by Kevin Bunn | Feb 6, 2014 | Uncategorized
According to a News and Observer article the Division of Employment Services is taking longer to issue NC unemployment benefits. Many workers are waiting more than three weeks to receive benefits. Unemployment benefits are temporary payments made to tide over employees who are fired. Employees who are fired because of their bad conduct are generally not eligible for unemployment benefits.
According to the article the backlog has increased from 7296 claims in July to about 12,000 in January. Employment Security officials blame the backlog on increased efforts to ensure that payments are made to employees entitled to the benefits, and the fact that many employers fail to timely submit needed paperwork. Up to 40% of employers do not report the reason an employee was separated from their employment.
Federal standards require the payment of 87% of claims within 21 days. The U.S. Department of Labor is also pressuring the state to not overpay or improperly pay benefits. Under a new state law Employment officials are required to attempt to recoup any improper payments.
Claims where the employer and employee disagree on the reason for the separation must be heard, or “adjudicated,” by the ESC. Typically ESC will make an initial decision based on reports from the employer and the employee. If the stories match up, and the employee is eligible for benefits, then payments begin. If there is a dispute between the parties as to how the separation from employment occurred then benefits may be denied. Either party can appeal and request a more formal hearing before a hearing officer.
NC unemployment benefits can play a critical role in a NC automobile accident or other personal injury case. An employee who is fired because he or she is unable to return immediately to work because of injuries sustained in an automobile accident can claim unemployment benefits while they recover. While unemployment benefits will not replace lost wages then can provide some short term support for an accident victim. Unemployment benefits can provide a similar benefit in a denied North Carolina workers’ compensation case. While the employer may get a credit for unemployment benefits if the workers’ compensation case is later determined to be covered the benefits can at least provide some income during a period of disability.
by Kevin Bunn | Feb 3, 2014 | Car Accident
Often the most difficult aspect of a NC automobile accident case has nothing to do with who was at fault in the accident, the nature of the injuries or how to find insurance to cover the claim. Increasingly personal injury cases are dominated by efforts to ensure that the recovery goes to benefit the injured person and not to reimburse a third party health plan. This article discusses the increasingly important issue of ERISA reimbursement in NC auto accidents.
In North Carolina, private health insurers are prohibited from seeking reimbursement for payments made for medical treatment when there is a recovery from the person who caused the injury. Such reimbursement is called “subrogation.” Insurers in North Carolina are also prohibited from denying payment for injuries that arise from another’s negligence, like an automobile accident.
Most large employers however provide their employees health benefits through self-funded health plans authorized under the Employee Retirement Income Security Act of 1974 (ERISA). These self-funded plans are exempt from North Carolina’s anti-subrogation law and so are allowed to seek to recover a part, or even all, of any settlement or judgment recovered from an at-fault party.
So, for example, assume an IBM employee is injured in an automobile accident in Cary NC caused by a drunk driver. The IBM employee gets medical treatment for his or her injures, and these medical bills are paid by IBM’s self funded ERISA health plan. IBM will seek to recover the money it has paid in health expenses from the employee’s settlement or judgment with the drunk driver.
To have a right of subrogation an ERISA health plan must be self-funded, that is the employer must put its own money into the plan to pay health claims. If the plan itself purchases health insurance to pay the employee’s medical claims then North Carolina’s anti-subrogation statute applies and the plan is denied a recovery. Also, the plan language must meet certain highly technical guidelines and must plainly provide for subrogation. The right of subrogation applies not only to the employee but to all the beneficiaries under the plan, including typically the employees family members.
When a valid right of subrogation exists it can dramatically affect the rights of the injured driver to recover for their NC automobile accident injuries. Typically, ERISA health plans provide that the plan is entitled to recover all of the money it has paid out before the injured party receives anything. The right of subrogation attaches to the entire settlement, without regard to whether the money is for medical bills, pain and suffering or lost wages.
Plan documents typically allow the plan to file a lawsuit in federal court to recover the medical expenses it has paid that are later recovered from an at-fault party. Additionally, the plans can deny payment on unrelated claims for the injured party as well as for other plan participants.
It is possible to negotiate the right of ERISA reimbursement in NC auto accidents. Key factors in the negotiation will be the exact plan language, the amount of medical expenses paid, and whether the injured party is still covered under the plan. An experienced NC automobile accident attorney will be able to help make sure the recovery benefits the injured party and not the self-funded ERISA health plan.
by Kevin Bunn | Jan 27, 2014 | Car Accident
This blog discusses the role of Med Pay in NC Automobile Accident Cases. Med Pay, or Medical Payments Coverage, is insurance coverage typically combined with an automobile policy. The coverage is optional but most insurance agents include Med Pay coverage with automobile insurance plans. Med Pay limits are relatively small — $1000, $2000 or $5000 – and the coverage is inexpensive.
Persons eligible to file a Med Pay claim on an automobile policy generally include: 1) any named insured on the automobile insurance policy; 2) the insured’s spouse; 3) the insured’s family; 4) any person occupying a vehicle insured under the policy; 5) any person occupying a vehicle driven by someone insured under the policy. An insured who is a pedestrian may collect Med Pay benefits when struck by a vehicle. There are a number of specific exclusions from Med Pay coverage so check the policy carefully to see if your particular situation is covered.
