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Workers Compensation: The North Carolina Industrial Commission held that National Benefits Association had wrongfully denied this claim for more than a year...but only when the Industrial Commission finally heard all the evidence -- that the employer admitted that they knew the plaintiff was hurt, that they had sent him to a doctor but didn't follow his direction, and that there was no way our client could do his job with his severely-injured back.

How unreasonable can an employer and the employer's insurance company be in denying a claim? This case. involving National Benefits Association and a steelworker, perfectly illustrates “deny and buy."

Our client was lifting steel at work when he felt an immediate onset of pain. This was reported to his supervisor, the job foreman and the company’s safety manager. The employer sent our client to the doctor who ordered only light duty work for the steelworker.  The company, though, promptly disregarded the light duty restrictions.  Unfortunately, that’s not unusual in our experience. Neither was the fact that the employer then refused to authorize a return visit to the doctor. Since he was in such intense pain, our client had to take himself out of work. The employer then decided to send our client to their hand-picked doctor for a second opinion – but then they refused to authorize the MRI this doctor requested. The combination of all this confusion left the plaintiff out of work and without either medical or financial benefits. Fortunately, he was able to survive financially by taking another job.  

He agreed that it was important to take this case to a hearing rather than settling for a nominal sum. At the hearing, we cornered the employer’s witnesses who admitted that they had no real light-duty work available for our client. We were happy to win the claim for ongoing medical treatment. As is often the case, however, we had to appeal a portion of the Opinion and Award because it did not provide for enough weekly benefits for our client. The claim ultimately settled while the appeal was pending.

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

Read More About Workers Compensation: The North Carolina Industrial Commission held that National Benefits Association had wrongfully denied this claim for more than a year...but only when the Industrial Commission finally heard all the evidence -- that the employer admitted that they knew the plaintiff was hurt, that they had sent him to a doctor but didn't follow his direction, and that there was no way our client could do his job with his severely-injured back....

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1155 Revolution Mill Drive,
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Greensboro, NC 27405
Phone: 336-274-4494
Fax: 336-274-4525
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OTP - Winston-Salem
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Winston-Salem, NC 27103
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Burlington, NC 27215
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Asheboro, NC 27203
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Wilmington, NC 28405
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Rock Hill, South Carolina 29730
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FAQs

Workers' Compensation

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Case Studies

Workers' Compensation

When is it helpful to LOSE a case

The Workers' Comp Adjuster Denied a Perfectly Legitimate Claim.

What Can Go Wrong with a Return to Light Duty Work.

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