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"You were right up front about what the workers' compensation adjuster would try to do. I did not know anything about workers' compensation laws. I think your firm did an amazing job for me and my family."

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News

Workers Compensation: North Carolina Industrial Commission shows we beat both AIG and Zurich in proving that this truck driver for a brick company had two separate accidents which both injured his knee, ultimately disabling him.

This case illustrates a rare, but difficult situation. Our truck driver client had two separate accidents and didn't report either of them until a month or so after the second. Which accident lead to the need for surgery? Often it doesn't matter but in this case the employer had changed insurance companies in the interim. Neither wanted to take responsibility for it.

The biggest weakness in the case was our client's delay in reporting the claim. In fact he didn't do so until he found out he needed surgery. The next biggest problem was that he didn't get his information lined up beforehand. He described the facts of the accident but had it occuring in the wrong month. This gave the company's safety manager a cheap and easy excuse to deny the claim.

We took statements from a coworker and put the employer's safety manager on the stand immediately. We forced her to admit that the injured worker had indeed reported the claim to the company although to the wrong supervisor. However it is the Industrial Commission which defines the rules for reporting the claim -- not an adjuster or safety manager. We also forced her to admit that while our client put the initial accident in the wrong month she could very easily have confirmed the correct date by all of the other facts which he did have straight.

As a side note, several months after this one of the insurance company's witnesses referred a friend of hers to us for another denied claim. After having been involved in dozens of hearings she said this was the one time that the plaintiff's attorney was in complete control of the hearing from start to finish and her attorneys didn't stand a chance.

Read the entire opinion below. The username is "public" and there is no password.

Read More About Workers Compensation: North Carolina Industrial Commission shows we beat both AIG and Zurich in proving that this truck driver for a brick company had two separate accidents which both injured his knee, ultimately disabling him....

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Workers' Compensation: North Carolina Industrial Commission says Liberty Mutual must provide yardcare and housecleaning to an injured brickmason.

Our client, a brick mason, fell and injured his back. After lengthy treatment he was able to walk -- but awkwardly with a cane. He needed modifications to his kitchen, bathroom, and other parts of his house to make it easier for him to get around.  Additionally, because he had difficulty keeping the house and yard up to proper standards the Industrial Commission ordered Liberty Mutual to provide a housekeeper and a yardboy.

Additionally, we were able to prove that our client had previously roofed his own house and painted it. So when the house required a new paint job Liberty Mutual had to pay for it.

The key to this case was our willingness to hire an expert to go with us to our client's house, meet with him, and make recommendations as to what he needed. This is an example of why spending a $1,000 up front can payoff ten or twenty times that in the value of the case. Plus we had negotiated with Liberty Mutual's attorney upfront that they would accept the expert's recommendations. In a calculated gamble we used an expert which Liberty Mutual themselves often hired. Faced with our client's devestating injury she did the right thing and documented that he needed yardcare, housecleaning, and general attendant care.

Read the opinion below. The username is "public" and there is no password.

Read More About Workers' Compensation: North Carolina Industrial Commission says Liberty Mutual must provide yardcare and housecleaning to an injured brickmason....

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Workers' Compensation: North Carolina Industrial Commission rules that a restaurant dishwasher who slipped and fell, and was taken straight to an emergency room has proven that he was injured on the job.

In another failed attempt at "deny and buy" (the insurance industry trick of denying an obviously good claim in the hope of starving an injured worker into a cheap settlement) this restaurant denied the workers comp claim when their dishwasher slipped on a piece of butter, fell on his back, and was taken to the emergency room.

While it isn't recorded in the Opinion and Award the defendant first tried to claim that our client wasn't even on the job. Fortunately we'd immediately made copies of his time card -- so we were able to prove that was, in fact, there. This claim got ugly fast as the defendants poured thousands of dollars into trying every dirty trick in the book. We fought back with a series of tape-recorded interviews, our own investigator, and relentless pressure on a defendant who was willing to do almost anything to avoid payment of the claim.


