Workers’ Compensation and Medical Care In North Carolina

In 2024 workers’ compensation, your employer, or their workers’ compensation insurance company are responsible for paying all of your medical bills one hundred percent if they accept your case as compensable under the law.  The rub on this is that they get to direct your medical care to a doctor of their choice, not your choice.  This quirk of the law would seem to be a built in conflict of interest in that the person responsible for paying your bills gets to send you to whomever they choose.

Quite often, companies choose to send injured workers to urgent care clinics that “specialize” in workers’ compensation injuries.  These organizations are the gatekeeper to an injured worker seeing a true specialist.  The prime directive of these organizations is to keep the costs of medical care down, and to get the injured worker back to work as soon as possible.  It stands to reason if the person paying the bill wants a certain result, you can bet the medical provider will do what they can to make that happen.  The built in conflict of interest part comes in where the medical provider wants to keep getting business from the employer, or workers’ compensation insurance company.  Naturally, they are afraid of doing something the employer, or workers’ compensation insurance company doesn’t want them to do: like recommend an expensive MRI, take the injured worker out of work, or refer the injured worker to see a surgeon.  We have had clients that were told by these types of medical facilities that they “weren’t allowed” to take them out of work, or “couldn’t” recommend an MRI.  So, if the company, or their workers’ compensation carrier, is the one driving the medical care bus, you can imagine why your workers’ compensation doctor may be rather dismissive.

The other thing which sometimes can result in speedy physicians in and out of an exam room is the fee schedule.  The fee schedule is set by the state and determines what the physician is paid for his, or her, services.  The amount of money set by the fee schedule is usually less than that of what the physician gets paid for the same services from other sources such as private health insurance.  Thus, in workers’ compensation it is not unusual to hear of a physician, triple or quadruple booking the same hour for workers’ compensation patient appointments.  If this happens to you don’t be discouraged from asking questions and getting the care you need, and deserve.  The doctor has a professional obligation to be there for you, and answer your questions!

Tippens & Zurosky is here to serve your  workers’ compensation needs, and has skilled and compassionate attorneys available to answer any and all questions that you might have about your case.  Tippens & Zurosky has represented people who were hurt on the job in North Carolina and South Carolina for nearly twenty years.  Let us answer any of your questions regarding any work-related injury.  Call us at 704-343-0018 to schedule a consultation so that we may assist you.

Should I Settle My Workers’ Compensation Claim?

 Having an accepted workers’ compensation claim can be a long process.  Not only are you getting paid less than your average weekly wage, but you also may not have a say in selecting which doctor is working with you.  Some workers’ compensation cases go on for years through surgeries, rehabilitation, and vocational rehabilitation. Tippens & Zurosky is here to fight for you.

 

A workers’ compensation case can settle one of two ways.  You can settle on what is called an open agreement, referring to you not closing out your right to future medical care paid for by the workers’ compensation insurance carrier, or your employer.  You can also settle on what is called a clincher, or compromise settlement agreement.  These full and final agreements will typically compensate you for a higher sum than an open agreement because you are waiving your right to future medical care, and sometimes weekly indemnity payments.

So, which way of settling your workers’ compensation case is best?  There is not an easy answer to this question as no workers’ compensation case is exactly the same.  If you had the type of injury where you returned to work with your employer relatively quickly, then an open agreement is usually done. The decision to clincher, or fully and finally settle your workers’ compensation case is often a complicated one.  You may not know what future medical treatment you are going to need. Many workers’ compensation insurance companies would rather offer a lump sum than stay on the hook for your medical care in the future. 

 If you have a workers’ compensation case, and you have reached the point in your case where it is time to resolve it one way, or the other, please pick up the phone and call Tippens & Zurosky. Trying to settle a workers’ compensation case on your own can be difficult, especially when the workers’ compensation insurance company is in business of settling claims, and you are not!  You need someone to look out for you, so call us, so we can be your voice, answer all of your questions, and help you resolve your claim!  Tippens & Zurosky has knowledgeable, experienced attorneys certified in North Carolina and South Carolina, who can fight for your rights during this often long and difficult workers' compensation process. Call us at 704-343-0018, for a free consultation. Let us help you!

