There comes a turning point in every worker’s compensation case; whether it be returning to work, stopping benefits, or having reached maximum medical improvement. The latter, referring to a point in which your injury has gotten as good as it’s gonna get. But, what exactly is maximum medical improvement? When do I know I’ve reached it? And where do we go from here, being that you still need medical assistance?
Maximum Medical Improvement: What does it mean? And what’s the next step?
Maximum medical improvement (or, MMI) signifies the point act which you’ve reached your maximum potential for recovery. You might not be back to your 100%, and you still might need assistance— maybe even indefinitely. But, it’s as good as it’s going to get for you.
How do I know I’ve reached this point?
That decision is going to come from your doctor. They will be there with you every step of your recovery journey. Therefore, these doctors will be the one to make the determination of MMI.
What happens next?
From the point that you are notified of your MMI, there will be a few different options. These options will also be assigned by your doctor:
Permanent Partial Disability (or, PPD): a PPD means that your body is permanently disabled in some way. From there, you may accept a payment from the company indefinitely as a settlement for you injury. Or, you may go to court to further that settlement.
Permanent Work Restriction: this type of restriction basically limit the amount and type of work you are able to perform. From here, you’ll decide whether your current employment is a good fit, or if you should consider other opportunities. When going through the process, your employer can give you certain responsibilities that meet your restricted needs— taking the place of your real job. However, once you’ve reached MMI, it must be a real job and not just shifted responsibilities.
You still likely can obtain benefits…
This injury is a result of the job; those responsibilities of yours are party to your current condition. So, it’s only right that the company pay you for damages. Your ability to work, function normally, and make a suitable wage— might be different now. Therefore, it’s important that you seek out an attorney. At the point of reaching MMI, you now know that your life will forever be a little bit different. So, it’s time to consider your options. You may require special services, physical therapy, or emotional support for your current condition. Understand that you don’t have to go at this, or pay for this, on your own.
Worker’s compensation claims should be cut and dry. A worker receives injury, sees a doctor, rehabilitates, and comes back to work. However, all worker’s compensation claims might not go that way. Actually, there is the potential for other factors, such as employer’s tort, which can make the case more complex. An employer’s tort can be any number of things, and tort does not have to occur just as a result of your employer. Instead, it can be a number of instances, people, or occurrences which lead to emotional or physical trauma. But what exactly is ‘tort’? And how could it affect my case?
Employer’s Tort After Work Injury: What Are They and When Do They Occur?
First off, what is employer’s tort?
The term ‘tort’ refers to a civil wrong that causes someone to become hurt or injured. In these cases, the person who commits the wrongdoing acts as the ‘tortfeasor’. When it comes to worker’s comp, this is most often the employer. Furthermore, this harm does not have to be physical, it can be emotional as well. Following, you will find some examples where an employer’s tort will become an appropriate movement:
Instances of Tort:
Battery/Assault. Battery and assault can both be extreme cases of employer’s tort. For instance, battery refers to injuring someone by hitting them with something. Like battery, assault just refers to attempt at battery or a threat.
Fraud. In the case of fraud, someone lies to you and that eventually leads to your injury. For example, an employer or boss may tell you they tested a new piece of equipment to ensure it is safe. However, they never tested that equipment and it causes your accident.
Intentional infliction of emotional distress. Another type of employer’s torts can come when an employer inflicts emotional distress. An example of this would be having poor workplace conduct, or being emotionally abusive, as an employer or boss, which leads to emotional trauma to an employee.
Defamation. One last form of employer torts can come in the form of defamation. This means an employer or boss says something false about you. Then by telling this lie, they bring about harm to you or your character.
Employer’s Torts and Worker’s Comp: Can You Sue?
In the event of tort, you might want to take your case one step further and pursue a lawsuit. While an everyday worker’s comp claim could potentially be the answer to your problems, financially. A lawsuit might be the right choice for you, considering the circumstances surrounding your case. However, you’ll never know until you speak with an attorney and decide a proper next move. We offer our condolences for your difficult time, and will happily render our services if need be.
Scaffold injuries are some of the most common complains when it comes to worker’s comp claims. Due to the nature of the job, these types of accidents have the potential to take place quite often. In fact, OSHA created rules and guidelines to help prevent these specific injuries. But, no matter the guidelines, these accidents still occur. So, here are a few reasons why. That way, you might be able to keep them from occurring on your work site.