This case was not easily won, however. The uninsured owner of the restaurant poured money into his defense, using one of the highest profile attorneys in the state to argue the case to the North Carolina Court of Appeals and back.

Read the full opinion below. The usename is "public" and there is no password.

Read More About Workers' Compensation: North Carolina Industrial Commission rules that a restaurant dishwasher who slipped and fell, and was taken straight to an emergency room has proven that he was injured on the job....

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Workers' Compensation: North Carolina Industrial Commission sanctions against the insurance company for failing to accept a claim when our client, an insulation installer, was in an auto accident.

Our client was an insulation installer on his way to a job site. He was the passenger in a company truck which got in an accident and rolled over. In a classic example of insurance company delay tactics the adjuster refused to accept or deny the claim. When we filed a written request to the Industrial Commission to force a decision in this obvious case, the insurance defense attorney blatantly lied to the Commission claiming that benefits were being paid on a Form 63.

This story fell apart at the hearing and the insurance company took the creative approach of arguing that while the truck rollling over and, yes, the plaintiff had to be taken to the emergency room for treatment there was not enough evidence for them to determine if the treatment offered at the emergency room was related to the accident. It would be funny if it hadn't taken our client nearly a year to get the benefits he should have had from the start.

Read the full opinion by clicking below. The username is "public" and there is no password needed.

Read More About Workers' Compensation: North Carolina Industrial Commission sanctions against the insurance company for failing to accept a claim when our client, an insulation installer, was in an auto accident....

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Workers' Compensation: North Carolina Industrial Commission: The Vocational Rehabilitation Professional, from Page Rehabilitation, had a "strained interpretation of suitable employment and the duration of her proposed job search raises serious questions as to whether her objective was to benefit plaintiff or defendants."

Our client, a truck driver, had earned nearly $1000 per week as a tractor-trailer driver. His truck flipped and he suffered head injuries and back injuries. He couldn't return to work as a truck driver. As is often the case the insurance adjuster assigned a vocational rehabiliation professional to have him look for work.

We proved the vocational rehabiliation professional from Page Rehabiliation (on of the largest and most aggressive vocational rehab companies) completely disregarded the Industrial Commission rules for job searches. These included her request that our client put in for $8/hr jobs, part-time jobs, look for jobs in 30 miles from him home, and continued the job search when it should have been obvious that he wasn't going to find suitable employment.

This case is an example of why adjusters love vocational rehabilitation. Indeed many of them use a short-hand verb, "to voke" an injured worker is to try to drive the plaintiff into giving up by having him look for terrible jobs. In fairness, some vocational rehab professionals refuse to cooperate with such goals, and nearly all get angry at the term "to voke." Fortunately our client was willing to stay the course and we had this rehab provider removed from the claim.

Footnote: We also learned a lesson in this case. The Industrial Commission is no longer satisfied with just tearing up defendants' witnesses. We needed to hire our own experts to put on the necessary evidence. In this case we produced sufficient evidence after the claim that defendants settled on terms quite favorable to our client. 

Read More About Workers' Compensation: North Carolina Industrial Commission: The Vocational Rehabilitation Professional, from Page Rehabilitation, had a "strained interpretation of suitable employment and the duration of her proposed job search raises serious questions as to whether her objective was to benefit plaintiff or defendants."...

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Workers' Compensation: North Carolina Industrial Commission rules against The Hartford Insurance Company and holds that a nurse who was still on her employer's property when she was hit by a car is within the course and scope of her employment and entitled to workers' compensation benefits.

Our client, a nurse at a private college, was on her way to lunch when she was hit by a speeding student. For nearly two years no attorney would touch her case. The problem was that while the Industrial Commission admits that a workers is still within the course and scope of their employment if they are injured in the company-owned and controlled parking lot, our client had left the parking lot at the time of the auto accident.