Can Managers and Supervisors File For Workers Compensation?

What happens when managers, or supervisors, get hurt on the job in North Carolina or South Carolina? The reality of the matter is that highly paid employees, such as managers, or supervisors, have high compensation rates that make their workers’ compensation cases very expensive to their company.  So, the company does what is in the best interest of the company, and quite often cuts their losses, and may fire their loyal employee. Tippens & Zurosky can help you win your workers’ compensation case.

 

Workers’ compensation cases can be confusing, especially when your company is not doing what is best for you.  Tippens & Zurosky, can be your voice, answer all your questions, and file your workers comp claim.  Tippens & Zurosky has knowledgeable, experienced attorneys certified in North Carolina and South Carolina, who can fight for your rights during this often long and difficult workers' compensation process.  Call us at 704-343-0018, for a free consultation.  Let us help you!

 

 

I Got Hurt During My Company’s Trip – Is that Workers’ Compensation?

 

Many companies have a yearly company trip where alcohol is flowing freely, and judgment can be compromised by a “party” atmosphere.  So, what happens if you get injured during the company trip?  Is your injury covered under workers’ compensation?  If you slip and break your collarbone because you slipped on the hotel’s steps, there are factors which dictate whether this is workers’ compensation or not.  The workers’ compensation laws of North Carolina and South Carolina construe what is in the course of your employment very broadly.

 

Factors that come into play for an injury that occurred at a company outing include:

• Whether the outing was paid for by your employer.
• Whether you were paid wages while on the trip.
• Whether the outing was considered a fringe benefit of your job.
• Whether attendance was mandatory.
• Was the purpose of the outing was to benefit the employer.

 

So, if you have been hurt on the job during a company trip, pick up the phone and call Tippens & Zurosky, so we can be your voice, answer all of your questions, and file your claim!  Tippens & Zurosky has knowledgeable, experienced attorneys who can fight for your rights during this often long and difficult workers' compensation process.  Call us at 704-343-0018, for a free consultation. Let us help you!

Who Can You Trust When You Have An Accident?

It used to be in the time before social media, texting, and cell phones, that if someone knew they had wronged you in some way, they would take responsibility for their actions.  If someone caused a car accident, they would admit to their insurance company, and the investigating officer that it was their fault.  Now, we hear of those people that encourage the person they hit in an automobile accident to not call the police “because their insurance is good, and they will take care of everything.”  But, when they do talk to their insurance company they say that you were at fault, and they were the innocent party.  If you are involved in an automobile accident, it is sad to say, but you cannot rely on the other party to do the right thing.

First, immediately call the police to get an accident report done that shows exactly how the accident happened.  Take pictures of the accident scene, your injuries, and the license plate of the other party.  If there are any witnesses to the accident, find out what they saw, encourage them to talk to the police, and get their contact information .  A lot of folks want to wait to see how they feel before seeking medical attention.  But, the insurance company will not give you that benefit of the doubt, and will hold a delay in medical treatment against you.  Even though their insured driver was the one that injured you, the insurance company’s sole goal is to get out of this situation for as little money as possible.  So, don’t delay in seeking medical care.  Consult a doctor, or chiropractor immediately, so that your injuries are documented, and there are not gaps in your treatment.

It also used to be that if you got hurt on the job that you could rely on your long-time employer to take care of you, and get the workers’ compensation process started for you.  Some employers, though it seems fewer and fewer by the year, still do this, and really have their employees’ best interest at heart.  An all too increasing number of employers will do anything they can to deny workers’ compensation claims.  Don’t fall for the manager that tells you to go home, or that tells you they have no idea how to file workers’ compensation claims.  Most managers as part of their training know how to file workers’ compensation claims for their injured workers, they simply don’t want to do so, and have the injury be tagged to them, and thus be known as an “unsafe” manager.  Is this your problem as the injured worker?  Of course not!  So, the unfortunate answer to the who can you trust question above, if you have a workers’ compensation claim, is…no one but yourself!

