I read just about everywhere this week about the Fayetteville NC workers’ compensation case involving a postal carrier who pled guilty in federal court to workers’ compensation fraud. Apparently Cathy Wrench Cashwell was caught on “The Price is Right” spinning the “big wheel” twice, after claiming that she was unable to lift mail trays into a truck because of a 2004 on-the-job shoulder injury, along with claiming other serious physical limitations. According to WRAL the indictment alleged that Ms. Cashwell “raised her left arm above her head and gripped the handle with her left hand.” On a second spin, she “raised both arms above her head and gripped the same handle with both hands.” The indictment also alleges she went ziplining while on a Carnival Cruise and was seen lifting furniture and groceries.
I expect that she will punished appropriately.
Unfortunately, there is never quite the same enthusiasm when it comes to prosecuting employer workers’ compensation fraud in North Carolina. I have written a number of times on my own NC workers’ comp blog, and recently on as a guest writer on Raleigh divorce lawyer Jim Hart’s blog, about the failure of state-wide leaders to address the issue of employers that fail to provide workers’ compensation insurance for their employees. To my knowledge, not a single one of the thousands of employers that break North Carolina’s workers’ comp laws has ever been prosecuted.
I know private investigator Allison Blackman who was quoted in the WRAL article as saying that a big chunk of workers’ comp claims are fraudulent. Allison is a skilled private investigator and a good man. But I have to disagree with him on this one. The fact is the vast majority of fraud in the workers’ compensation system is on the employer side. I have represented a number of people in their Fayetteville NC workers’ compensation case and all of them were seriously and legitimately injured.
People who cheat the workers’ compensation system in North Carolina or elsewhere need to be identified and prosecuted, whether they are employees or employers. I would be nice to see some equality of effort in prosecuting both types.
I hate to say it, but here they go again.
Currently, if an injured NC worker needs medical treatment that has been prescribed by the employee’s workers’ comp doctor, but the workers’ compensation insurance company refuses to approve the treatment, the injured worker can file a simple motion with the North Carolina Industrial Commission for an expedited or emergency hearing on the issue. (The NC Industrial Commission administers the NC Workers’ Compensation Act.) An Industrial Commission hearing officer conducts a telephonic hearing, listens to both sides, considers the evidence including any medical records the parties present, and makes a decision, usually within a few weeks of when the request was first made. Its a simple, fair process that generally works well for everybody. Senate Bill 174 would change that.
Senate Bill 174 would require that all requests for denied medical treatment in NC workers’ compensation cases be decided only after a full hearing before the Industrial Commission, which would include life testimony and medical depositions of the relevant doctors. The effect would be to delay the needed treatment months or even years. There is no reason to further delay NC workers’ compensation medical treatment. And keep in mind that in most NC workers’ compensation cases the insurance company chose the employee’s doctor in the first place. The bill would also place a greater burden on doctors who take workers’ comp cases, who would have to spend more time in depositions.
The vast majority of injured workers in North Carolina simply want to get the medical treatment they need to get better and return to work. This bill would complicate and delay the process and make it harder for workers to do that.
Go here for an interesting article on the kind of damage Senate Bill 174 could do to injured workers in North Carolina.
If you have questions about your workers’ comp case in North Carolina please feel free to contact me for your free evaluation of by a North Carolina workers’ compensation attorney.
How do I pay for my medical treatment if I am hurt in a NC car accident?
In general, you should not let the fact that you were injured by someone else’s carelessness affect how you pay your medical expenses or what treatment you receive after a NC car accident. If you have health insurance have your doctor submit the bills for your medical treatment to your health insurer. Remember that your health insurance insures you and that you pay the premiums and you should get the benefit of that coverage no matter how you were injured. By billing your health insurance you get the treatment you need, when you need it, from a doctor you choose.
Health insurance policies issues in North Carolina are prohibited from denying treatment just because it relates to an automobile accident. They are also prohibited from seeking a refund for payments they make for injuries that arise out of a NC car accident. There are a few important distinctions however.
Certain self-funded health plans that qualify under federal ERISA laws may be entitled to recover money they pay for medical treatment that is later recovered by the injured party from an at-fault third party. Also, government funded plans including Medicare, Medicaid, and the State Health Plan (which covers state employees in North Carolina) are generally entitled to reimbursement for amounts paid that are later recovered from an at-fault third party.
The laws determining whether and to what extent these health plans can recover or “subrogate” their payments are complex. Properly determining reimbursement amounts, if any, can be critical to a fair recovery in a NC car accident claim. In each case there are limits to what the plan can recover. If you are injured in an automobile accident in NC and you think you may have to reimburse a health plan you should contact a NC car accident attorney.
Even if you have to reimburse your health plan for some of the benefits it pays you should still file all of your bills related to a NC car accident with the plan. The reason is that way you get to take advantage of the health plan’s discount with the health provider. For example, the provider may have agreed to accept a 40% discount for x-rays. And you get the benefit of that discount when you pay your provider back.
For more information about nc car accident law contact Cary Attorney Kevin Bunn.
What is the earnings requirement to qualify for Social Security disability benefits?
In general, to qualify for Social Security disability benefits, you must meet two earnings tests:
- A “recent work” test based on your age at the time of disability; and
- A “duration of work” test to show that you worked long enough under Social Security.
Certain blind workers only have to meet the “duration of work” test to qualify for Social Security disability.
The following information from Social Security shows the rules for how much work you need for the “recent work” test based on your age when your disability began. The calendar quarters are: 1st Quarter: January 1 through March 31; 2nd Quarter: April 1 through June 30; 3rd Quarter: July 1 through September 30; and 4th quarter: October 1 through December 31.