We had met with our client to handle the personal injury claim against the student who hit her. No one had been willing to take the workers compensation case before  but we decided to consider it. During the course of tallking the facts through with several of our attorneys we developed an argument which proved successful. The rationale behind the "parking lot rule" is that a worker is acting to the benefit of the employer even while walking in/out of the job. The employer should be responsible for injuries in the parking lot if they own and control it or, in other words, have the capacity to keep it a safe place. That rationale should extend to the full extent of an employer's property. The side argument in this case was that the university campus was particularly risky given the concentration of young drivers who are known to be more accident-prone that older drivers.

We discussed the idea with our client and, making no promises of success, agreed to take this case straight to a hearing. The final Opinion and Award is a little anticlimactic because it doesn't detail the lengthy arguments presented for and against awarding our clients benefits. While Hartford Insurance promises an appeal we are confident that we've got a solid argument going in to the Full Commission.

Read the full opinion by clicking below. The username is "public" and there is no password needed.

Read More About Workers' Compensation: North Carolina Industrial Commission rules against The Hartford Insurance Company and holds that a nurse who was still on her employer's property when she was hit by a car is within the course and scope of her employment and entitled to workers' compensation benefits....

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Workers' Compensation: North Carolina Industrial Commission finds that Diebold and Broadspire MUST pay weekly benefits even after they fired the injured worker from her "light duty" job.

We are skeptical of "light duty work" for a whole lot of reasons and this case illustrates several of them.  Our client in Lexington had an assembly job with Diebold. She injured her shoulder and the employer began directing her medical care. Notably, however, they refused to file a Form 60 or a Form 63 formally accepting the claim. They sent her to the company doctor who, pretty reliably, returned her to light duty work instead of taking her out of work.

Nearly immediately upon return to work with a 5 pound lifting restriction Diebold moved her to a different job which required her to lift over 40 pounds regularly. Without any other way to pay her bills our client had to try to stick it out. Like many employers and insurance companies, Diebold and Broadspire responded by writing her up for allegedly being less than five minutes late to work. They followed this up with another write-up for a highly disputed instance of tardiness and fired her.

Not surprisingly Broadspire declined to start her on weekly checks.

Like many injured workers this hard-working woman hadn't wanted to hire an attorney. Yet at this point she had no other options. She hired us and we sent her back to an authorized orthopedic surgeon who wrote her out of work. We immediately filed a Motion to Reinstate Benefits, however the Industrial Commission denied this due to Broadspire's failure to formally accept the claim. (Rather than punishing Broadspire for this violation of the law, the Industrial Commission effectively punished our client by requiring her to go to a full hearing without any weekly income at all.)

After the hearing and doctor's depositions the Industrial Commission correctly ruled that Broadspire had illegally failed to accept or deny the claim. The NCIC also held that Diebold had violated the light duty restrictions and therefore plaintiff should not have been at work -- and thus shouldn't have been exposed to the risks of termination. The NCIC proceeded to order weekly benefits paid from the date of termination ongoing as well as all medical treatment necessary to get plaintiff better.

Read the full opinion by clicking below. The username is "public" and there is no password needed.

Read More About Workers' Compensation: North Carolina Industrial Commission finds that Diebold and Broadspire MUST pay weekly benefits even after they fired the injured worker from her "light duty" job....

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North Carolina Industrial Commission: OTP Lawyers stepped in to save an injured plumber whose original lawyer couldn't get the job done against Key Risk.

We don't go out of our way to get involved in other North Carolina lawyer's cases. But when we see an injured worker who isn't getting the help he needs in his workers' compensation case we'll intervene. Sometimes this is when the other attorney is passing all of the work off onto paralegals and doesn't have time for the injured worker. Other times it's when the attorney won't return phone calls.  In this case the original attorney, a well-known auto accident defense attorney, was trying his hand at representing an injured worker. While he was inexperienced at this type of law Key Risk's lawyer wasn't and was beating the plaintiff badly. The original attorney got in over head at the hearing and basically threw up his hands and went no further.

We were able to get involved in the case, get the medical evidence we needed,  succussfully got the insurance company's doctor to change the date of  maximum medical improvement so that we could obtain far more in benefits than our client expected, and secured lifetime medical benefits for this injured plumber to boot.