If you are hurt on the job, don’t automatically think your employer, or supervisor is going to be a responsible manager, and do the right thing by reporting your injury, and making sure you get the medical care you need.  Make sure an accident report is done on the day of your injury.  Make sure you seek medical attention as soon as you possibly can do so.  Make sure you know the names and contact information of any witnesses to your accident on the job.  Above all else, do not do what some managers suggest, and go to a hospital, or urgent care, and tell the doctor that is happened at home, or somewhere else other than at your place of employment.  The first time you see a doctor is very important in workers’ compensation cases.  Because if you have a contested case, that first medical record is the very first evidence a hearing officer for workers’ compensation commissions will look at to determine if your case is compensable, or not compensable.

Also, if you are involved in an automobile accident, or injured on the job, it is helpful to speak with an attorney before you speak with any insurance company.  You can’t even sometimes trust what your own insurance company tells you, particularly if they are the ones that have to pay out on your behalf.  Tippens & Zurosky has represented people involved in auto accidents and hurt on the job, in North Carolina and South Carolina for over twenty years.  Let us help you deal with the unexpected, and get your life back on track.  Call us toll free at (877) 372-3580, or 704-343-0018 to schedule a consultation so that we may assist you. 

How Some Companies Avoid Having Their Employees Have Workers’ Compensation Cases – Gaming the System

With the dark clouds of an economic downturn seemingly on the horizon, companies are looking for ways to save money, and develop a cushion in case things really do get worse for them.  One of the most expensive parts of any company’s overhead is paying for workers’ compensation insurance.  The more workers’ compensation claims a company has in a given year, the higher their workers’ compensation premiums will be in the next year.  So, this year particularly, companies are very wary of incurring additional workers’ compensation expenses, which leads them to act in very creative ways to avoid having the claim show up on their books.

Instead of opening up a workers’ compensation claim for their employee who just got injured on the job, many employers will encourage their injured worker to use their company health insurance to pay for all medical bills related to their injury.  Some companies even go so far as to help their injured employee get on short-term disability, so that the injured worker has some money coming in while they are out of work.  In this scenario, the injury is never reported as workers’ compensation, thus never counts against the company for the purposes of assessing workers’ compensation premiums for the next year.  We have heard injured workers tell us that their companies have told them that they “don’t do” workers’ compensation claims, or the company “takes care of everything,” and they have nothing to worry about because their bills are being paid, and they are getting a short, or long-term disability check.


But, the reality is that the injured worker has plenty to worry about.  If the injured worker was in an automobile accident on the job, many hospitals will not even file health insurance, instead claiming a lien against the liability insurance company for the driver that caused the accident.  The injured worker then has to worry about getting stuck with an expensive hospital bill that is not paid in full!  Short-term disability policies may also not cover the injured worker for the time he, or she, is out of work because of their work-related injury.  There might not be a long-term disability policy available to the injured worker, or if there is, the transition between the policies is not seamless.  Thus, the injured worker may not be getting a weekly check for being hurt on the job like they would if they were on workers’ compensation.  For an accepted workers’ compensation claim, the company, or workers’ compensation insurance company, is obligated to pay the injured workers medical bills in full, 2/3 of their average weekly wage while they are written out of work, and a settlement for a permanent injury.  So, the only one that benefits from a legitimate workers’ compensation case from being handled this way is – the company!  If you are injured on the job, make sure you do what is best for you, and not what is best for your company!  Your interests and the company’s interest are not remotely the same, and don’t let them convince you otherwise.


If you have been injured on the job, don’t get an opinion on what you should do from your supervisor, manager, or the human resources department. You need to protect yourself, and the first step in that is calling us! Tippens & Zurosky has knowledgeable, experienced attorneys certified in North Carolina and South Carolina, who focus on workers' compensation and automobile accidents.  Call us toll-free at 877-872-3580, or at 704-343-0018, for a free consultation.  Let us help you!

Having a Super Workers’ Compensation Claim Starts with A Super Attorney

The Super Bowl has turned into a veritable national holiday in the United States.  No matter if your team is in the big game, or not, many folks tend to tune in to see the latest commercials, the halftime show, and even who wins!  This year’s Super Bowl pitted the young upstart Los Angeles Rams against the tried and true New England Patriots led by the grizzled Head Coach Bill Belichick, and the legendary quarterback Tom Brady.  In a throwback game, the Patriots prevailed 13-3, buoyed by a suffocating defensive effort, and making the clutch plays when it mattered.  At the end of the game, Sean McVay, the Rams Head Coach, was still flabbergasted by what had happened to his team, uttering the words “I got outcoached.”

