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!

Back To School Driving Safety Tips For North Carolina and South Carolina

School is Back in Session!!!


Unfortunately, the summer is now over, so gone are those wistful days at the pool, beach, or lake, although some parents are probably doing a little dance that their kids now have something to do – go back to school.  So, here we are again at the end of August where most of North Carolina and South Carolina gears up for another year of PTA meetings, sports events, and practices, concerts, and teacher conferences.  Some would say that being a parent is like having another full-time job.  Parents now have to skip that second cup of coffee, or worst yet their coffee altogether, and get ready for a new school routine.  Typically, someone in the household is starting at a new school, doing a new activity, or maybe even going to school for the very first time.  Parents have to transport their children to school, get to work on time, and then sprint out of the door to begin a totally new after school routine.   Drivers who don’t have children may also be learning new routines as they could have switched jobs, or moved to a different part of town.  Every single driver on the roads and highways of North Carolina and South Carolina will be dealing with new commuting routes, new traffic patterns, but the same hustle and bustle!

If at all leave your home, or apartment, much earlier than normal to avoid driving negligently and thus end up as the person responsible for an automobile accident.  When you are running late, it is easy to give in to the temptation to speed, try to beat a red light, or worse email or text someone while driving.  Also, be aware of the school buses on the road as both North Carolina and South Carolina law allots significant points to your drivers’ license if you make a bad decision and pass a stopped school bus with its signal lights flashing and caution arm engaged.  A great way to decrease the chance of this ever happening is to know where the school bus stops are in your neighborhood, on your way to work, and anywhere else you are traveling as part of your new routine.  Drive responsibly and slowly when you are passing schools, bus stops, and stopped school buses, because we all want the kids to get on their bus safely, walk home safely, and you, of course, want to get where you need to on a daily basis without getting an unwanted ticket, or by driving negligently causing a tragedy.

Sharing the highways and byways of your town or city are inexperienced drivers that just got their licenses, or permits, drivers who have relocated to your town, or city, and even drivers whose new commute brings them into a new area that they are unfamiliar with.  Driving cautiously and defensively will help you be aware of drivers who may be speeding because they are running late, changing lanes improperly because they don’t know where they are, or simply not paying attention to the road in front of them.  It is easier to let someone merge on your terms, rather than have the person try to “force” their way in!  Driving courteously and calmly will always be the safest way for you to travel, even if the others on the road with you are not behaving in the same way.  The beginning of the new school year is always symbolic of new experiences, and driving responsibly will make it that much better for all of us!  The attorneys of Tippens & Zurosky wish you the best for a happy and prosperous new school year. 

Tippens & Zurosky has represented people involved in auto accidents in North Carolina and South Carolina for over twenty years.  Let us answer any of your questions regarding any automobile accident.  Call us toll free at (877) 372-3580, or 704-343-0018 to schedule a consultation so that we may assist you.

I Hurt My Back on the Job – Is that Workers’ Compensation?

Workers’ Compensation and Back Injuries

Hurting your back on the job if you work in a warehouse, factory, construction site, shipping and receiving, logistics, or retail is a very real possibility as most of the jobs in these places of employment involve heavy lifting.  The part of the body that people are most vulnerable to injuring on the job in these places of employment, are their backs.  But, what is considered a compensable back injury for workers’ compensation purposes?

A compensable back injury must be the result of what is called a specific traumatic incident.  A specific traumatic incident can be defined as an injury that happened at a specific time – for example: lifting a heavy box on the job and feeling pain in your back.  If your back is simply sore from lifting boxes over time, and you cannot pinpoint any specific time where you lifted a box and felt pain in your back that is not considered a compensable workers’ compensation case.  Pain on its own does not meet the definition of a specific traumatic incident.  It is perfectly fine to not know the exact time, or date, you suffered a specific traumatic incident.  If you know you lifted a box, and felt pain in your back, but you are not sure if you did it at midnight, or at two o’clock in the morning, that is still a compensable workers’ compensation back injury. 