Click to read the Industrial Commission decision. User name is "public" and there is no password

Read More About North Carolina Industrial Commission: OTP Lawyers stepped in to save an injured plumber whose original lawyer couldn't get the job done against Key Risk....

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North Carolina Industrial Commission: Facing down the Argonaut workers' compensation adjuster in a disputed carpal tunnel case

The workers' compensation adjuster at Argonaut Insurance Company denied this carpal tunnel syndrome case for a truck driver. The injured worker came to us for help based on the referral from a friend. We retained an ergonomics expert who testified that the vibration coming from the steering wheel and the gear shifter could cause carpal tunnel syndrome. With this piece of evidence we refused to settle at a mediation and took the case to a hearing. Without it we surely would have lost the case. Defendants sought permission to send our client to their hand-picked doctor; however we prepared our client for this visit and sent him with the ergonomics report. Even the insurance company doctor had to concede the point in the face of our ergonomics report. The workers compensation defendants dropped their denial and gave in even to our choice of treating doctors.

Our client underwent successful surgery, collected his permanent partial disability ratings, and is back at work as a truck driver.

Follow the link to read the decision. The user name is "public" and there is no password.

Read More About North Carolina Industrial Commission: Facing down the Argonaut workers' compensation adjuster in a disputed carpal tunnel case...

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North Carolina Industrial Commission: In this case with Kemper Insurance company the NCIC found that the employer, Cintas, "schemed" to fire plaintiff while she was on light duty.

The workers' compensation adjuster at Kemper Insurance accepted this claim as compensable and sent this injured laundry worker to the "company doctor" who told her to work light duty. When she did this she was soon fired from the job.  Through extremely aggressive courtroom tactics we produced evidence that the North Carolina Industrial Commission described as follows:

"Employer terminated plaintiff as part of a scheme between Mr. Barnes and Mr. Williams and not due to any fault or misconduct on the part of plaintiff.  Mr. Barnes and Mr. Williams specifically created a scenario under which they could terminate plaintiff and claim that it was for absenteeism. Mr. Barnes and Mr. Williams continued this scheme through their sworn testimony"

Unfortunately we see this happening in most cases where injured workers go back to their jobs too soon. While this time it was in Greensboro, North Carolina we've seen it occurring throughout the state.

Follow the link to read the decision. The user name is "public" and there is no password.

Read More About North Carolina Industrial Commission: In this case with Kemper Insurance company the NCIC found that the employer, Cintas, "schemed" to fire plaintiff while she was on light duty....

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North Carolina Industrial Commission: When are you "on the job" to be covered by workers' compensation?

My client, a collections worker for Oakwood Homes, was asked to participate in a fundraising event for charity. While he was off the clock everyone in his department was doing it and he was pressured to help out. Unfortunately while working on the project he seriously injured his back.

The workers' compensation adjuster from ACE USA denied the claim and basically tried to starve the injured worker into a settlement. He refused and we took this case to hearing even though most similar cases had gone down in defeat.  Our willingness to take risks was rewarded with a big win for our client.

The key bit of testimony was that the employer benefitted from the "team-building" aspects of the project, and thus while it was technically for charity the employer profited from it as well.

To read the North Carolina Industrial Commission decision click. User name is "public" and there is no password.

Read More About North Carolina Industrial Commission: When are you "on the job" to be covered by workers' compensation?...

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North Carolina Industrial Commission: Family members are entitled to be paid for providing attendant care.

Our client fell and injured her elbow, ultimately requiring surgery. She then contracted a terrible case of Reflex Sympathetic Dystrophy which largely confined her to a wheelchair. We persuaded her physicians to order attendant care for her (having someone help with her activities of daily living) as well a major renovations to her house to make it wheelchair accessible.

The adjuster initially agreed to provide attendant care but couldn't find anyone in this rural area to do it. The adjuster refused to pay family members to provide the care. The North Carolina Industrial Commission ruled in our favor.

Note: in this Opinion and Award the NCIC also required defendants to build a new house for the plaintiff. This was subsequently overturned.  Defendants instead spent over $100,000 in modifications.

