Advice/Suggestions Needed

[nobody]

Just stay on point with the claim and get it completed before you take on the payroll issue. Also I dont know if anyone else has mentioned it but your local super walmart will sell decent (ish) recorders that will be pretty small. Worth there weight in gold if you can record you conversations about this issue.

[Stay Puft]

Ok, I am new here. I have lurked here for some time, but when I read this thread I decided to sign in to give some advice. I work in insurance and am a Worker's Compensation specialist.

I am a huge Panthers fan, and I thought I would try to help you out. Worker's Compensation issues can be complex and intimidating for the injured worker. A board certified worker's compensation attorney can help you with your case, but it is not necessary. You should realize that they are firstly in business to make money, and will usually take an attorney's fee of 25% of any settlement or weekly disability check you may be entitled to. There is nothing that the attorney can do that you cannot do yourself. It is just easier if you know your rights.

The North Carolina Industrial Commission governs all Worker's Compensation claims in NC. There are two forms that are filed to report a claim. A form 19 is filed to the IC by your employer. This form simply sends acknowledgement that an incident occurred at your job. It really doesn't mean anything. The form 18 is the filing of a claim by the employee. It must be filled out by the injured worker and submitted to the IC. It sounds like you have already done this, so that is good for you. Once a Form 18 is filed the IC sends notice to the insurance carrier, and they have a short amount of time to either accept, deny, or pay your claim without prejudice. A form 60 is filed to accept your claim, a Form 61 is used to deny your claim, and a Form 63 is used to pay without prejudice (this gives the insurance company time to further investigate your claim before making a compensability decision).

Based on what you described, you had a compensable injury by accident (an acceptable claim). In order for a claim to be acceptable an accident must occur, or something unusual or out of the ordinary. You may get contacted by a claims adjuster from the insurance company to obtain a recorded statement. They want to determine if an injury by accident occurred. If you have these types of incidents with the animals on a regular basis, they may deny your claim. If it was the first time it happened and you work with these animals all the time, then you would be in the normal course and scope of your employment, and your claim will likely be accepted. Just make sure that you emphasize that this event was out of the ordinary. Also, the words twisted, slipped, tripped, or fell, generally make any accident compensable. Just do not say that something popped, gave away, or happened without known cause.

If your claim is accpeted the carrier will authorize medical treatment with the physician of their choosing. NC general statutes under worker's compenastion law allow them to do so (NC-GS 97-25). You should comply with the treatment. Generally speaking worker's compensation adjusters want to send you to a good physician, as it generally saves money in the long term. Repeat surgeries etc. cost a lot of money. That being said, if your doctor releases you at Maximum Medical Improvement (MMI) you should know that you are entitled to a 2nd opinion with a physician of your choice.

At the conclusion of your treatment you may receive a permanent partial disability award. However, these are generally given if a claimant has surgery, or if they have some permanent disability due to the work injury (range of motion etc..) The amount you are paid are based of guidelines set forth by the NCIC, and the percentage of disability assigned by your physician. If you have no permanent disability you may be entitled to a disfigurement award, but only if you have permanent scarring etc..

Be aware that your claim has nothing to do with your current employment. If you quit, get fired, etc, it does not affect your claim. If you are released from care you have up to 2 years to seek additional medical treatment from the date of the last payment made by your insurance carrier.