- If you become disabled in or before the quarter you turn age 24, then you generally need 1.5 years of work during the three-year period ending with the quarter your disability began.
- If you become disabled in the quarter after you turn age 24 but before the quarter you turn age 31, then you generally need to have worked during half the time during the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled.
- If you become disabled in the quarter you turn age 31 or later, you will generally need to have worked during five years out of the 10 years ending with the quarter your disability began.
Below, are examples from Social Security of how much work you would need to meet the “duration of work” test based on when you become disabled. Your work does not have to be within a certain period of time to meet the “duration of work” test.
If you become disabled… Then you generally need:
- Before age 28 1.5 years of work
- Age 30 2 years
- Age 34 3 years
- Age 38 4 years
- Age 42 5 years
- Age 44 5.5 years
- Age 46 6 years
- Age 48 6.5 years
- Age 50 7 years
- Age 52 7.5 years
- Age 54 8 years
- Age 56 8.5 years
- Age 58 9 years
- Age 60 9.5 years
If you have questions about whether you meet the earnings requirement to qualify for Social Security disability contact Cary, NC, North Carolina Social Security Disability lawyer Kevin Bunn for your free consultation.
Automobile Accidents in North Carolina – Auto Accident Lawyer Cary NC
Automobile accidents are a type of personal injury or “negligence” case. Negligence is the failure of someone to comply with a duty imposed by law. For example the law imposes a duty to stop at a stop sign. If a driver fails to comply with that duty and as a result someone is injured, the injured party may recover money damages from the person at fault. The person who was injured is called the “plaintiff” and the person or organization at fault is called the “defendant.” Unfortunately, these common cases are among the most complex and frustrating to resolve.
Every vehicle registered in North Carolina must be insured with at least $30,000 in bodily injury liability coverage for one injured party, $60,000 in coverage for two injured parties, and $25,000 in property damage liability coverage. This means that if you are in an automobile accident you will be dealing with a trained and experienced insurance adjuster whose job it is to pay as little as possible to settle the claim.
If you are in an auto accident in NC call the police even if you are not hurt. The responding officer will interview each party and any witnesses, examine the accident scene and prepare an accident report. This report will be filed with the Division of Motor Vehicles and is a public record. The officer will also see to it that the parties exchange insurance information and may charge the party he or she determines to be at fault. The law requires that you provide the officer your name, address, license number and the registration number of the vehicle you were driving. Please free to contact 0ur office for more NC automobile accident information.
Kevin Bunn is an Automobile Accident Lawyer in Cary, North Carolina. His office is off Interstate 40, convenient to Raleigh, Apex, Holly Springs, and Fuquay-Varina. If you have been injured in an automobile accident in North Carolina, please call or email for your free consultation with an experienced NC automobile accident attorney.
Is my injury covered by NC workers’ comp?
The North Carolina workers’ comp system provides important medical and wage benefits, but only if the injury is covered. Not all workplace injuries and occupational diseases fall within the North Carolina workers’ compensation system. Many times injured workers will contact me to ask “is my injury covered by NC workers’ comp?”
Workers’ compensation applies to injuries that arise from an accident that occurs during the course and scope of the employment. In general, an accident is an unexpected or unforeseen event that is outside the normal work routine. So, an employee who is stacking boxes in their normal routine and suddenly feels pain in their shoulder may find their claim denied, while an employee who slips in a pool of water will be covered. Common accidents include slips, trips, and falls, machine accidents, load handling accidents and automobile accidents. Back injuries require only a specific traumatic incident and may be covered so long as the employee can identify the point in time when the injury occurred.
Workers’ comp injuries in North Carolina must also occur during the “course and scope” of the employment. This means the injured worker must be doing the business of his or her employer when the accident occurs. Course and scope should be broadly interpreted to include activities that benefit the employer.
Employees who have been injured on the job should consider consulting an experienced workers’ comp lawyer prior to giving a statement to an adjuster. Frequently injured workers will say they felt tricked into saying something that hurt their case.
An occupational disease will be compensable under the N.C. workers’ comp system if: 1) the employment placed the employee at an increased risk of contracting the occupational disease compared to the general public, and 2) the employment actually caused the disease. Traditional occupational diseases such as brown lung and asbestosis fall in this category, as do carpal tunnel and bursitis conditions.
An injured North Carolina employee is covered under the NC workers’ compensation system even if he or she is at fault in the accident. However, a recovery may be denied under if the injury is intentionally self-inflicted or is a result of the employee’s use of alcohol or drugs. An employer’s violation of a safety rule may cause the recovery may cause a recovery to be increased.
An employee injured on the job as a result of the negligence of a person who is not their employer or co-employee should file a claim in the NC workers’ compensation system with their employer, as well as in civil court against the at-fault third party. Third party workers’ comp claims in North Carolina often involve automobile accidents and defective products. The workers’ comp insurance company may have a lien against the third-party recovery but this can be negotiated or, if necessary, compromised in court.
Frequently NC workers’ compensation insurance companies will deny valid claims, often by applying a narrow definition of “accident,” “course and scope” or “increased risk.” A North Carolina workers’ comp lawyer can help evaluate whether you have a claim under the NC workers’ comp system and, if so, ensure you get the benefits you deserve.
Kevin Bunn is a North Carolina workers’ compensation attorney located in Cary, NC, convenient to Raleigh, Apex, Holly Springs and Fuquay-Varina. Please call or email for your free consultation with an experienced NC workers’ comp lawyer.