It is important to remember that major self-injured corporations, and workers’ compensation insurance companies dread back injuries.  Back injuries generally are viewed as costing them the most money, and result in the most lost time for their employees.  We have seen circumstances where injured workers have been purposely told incorrect information regarding the compensability of their workers’ compensation back injury, and told to file it under their private health insurance.  We have also had injured workers told by their bosses to tell the hospital the back injury happened at home and not at work.  The bosses then promise to take care of everything, but ultimately the workers’ claims are denied.

It is absolutely crucial that if you hurt your back lifting something on the job, you report it immediately, have an accident report done, and insist they send you for medical care.  Do not try to tough it out, or wait until the next day to see how it feels.  When you see the medical provider, make sure to state that your lifting injury to your back happened on the job.  Do not let yourself be a casualty of a cost-savings maneuver by your company.  Your company is going to do what is best for it – you need to protect yourself and consult an experienced workers’ compensation attorney.

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. 

Am I an Employee, or an Independent Contractor?

Workers’ compensation covers an injured worker if they get injured in the scope of their employment.  But, what if you are not sure if you are actually an employee of the business you were working for when you got hurt on the job?  The law looks at several factors to determine if you were an employee, or you were an independent contractor.  The difference means getting covered for workers’ compensation as an employee, and being denied workers’ compensation benefits as an independent contractor.

Generally, the elements that delineate if you are an independent contractor are:  if you are running an independent business, or occupation, that specializes in doing the kind of work you were doing when you got hurt, you have the independent use of your knowledge, skills, and training to do the work, you are doing the work at a fixed price, or for a lump sum, or upon a quantitative basis, you are not subject to firing for doing the work one way versus another, you are not in regular employ of the other contracting party, you are free to use such assistants as you see proper to use, you have full control over such assistants, and you control the hours that you work. 

Every case is different, but the more control you have over a job and its details, the more likely the courts using the factors above will lean to you being considered an independent contractor.  Other common examples of independent contractors are paper boys, taxi drivers, and certain agricultural harvest workers.  Sometimes the differences in this area of law are very subtle, and thus if your workers’ compensation case is denied because you are in deemed an independent contractor, you should call us for assistance.

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. 

My loved one died after they got hurt on the job – is that workers’ compensation?

Workers’ Compensation Related Deaths

Workers’ compensation protects an injured worker if they get injured in the scope of their employment.  Likewise, if an injured worker is killed on the job, workers’ compensation is there to provide benefits for the injured worker’s family.  In cases where a worker was killed in a motor vehicle on the job, or involved in a fatal industrial accident, it is usually fairly clear cut that workers’ compensation is responsible.  But, what happens if an injured worker passes away some time after the accident.  Does that death still fall under workers’ compensation?

If an injured worker is hurt on the job, and has surgery because of this injury, and develops complications from the surgery, and dies that would turn into a workers’ compensation death claim.  Likewise, if an injured worker is recovering from a surgery and suffers an aneurysm, and dies that too would be a workers’ compensation death claim.  The caveat to these cases are the medical professionals involved must be able to say that more likely or not the injured worker’s death was related to the surgery, and the aneurysm respectively.  If they can’t or won’t say, then the burden becomes more difficult to meet.  Expert testimony in the form of a medical professional is necessary to prove the relationship of the death to the original workers’ compensation injury.

If an injured worker suffers a job-related injury, and aggravates a preexisting heart condition, which causing their death, that is also considered to be a compensable workers’ compensation death claim.  Also, if an injured worker receives a compensable injury on the job and because of the pain and suffering becomes so depressed, and/or not in his or her right mind, that he or she commits suicide, that is a compensable workers’ compensation death claim.  As with many aspects of workers’ compensation law, the details of each particular case can be subject to interpretation.

Don’t go at it alone, 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.