Again, there is really no reason you need an attorney unless your claim is denied. In that event you may file a Form 33 (request for a hearing) to the IC. If you do request a hearing you would be best to retain counsel, as the insurance company will definately be represented in those matters. These hearings go before the Industrial Commission and not a judge and jury. You only get into those matters if the matter is appealed. NC laws are generally favored in the injured worker's behalf, so I think you will be fine. I am not necessarily advocating that you do not need to hire an attorney, but there are downsides as well. You may end up sitting there in pain while your attorney and the insurance company's attorney(s) litigate everything. It may not be to your advantage. You cannot sue your employer.. Worker's compensation was created to eliminate law suits against employers... there is no pain and suffering to collect. You may end up receiving a settlement, but that is a mutual agreement between you and the insurance company. As pointed out earlier, the insurance company may only offer about 20% of what your settlement is worth, it should also be noted that plaintiff attorneys request 300 - 400% or more of what the actual value of the claim is worth. Generally, the plaintiff attorney makes a demand of a very high number, then the insurance company makes a very low couter offer, and the idea is that they generally meet in the middle.. i.e. if an attorney makes a demand of 100k the claim is usually worth about 50k.. The insurance company will make a counter offer of 25k, and they both work from both ends until a settlement is reached.

I hope this helps you. If you have any concerns, I would be glad to help.

[CRA]

Ok, I am new here. I have lurked here for some time, but when I read this thread I decided to sign in to give some advice. I work in insurance and am a Worker's Compensation specialist.

I am a huge Panthers fan, and I thought I would try to help you out. Worker's Compensation issues can be complex and intimidating for the injured worker. A board certified worker's compensation attorney can help you with your case, but it is not necessary. You should realize that they are firstly in business to make money, and will usually take an attorney's fee of 25% of any settlement or weekly disability check you may be entitled to. There is nothing that the attorney can do that you cannot do yourself. It is just easier if you know your rights.

The North Carolina Industrial Commission governs all Worker's Compensation claims in NC. There are two forms that are filed to report a claim. A form 19 is filed to the IC by your employer. This form simply sends acknowledgement that an incident occurred at your job. It really doesn't mean anything. The form 18 is the filing of a claim by the employee. It must be filled out by the injured worker and submitted to the IC. It sounds like you have already done this, so that is good for you. Once a Form 18 is filed the IC sends notice to the insurance carrier, and they have a short amount of time to either accept, deny, or pay your claim without prejudice. A form 60 is filed to accept your claim, a Form 61 is used to deny your claim, and a Form 63 is used to pay without prejudice (this gives the insurance company time to further investigate your claim before making a compensability decision).

Based on what you described, you had a compensable injury by accident (an acceptable claim). In order for a claim to be acceptable an accident must occur, or something unusual or out of the ordinary. You may get contacted by a claims adjuster from the insurance company to obtain a recorded statement. They want to determine if an injury by accident occurred. If you have these types of incidents with the animals on a regular basis, they may deny your claim. If it was the first time it happened and you work with these animals all the time, then you would be in the normal course and scope of your employment, and your claim will likely be accepted. Just make sure that you emphasize that this event was out of the ordinary. Also, the words twisted, slipped, tripped, or fell, generally make any accident compensable. Just do not say that something popped, gave away, or happened without known cause.

If your claim is accpeted the carrier will authorize medical treatment with the physician of their choosing. NC general statutes under worker's compenastion law allow them to do so (NC-GS 97-25). You should comply with the treatment. Generally speaking worker's compensation adjusters want to send you to a good physician, as it generally saves money in the long term. Repeat surgeries etc. cost a lot of money. That being said, if your doctor releases you at Maximum Medical Improvement (MMI) you should know that you are entitled to a 2nd opinion with a physician of your choice.

At the conclusion of your treatment you may receive a permanent partial disability award. However, these are generally given if a claimant has surgery, or if they have some permanent disability due to the work injury (range of motion etc..) The amount you are paid are based of guidelines set forth by the NCIC, and the percentage of disability assigned by your physician. If you have no permanent disability you may be entitled to a disfigurement award, but only if you have permanent scarring etc..

Be aware that your claim has nothing to do with your current employment. If you quit, get fired, etc, it does not affect your claim. If you are released from care you have up to 2 years to seek additional medical treatment from the date of the last payment made by your insurance carrier.