If you have a workers’ compensation case in North Carolina or South Carolina, it stands to reason that you want to be the New England Patriots, and not the Los Angeles Rams!  Don’t pick an attorney that is going to be outcoached, and out maneuvered.  Simply, if you are seeking representation for your workers’ compensation case, just like the Super Bowl, experience really does matter.  Tom Brady, the Patriots quarterback, had been there before, and it showed.  Jared Goff, the Rams quarterback, was playing in his first Super Bowl, and that showed too.  Don’t entrust your workers’ compensation case to an attorney that does not practice workers’ compensation, or does not have the level of experience that you want.  You want someone like Tom Brady that has been there before, and has the experience to do the very best to prevail on your case.  The Super Bowl is one game for all the marbles with no do-overs, or second chances.  Likewise, you have just one workers’ compensation claim, and how it turns out could go a long way in determining your medical, and financial, future.  

In a workers’ compensation case, your attorney serves as your quarterback, head coach, and your defense.  Coming up with a strategy to achieve the best result on your unique set of workers’ compensation case facts is crucial.  Sometimes as a workers’ compensation attorney you need to think outside the box, and try something the other side does not expect.  Other times you need to stick to your game plan, and trust that things will go exactly how all of your experience says it will go.  Coach Belichick, and Tom Brady are known for in game adjustments based on the flow of the game.  A good workers’ compensation attorney knows how to adapt to the flow of a case, and to do his, or her, best to achieve the best result for their clients.

Tippens & Zurosky is here to serve your auto accident and workers’ compensation needs, and has skilled and compassionate attorneys available to answer any and all questions that you might have about your case.  We have been there before and know what to do to help our clients navigate the often confusing world of workers’ compensation.  We know how to perform in the clutch, and give every bit of our effort for our clients because we know your case is not just a game, but real life with very real repercussions.  Tippens & Zurosky has represented people involved in auto accidents, or hurt on the job in North Carolina and South Carolina for over twenty years.  Let us answer any of your questions regarding any automobile accident, or work-related injury.  Call us toll free at (877) 372-3580, or 704-343-0018 to schedule a consultation so that we may assist you. 

How Do Workers’ Compensation Claims Get Settled?

Having an accepted workers’ compensation claim is a long and often physically and mentally demanding process.  Not only are you getting paid only 2/3 of your average weekly wage, but you also do not have a say so in selecting which doctor is coordinating your medical care, or doing surgery on you.  Quite often family relationships get strained due to money issues, and because the injured worker feels he, or she, is no longer a contributing member of the household.  Some workers’ compensation cases go on for years through multiple surgeries, rehabilitation, and vocational rehabilitation.  But, what happens when the authorized treating workers’ compensation physician reaches the point where you are as good as you are ever going to be?

Generally, a workers’ compensation case can settle one of two ways.  You can settle on what is called an open agreement, referring to you not closing out your right to future medical care paid for by the workers’ compensation insurance carrier, or your employer.  You can also settle on what is called a clincher, or compromise settlement agreement.  These full and final agreements will typically compensate you for a higher sum than an open agreement because you are “clinchering,” or waiving your right to future medical care, and sometimes weekly indemnity payments. Often, as part of a compromise settlement agreement, you are required to sign an employment release and resignation from your employer.  Sometimes this is not a big deal as you either voluntarily quit, or took a new job.  It becomes more complicated if you are nearing a year in which your retirement becomes vested, or are so close to retirement age that any likelihood of working elsewhere is slim to none.



