Suffering an injury on the job can be a minor inconvenience or a major disaster. Many accidents can fall in between these extremes, but any work injury means the worker should file a worker's compensation claim. Injuries that seem minor can suddenly turn into severe injuries.
One of the worst mistakes an injured worker can make is to try to tough it out and keep working; the person will usually make the condition worse. It is also a bad idea to not report the injury immediately, or the worker may lose the compensation he or she needs.
Misconceptions about workers' compensation
People usually assume that the state pays for workers' compensation benefits. This is false. North Carolina law requires businesses to carry workers' compensation insurance, but the business must contract with private insurance companies. The state does not use insurance companies to cover an injured worker. It is important to understand this concept. Workers' compensation is like any other insurance, whether homeowners or auto insurance. The insurance company supplies a claims adjuster, but the worker's company pays the actual cost of treatment for the injured worker. It is not surprising, therefore, that a company wants to get the injured employee off workers' compensation as quickly as possible. The money for the medical bills and loss of employment costs is coming directly out of the company's pocket.
North Carolina's use of rehabilitation professionals
A new workers' compensation patient may receive a surprise phone call or visit from someone called a medical case manager, medical services coordinator, vocational rehabilitation professional or nurse case manager. The employer's insurance company pays this person, and the potential exists for an unhealthy conflict of interest.
The case manager coordinates the employee's medical care and treatment. The injured employee must communicate regularly and follow the treatment plan of the rehab professional or else risk losing workers' comp benefits. Unethical rehab professionals will try to convince the injured worker's doctor that the employee is ready to return to work when, in fact, the person is still too injured to work. This is because the employee's company is working hand-in-hand with the insurance medical case manager to rush the employee back to work. Some medical case managers get doctors to prescribe cheaper medications and skip essential therapy, surgery or other treatment. A case manager can cause a worker who does not know his or her rights to return to work too soon and risk making the injury worse.
How injured workers can protect their health rights
First, read North Carolina's limitations on what the case manager can and cannot do. This is vital. Unethical case managers assume the injured worker does not know her or his legal rights, so they feel confident in interfering with proper medical care.
Injured workers need to immediately find an advocate they trust who knows how to deal with unethical medical case managers and understands workers' compensation rules. The sooner an injured worker gets qualified protection to defend their medical treatment rights, the better.