Read the full case below. The username is "public" and there is no password.

Read More About North Carolina Industrial Commission: Family members are entitled to be paid for providing attendant care....

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North Carolina Industrial Commission: Adult daughters of this injured Lexington Memorial Hospital worker were entitled to compensation for taking care of their mother.

Our clients were the children of a cafeteria worker who broke her pelvis when she slipped and fell, with a cart landing on top of her. While they had willingly taken care of their mother, who passed away from other causes, they came to us when Cambridge's adjuster refused to even pay their mother's rating for her fracture.

We retroactively obtained evidence of the need for attendant care and also of the permanent partial disability rating, and won both of these fights at the North Carolina Industrial Commission.

We also tried to find a link between our clients' mother's death from COPD and her being bedridden. While it made sense to us that this would have worsened by her lack of exercise her physicians explained that she was in pretty bad shape already at the time of the fall. While we lost on that point we firmly believe it is critical to be (a) willing to lose and (b) never give up trying to win.

Read the opinion and award below. The username is "public" and there is no password.

Read More About North Carolina Industrial Commission: Adult daughters of this injured Lexington Memorial Hospital worker were entitled to compensation for taking care of their mother....

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North Carolina Industrial Commission: Hartford Insurance wrongfully used a "pre-existing condition" as an excuse to deny an automotive tech's workers' comp claim

Our client, an oil change technician, injured his back rotating tires. He had previously injured his back while working in construction but did not require surgery. He settled his first workers' comp claim and changed jobs into something easier.

While this should have been obviously a compensable claim given that he complained of pain immediately while working, the adjuster from Hartford employed an old "deny and buy" trick of denying the claim because she couldn't tell whether or not the current need for surgery was due to the old accident or the new one. Plaintiff's neurosurgeon was perfectly clear about it but Hartford apparently wanted to see if the automotive tech would fold and settle cheap.

Fortunately he didn't and Hartford Insurance ended up paying the claim.

Read the decision below. The username is "public" and there is no password.

Read More About North Carolina Industrial Commission: Hartford Insurance wrongfully used a "pre-existing condition" as an excuse to deny an automotive tech's workers' comp claim...

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North Carolina Industrial Commission: A restaurant manager who suffered gunshot wounds in a hold-up is entitled to a yard worker and a housecleaner because he cannot do much of his own work anymore.

Our client had gunwounds to his hand, shoulder, and thigh. As a result of these he struggles to do his own yardwork and housecleaning. Given that he had been able to do all of this before he was shot in a robbery outside his Charlotte restaurant we believed that GAB Robbins and Royal Insurance should provide assistance with this.

Unfortunately plaintiff's doctor, an excellent surgeon, was not willling to go along with this idea. When he was quizzed about the North Carolina Industrial Commission's requirement of all medical treatment necessary to "effect a cure, provide relief, or lessen the period of disability" he noted that a yardboy would provide relief to anyone -- whether they were on workers compensation or not.

Fortunately, we had already had an expert in the area of attendant care meet with our client at his house. While the surgeon didn't see what was really necessary he did agree to defer to this expert. The North Carolina Industrial Commission agree with us and awarded the requested services.

This is a real example of being prepared. Had we walked into the doctor's office without the expert's statement we would have walked out losing the case. By arranging for this ahead of time we won what GAB Robbin's adjuster thought was an impossible case.

Read the opinion below. The username is "public" and there is no password.

Read More About North Carolina Industrial Commission: A restaurant manager who suffered gunshot wounds in a hold-up is entitled to a yard worker and a housecleaner because he cannot do much of his own work anymore....

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Greensboro, NC 27408
Phone: (336) 274-4494
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FAQs

Workers' Compensation

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Social Security Disability

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General

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Case Studies

Workers' Compensation

The Workers' Comp Adjuster Denied a Perfectly Legitimate Claim.

An Example of a Workers' Comp Adjuster Manipulating the Recorded Statement.

How a Functional Capacities Evaluation Can Wreck a Claim.

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