So, which way of settling your workers’ compensation case is best?  There is not an easy quick answer to this question as no workers’ compensation case is exactly the same.  If you had the type of injury where you returned to work with your employer relatively quickly, then an open agreement is usually done.  The exception to this is if your company has switched workers’ compensation carriers since you were injured.  Then, the old workers’ compensation company that is still responsible for your claim often wants to have you close out your workers’ compensation claim so that they can close their file.  Of course, you do not have to do this if you do not want to.  If you do an open agreement, different states have different options for giving you a chance to have someone else opine on the disability rating that your settlement is calculated on.  In North Carolina, you have a statutory right to a second opinion on the disability rating with a physician of your own choosing.  The workers’ compensation carrier has to pay for this visit, and the North Carolina Industrial Commission, the state agency that regulates North Carolina workers’ compensation, will typically average the rating of the workers’ compensation physician, and the physician you chose, to come to the amount of your compensation.  In South Carolina, while there is no right to a statutory second opinion on the rating, you are able to go in front of a hearing commissioner of the South Carolina Workers’ Compensation Commission, and they get to decide your percentage of disability, or impairment.



The decision to clincher, or fully and finally settle your workers’ compensation case is often a complicated one.  You may not know what future medical treatment you are going to need.  You can, of course, clarify this with the workers’ compensation physician, but some people don’t want to make a decision without an unbiased second opinion.  Some folks will see a physician entirely outside of workers’ compensation to get this type of confidential opinion.  But, if you don’t have the means to see a physician outside of workers’ compensation, you are not going to have this option.  So, you are going to ultimately have to bet on yourself in terms of when you will be able to return to work, if at all, and what kind of medical treatment you may need in the future.  Also, though it may be possible for you to return to work, your employer may not want to bring you back for fear that you will get injured again, or they have simply filled your job in the interim.  Nothing requires them to bring you back to the job, or provide another that meets with your permanent restrictions.  If they don’t have a job that meets your permanent restrictions, that is just one factor that determines what the workers’ compensation insurance company looks at in terms of evaluating your case for a full and final settlement.  They will also look at the doctor’s final note, and see what future medical treatment he, or she, is recommending.  Many workers’ compensation insurance companies would rather offer a lump sum than stay on the hook for your medical care in the future.   As you may have guessed, figuring out what to do when you are trying to close out your workers’ compensation case can be quite confusing.  Making a decision that literally may affect the rest of your life should not be made without consulting an attorney that practices in the field of workers’ compensation.



If you have a workers’ compensation case, and you have reached the point in your case where it is time to resolve it one way, or the other, please pick up the phone and call Tippens & Zurosky.  Trying to settle a workers’ compensation case on your own can be difficult, especially when the workers’ compensation insurance company is in business of settling claims, and you are not!  You need someone to look out for you, so call Tippens & Zurosky, so we can be your voice, answer all of your questions, and help you resolve your claim!  Tippens & Zurosky has knowledgeable, experienced attorneys certified in North Carolina and South Carolina, who can fight for your rights during this often long and difficult workers' compensation process.  Call us toll-free at 877-872-3580, or at 704-343-0018, for a free consultation. Let us help you!

Why is my Workers’ Compensation Doctor in such a rush?

Workers’ Compensation and Medical Care

In workers’ compensation, your employer, or their workers’ compensation insurance company are responsible for paying all of your medical bills one hundred percent if they accept your case as compensable under the law.  The rub on this is that they get to direct your medical care to a doctor of their choice, not your choice.  This quirk of the law would seem to be a built in conflict of interest in that the person responsible for paying your bills gets to send you to whomever they choose.

Quite often, companies choose to send injured workers to urgent care clinics that “specialize” in workers’ compensation injuries.  These organizations are the gatekeeper to an injured worker seeing a true specialist.  The prime directive of these organizations is to keep the costs of medical care down, and to get the injured worker back to work as soon as possible.  It stands to reason if the person paying the bill wants a certain result, you can bet the medical provider will do what they can to make that happen.  The built in conflict of interest part comes in where the medical provider wants to keep getting business from the employer, or workers’ compensation insurance company.  Naturally, they are afraid of doing something the employer, or workers’ compensation insurance company doesn’t want them to do: like recommend an expensive MRI, take the injured worker out of work, or refer the injured worker to see a surgeon.  We have had clients that were told by these types of medical facilities that they “weren’t allowed” to take them out of work, or “couldn’t” recommend an MRI.  So, if the company, or their workers’ compensation carrier, is the one driving the medical care bus, you can imagine why your workers’ compensation doctor may be rather dismissive.

