany’s airport before claiming injury around July 4, 2004. He filed workers’ comp paperwork with the Department of Labor and collected a payout of nearly $20,000 from September 2004 through August last year. This amount is (relatively) minor as far as workers’ comp fraud cases are concerned. But since Scepkowski pled guilty to making false statements, he now faces an array of strict penalties.

How This Small Case Relates Back to North Carolina Workers’ Compensation Concerns

1. It illustrates how persistent the government can be in terms of rooting out fraud and punishing offenders.

Scepkowski got away with collecting federal workers’ comp for more than five years before getting caught. This shows that people who attempt to defraud the North Carolina workers’ compensation system will always be at risk for getting caught and facing severe financial penalties and potentially other punishments, such as jail time.

2. Even small instances of workers’ comp fraud will be taken very seriously.

A felony conviction can result in jail time and the permanent loss of certain privileges, such as the right to vote in elections.

3. The case shows how important it is to file your workers’ compensation paperwork carefully.

In this case, a claimant willfully deceived the DOL in his paperwork. Nevertheless, even otherwise well-intentioned claimants who make mistakes in their applications can get in big trouble – or at the very least lose hard-won benefits.

If you have any questions about the North Carolina workers’ compensation process or about your paperwork, connect ASAP with a reputable and experienced NC workers’ comp attorney to learn more about your rights and responsibilities under state and federal law.

More Web Resources:

Scepkowski case

Another story about Scepkowski fraud

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