Again, there is really no reason you need an attorney unless your claim is denied. In that event you may file a Form 33 (request for a hearing) to the IC. If you do request a hearing you would be best to retain counsel, as the insurance company will definately be represented in those matters. These hearings go before the Industrial Commission and not a judge and jury. You only get into those matters if the matter is appealed. NC laws are generally favored in the injured worker's behalf, so I think you will be fine. I am not necessarily advocating that you do not need to hire an attorney, but there are downsides as well. You may end up sitting there in pain while your attorney and the insurance company's attorney(s) litigate everything. It may not be to your advantage. You cannot sue your employer.. Worker's compensation was created to eliminate law suits against employers... there is no pain and suffering to collect. You may end up receiving a settlement, but that is a mutual agreement between you and the insurance company. As pointed out earlier, the insurance company may only offer about 20% of what your settlement is worth, it should also be noted that plaintiff attorneys request 300 - 400% or more of what the actual value of the claim is worth. Generally, the plaintiff attorney makes a demand of a very high number, then the insurance company makes a very low couter offer, and the idea is that they generally meet in the middle.. i.e. if an attorney makes a demand of 100k the claim is usually worth about 50k.. The insurance company will make a counter offer of 25k, and they both work from both ends until a settlement is reached.

I hope this helps you. If you have any concerns, I would be glad to help.

This is good advice. I also work in the insurance field. Don't feel pressured to stay in a very bad scenario out of fear it will void your claim. The date of injury is what matters, you were employed then.....being employed a week or month later by the same company doesn't really matter.

I also agree with him on attorney as well....too often people rush to an attorney bc they think that is standard procedure. They are getting your money.....and that also don't always get enough "extra" to make their services worth it.

[sunbunny]

How long does it usually take? It's been almost a month and still no answer from wc.

[Stay Puft]

How long does it usually take? It's been almost a month and still no answer from wc.

It sounds like the employer may not have informed the insurance carrier. There isn't anything the wc carrier can do until they receive notice of a claim. The filing of the Form 18 to the NCIC will result in the NCIC sending notice to the wc carrier to either accept, deny, or pay your claim without prejudice within 30 days. If they do not respond, they are subject to sanctions (fines) by the NCIC. This money comes from the carrier and not the employer. If they are getting sanction notices they will definatley take action. If I were in that situation, I would call an ombudsman at the NCIC and find out who the carrier is for your paticular employer, and I would contact them directly. You may have to be persistant. I believe the OP indicated that she had been contacted by an adjuster so that should not be an issue. I would blow up their phone until you get some answers, or some direction regarding your medical treatment.

In the meantime, if no one is authorizing any medical treatment then you should seek it on your own. Go to either the ER or to your family doctor. In fact, if you do go to the ER, make sure you follow up with your family doctor anyways. The ER will not always address your work status. Make sure you report that the injuries occurred at work. Keep receipts of everything, including any co-pays, prescriptions, or medical equipment (slings, etc). If you have to travel greater than 20 miles round trip, keep a log of that as well. All of those things can be reimbursed to you by the carrier. You have to fill out a form 25P or form 25T, which you can download from the NCIC website http://www.ic.nc.gov/forms.html#claims. If for some reason your adjuster tells you that you sought this treatment on your own, and they are not responsible for reimbursing you, make it clear that you had no alternative, and that your employer did not direct you anywhere.

Once you have been to the doctor, make sure to turn in a work note to your employer. If you are given restrictions, then make sure that they can accommodate them. If you are taken out of work completely, make sure they have that note as well. If they cannot accommodate your restrictions, you will not be able to return to work. WC doesn't pay for the first 7 days of disability, unless your disability goes beyond 21 days (they go back and pick up the first week). This is called the waiting period.

Allow 30 days to pass since you filed the Form 18. If you haven't heard from anyone at that time, you will need to file a Form 33 and request a hearing. I doubt it will come to that, but if it does, then that particular filing will definatley get their attention.

I hope this helps. I know it is confusing because there are a lot of people involved (employer, injured worker, wc carrier, NCIC, and medical provider).