The other thing which sometimes can result in speedy physicians in and out of an exam room is the fee schedule.  The fee schedule is set by the state and determines what the physician is paid for his, or her, services.  The amount of money set by the fee schedule is usually less than that of what the physician gets paid for the same services from other sources such as private health insurance.  Thus, in workers’ compensation it is not unusual to hear of a physician, triple or quadruple booking the same hour for workers’ compensation patient appointments.  If this happens to you don’t be discouraged from asking questions and getting the care you need, and deserve.  The doctor has a professional obligation to be there for you, and answer your questions!

Tippens & Zurosky is here to serve your auto accident and workers’ compensation needs, and has skilled and compassionate attorneys available to answer any and all questions that you might have about your case.  Tippens & Zurosky has represented people involved in auto accidents, or hurt on the job in North Carolina and South Carolina for nearly twenty years.  Let us answer any of your questions regarding any automobile accident, or work-related injury.  Call us toll free at (877) 372-3580, or 704-343-0018 to schedule a consultation so that we may assist you.

Why Does My Company Not Want Me to File Workers’ Compensation?

When you get hurt on the job, you become the most unpopular person in the company.  Why does this happen?  You got hurt at work doing your job, and thus when you got hurt you were making the company money.  Shouldn’t they be bending over backwards to help you get the medical care you need, weekly compensation if you are unable to work, and a settlement at the end of the case?  While this would seem the just and logical way your company should look at an on the job injury, the reality is that most companies are all too concerned with the bottom line.  You may have been making them money when you were a healthy employee, but the moment you got hurt on the job, you went from a money-maker to a money-taker!

In today’s world, competition in all areas of commerce is fierce, and literally every penny is pinched in companies across North Carolina and South Carolina.  When you got hurt on the job, you set in motion a whole set of costs and expenses that have made you that most unpopular person.  If your company is self-insured, meaning they pay all of their workers’ compensation expenses themselves, then your injury just added to, or changed what they had budgeted for workers’ compensation injuries.  That money has got to come from somewhere, and often that money is reflected in safety bonuses, or manager bonuses that are now not going to be paid all because of you.  So, if your manager is trying to discourage you from filing workers’ compensation, he or she, may have a very real world financial reason for doing so!  And, if your fellow employees don’t seem like they want to be a witness for you, those safety bonuses are a powerful motivator for not documenting an on the job injury.  Any witness statement that they do for you is actually not for you, because they are going to feel the pressure from management and other co-workers to make what they write down to be as favorable to the company as possible.

Just how far will a workers’ compensation insurance company go to avoid paying on a claim?  The answer may surprise you.  A recent North Carolina case featured a workers’ compensation insurance company that lost a decision in front of a hearing commissioner and all appeal.  Instead of just paying for the injured worker’s medical treatment, and weekly indemnity benefits, instead they hired a private investigator to edit surveillance video in such a fashion that made it look like the employee that was hurt on the job was committing fraud.  The workers’ compensation insurance company then directed its investigator to convince the local police department to bring charges against the injured worker for fraud.  The poor injured worker was arrested, jailed, and indicted on charges of obtaining property by false pretenses, and insurance fraud.  The charges were dismissed after another medical exam showed that the worker’s injury and condition was consistent.  Obviously, not every workers’ compensation company, or workers’ compensation adjuster would go, or does go to this extreme.  But, we have seen numerous instances where the workers’ compensation insurance company, their adjuster, and/or the self-insured company makes things all too personal. 

If you have a workers’ compensation case, and have been hurt on the job, your company has the legal obligation in an accepted workers’ compensation case to pay your medical bills in full, pay you compensation at 2/3 of your average weekly wage if you are written out of work, and compensate you for a permanent injury.  Workers’ compensation cases can be confusing, especially when your company is just doing what is in its best interest!  You need someone to look out for you, so call Tippens & Zurosky, so we can be your voice, answer all of your questions, and file your claim!  Tippens & Zurosky has knowledgeable, experienced attorneys certified in North Carolina and South Carolina, who can fight for your rights during this often long and difficult workers' compensation process.  Call us toll-free at 877-872-3580, or at 704-343-0018, for a free consultation.  Let us help you!