In order for Med Pay to apply an insured must sustain an injury requiring medical treatment arising out of the use of an automobile. Med Pay pays the actual, reasonable medical expenses associated with injuries that arise out of the use of a covered automobile. Occasionally an insurance company will deny payment of a medical bill which it judges to be excessive.
Medical treatment must be provided by a licensed medical provider, including a chiropractor. Med pay is no-fault coverage, which means it does not matter who is at fault in causing the injury. Med Pay will pay the entire amount of the medical bill, without regard to whether that same bill is paid by health insurance. There is no deductible with Med Pay coverage and filing a Med Pay claim will not increase your insurance premium. Med pay does not cover pain and suffering, disability, lost wages or anticipated future medical expenses.
If you are injured in an automobile accident in North Carolina, Medical Payments Coverage can provide important flexibility in dealing with medical expenses. Med Pay in NC automobile accident cases can allow you to pay your medical expenses if you do not have health insurance and to collect a small cash benefit if you do. If you have questions about Med Pay in NC automobile accident cases call Cary, NC, automobile accident lawyer Kevin Bunn.
by Kevin Bunn | Jan 9, 2014 | Car Accident
If you are in an automobile accident in North Carolina that is someone else’s fault one of the first things you will have to deal with is what to do about the damage to your automobile. This blog will answer a few questions about how to deal with property damage after an automobile accident in North Carolina.
To begin with, make sure you have plenty of good pictures of the damage. This will help support your personal injury case as well as deal with the property damage after an automobile accident in North Carolina.
If your car is not drivable you have the right to have your car towed to and repaired at any shop you want. If you do not have a shop preference the responding officer will usually have the car towed to a local repair shop on the “rotation” or list of shops that will take vehicles damaged in automobile accidents. Ask the officer at the scene where your car will be towed to and write it down.
The workers at the repair shop will first prepare am estimate of damages. Generally you will want to make sure this estimate includes original equipment manufacturer (OEM) replacement parts. The adjuster with the at-fault insurance company will review this estimate and, hopefully approve the repairs. You will usually be provided a rental car for use while your vehicle is being repaired.
If the repair cost exceeds 75% of the value of the vehicle then it is a total loss by law. In this case the insurance company for the person at fault in the accident should compensate you for the fair market value of the vehicle. Do your research to help negotiate this amount. Use online resources like Edmunds.com and cars.com to find comparable cars in terms of make and trim level, model year and mileage. You are also entitled to be reimbursed for the sales tax you paid when you purchased the automobile.
If the repair cost is between 25% and 75% of the value of the car then the automobile will be reported to the Division of Motor Vehicles as damaged. This information will show up on services like Carfax, which identify automobiles that have been in an accident. If your vehicle fits in this range you should be compensated for this “depreciation” which is the difference between what the vehicle was worth wrecked versus not wrecked.
Please feel free to email or call if you have questions about property damage after an automobile accident in North Carolina.
by Kevin Bunn | Sep 23, 2013 | News, Social Security Disability
Social Security disability made $1.3 billion in potentially improper disability payments to people who had jobs when they were supposed to be unable to work. The Government Accountability Office estimated that 36,000 workers got improper payments from December 2010 to January 2013. The numbers represent less than 1 percent of beneficiaries and less than 1 percent of disability payments made during the time frame. But GAO said the overpayments reveal weaknesses in Social Security’s procedures for policing the system.
The Social Security Administration said its accuracy rate for disability payments is more than 99 percent. But the agency noted that even small errors translate into big numbers. More than 8.2 million disabled workers received disability payments in December 2010, a figure that has grown to nearly 9 million. Last year, the agency paid out $137 billion in disability payments.
Before people can receive disability benefits, there is a 5-month waiting period in which they can, in general, earn no more than about $1,000 a month. The waiting period is to ensure that beneficiaries have long-term disabilities. Using a federal wage database, investigators checked whether a sample of disability beneficiaries had worked and earned significant wages during the waiting period, the report said. They found that most of the improper payments went to people who worked during the five months they waited for payments to begin. Once people start receiving benefits, they can return to work and still get benefits during a trial work period.
Citing a potential weakness, the report said Social Security might not detect a person who worked during the waiting period if the period started in one year and ended in another. For example, if Social Security starts paying benefits in February, the agency might not detect significant wages earned the previous November because they weren’t earned in the same year that benefits were awarded, the report said.
In a written response to the report, the Social Security Administration agency questioned whether GAO overestimated the amount of overpayments. The report comes as the Social Security disability program faces a financial crisis. If Congress doesn’t act, the trust fund that supports the disability program will run out of money in 2016, according to projections by Social Security’s trustees. Congress could redirect money from Social Security’s much bigger retirement program to shore up the disability program, as it did in 1994. But that would worsen the finances of the retirement program, which is facing its own long-term financial problems.
For more information about Social Security disability contact Cary Social Security disability lawyer Kevin Bunn.