[LifeisaGarden]

Wow! I am astonished and feel blessed to have received so much help from the Huddle. Panther's fans are truly the greatest! Thanks Guys!!

Stay Puft, Thank you for all your information! I have questions forming in my head as I type. After I get it together I'll ask them.

[ladypanther]

Glenda....you are an awesome person. You do not deserve the circumstances you have been given. So glad to see good Huddle advice.

Animals deserve better too. So glad that you care.

[LifeisaGarden]

Thanks LP!

So here's an update on things,

I finally received my pay for the last pay period today, it was all cash and left in a bank envelope hidden in a cubby. It was actually rounded up to the next dollar instead of giving me $.07 in change, so now I "owe" them $.93. You better bet I'm going to give it back to them. She neglected to call me yesterday to tell me where it was so I called her and she said she didn't know why she forgot about telling me where it was. So anyway, I got it today and today marks 10 days since I was supposed to receive my check. Guess who's calling NCDOL to report a wage complaint tomorrow. :D

I just called her to notify her that I will not be coming into work until further notice because of my injury. I told her that when I worked, it was making it feel worse and I needed to look after my best interests. I didn't tell her I was quitting.

I was advised that I needed to not go into work so I could be reimbursed for lost pay because of my injury. It doesn't make sense for me to quit because then what am I going to do meanwhile? It's not like I can get another job right now, who is going to hire me with a bum hand and with the possibility of having to stay out of work for a period of time seeing that It might need surgery.

Btw, I cant believe this thread has had 64 posts and there's not one ounce of dumbassity in it. You all should be ashamed of yourselves!

[Anybodyhome]

well.... it is pretty difficult to hold onto misbehaving boxers with only one good hand.

...and in the immortal words of NC State basketball legend Charles Shackleford, "Left hand, right hand, it doesn't matter. I'm amphibious."

[LifeisaGarden]

Here are some more images of the shithole, my swollen hand and the dog that attacked me.

The photos need to be viewed from the last photo to the first photo. I don't know how to fix it right now.

I still haven't found out if he can keep chickens on the premises.

[LifeisaGarden]

I have an attorney now. I didn't even have to shop around.

We have known this guy for 15 years and it didn't even cross my mind until someone else we know mentioned it this weekend. I didn't think about it because he doesn't live locally. I called him this morning and he was like shoot yeah, I'll help. He's super smart, an honest fellow and a wonderful friend. I'm looking forward to working with him.

[ladypanther]

So...any updates?

[LifeisaGarden]

I gave my employer my Notice of Accident on Tuesday. Right before I gave it to her I had just hung up with the insurance adjuster. I told the insurance adjuster that I hired an attorney. So when I was walking into my workplace I was actually there when the insurance adjuster called my supervisor. The look on my supervisors face when she came out of the office and saw me was priceless. I could tell she was pissed. She hardly said 2 words to me. I gave her the notice and I left.

I just sent the paperwork off to my attorney so hopefully by the first of the week I'll hear at least something from them. My attorney said the insurance company has 30 days to respond once they notify them so it could take at least that long to find out anything. I was told I didn't need to wait that long to see a Dr though. So, hopefully it will be soon.

[nobody]

I gave my employer my Notice of Accident on Tuesday. Right before I gave it to her I had just hung up with the insurance adjuster. I told the insurance adjuster that I hired an attorney. So when I was walking into my workplace I was actually there when the insurance adjuster called my supervisor. The look on my supervisors face when she came out of the office and saw me was priceless. I could tell she was pissed. She hardly said 2 words to me. I gave her the notice and I left.

I just sent the paperwork off to my attorney so hopefully by the first of the week I'll hear at least something from them. My attorney said the insurance company has 30 days to respond once they notify them so it could take at least that long to find out anything. I was told I didn't need to wait that long to see a Dr though. So, hopefully it will be soon.

You should have taken a photo and shown us.

Not like she could fire you.

:thumbsu: (jk and good luck)