Scaffold Injuries for Worker’s Comp: Acknowledging and Preventing Accidents
Design and Construction. One of the key elements leading to scaffold safety is the design and construction of the layout itself. Since scaffolds are temporary structures, they are not always structurally sound. For this reason, OSHA requires scaffolds to meet specific guidelines. These guidelines cover a number of things such as type of equipment and building methods used for the scaffold. In addition, each piece of the scaffold must be able to support more than four times it’s own weight. Furthermore, any suspension ropes must be able to hold up to six times their intended weight.
Performing inspections. Before using the scaffold, employers should require someone to inspect the scaffold. First, this person should be competent and fit for the job of inspection. Secondly, this inspection should take place before each new shift. And then, again after someone moves the scaffold to take it down or put it back up. This person should also check over any equipment used while on the scaffold. For example, body belts or harnesses and drop lines.
Most Common Injuries
Even when following all the right steps, scaffold injuries can still take place. In fact, some common injuries are both bone fractures and amputations. Others can include damage to the spinal cord, or internal organs. And some of the most worrisome accidents can cause severe brain trauma. Any of these injuries can have long lasting and life altering affects.
So, as a business owner, you have to put the necessary precautions in place. And as a worker, you have to follow those safety precautions. At the end of the day, every person must do their part to ensure no unnecessary injuries take place.
If you’re dealing with a workers’ compensation claim, you could meet with a liaison that will do the mediating for you, and the insurance company. This typically comes in form of a nurse case manager. This person is typically a registered nurse who will be there every step of the way with you. But, you’re likely not familiar with their role and might feel unsure about their involvement in your personal business. Understanding their role is important to you, so we’re here to help…
Nurse Case Managers: Understanding Your Claim Liaison’s Role
What roles do a nurse case manager play in my claim?
Nurse case managers essentially serve as an unbiased third party who is familiar with the medical world, as well as that of your comp claim insurance. This liaison serves as a middle man for your doctor, the insurance company, and you. They serve as a knowledgeable third party who’s there for every step of your medical journey.
Are they representatives of the insurance company?
Not always. A nurse case manager is typically independent of the insurance company. However, they can be either third-party, a hospital employee, or an independent contractor. While they are working with the insurance company, it is only in reference to the patient and the medical treatment. They are not patient advocates, negotiators, or investigators. They are merely serving as a reporter of your condition, treatment, and progress for the insurance company.
So, do insurance companies hire them?
Yes, an insurance company will typically hire a nurse case manager to facilitate the treatment and report back on it. They will typically have a background in occupational health, home health, or medical management. When hired by an insurance company, their intended role will be to ensure efficiency when it comes to claims and medical treatment.
Nurse case managers work in two ways
A nurse case manager works in many different ways. They serve as a reporter, like we said. But, they are also quite useful to the patient. They do much of the leg work for you. Think about it— they keep track of your medical record, of doctor’s orders, and of prescribed medications. By having a medical liaison, you might be able to better focus on getting better— rather than providing documentation.
Starting a small business requires plenty of blood, sweat, and tears. However, you want to avoid those blood, sweat, and tears when it comes to your employees. Worker’s compensation claims can be costly in a number of ways, especially for a small business. So, let’s focus on reducing worker’s compensation claims for small business. But, remember, any business can follow these tips for a less accident-prone work, and we hope you will!
Avoiding Worker’s Comp Claims: Small Business Tips
Provide Proper Training for Health and Safety Protocol, and Provide Incentive
The key to keeping worker’s safe starts with having informed worker’s. Hosting a seminar once every few months, will keep safety protocol fresh in their minds. Identify common injuries, prevention, and hazards that fall into their line of work. Aside from prevention, it’s also important that you stress proper procedure, gear, and protocol for injuries.
Provide a Refresher, and Incentivize Safe Periods
While you want to prevent injury, you also want to make sure that employees are preparing for accidents that may come. Offer workshops, classes, safety seminars, and incentive. Make it 6 months without injury? Give your employees a little kickback. While financial incentives are any employees favorite— you could host a happy hour after work, buy them lunch one day, or give each person one paid day off at some point in time. The key is to encourage safety, but also incentivize it.
Provide Proper Screening At Time of Hire
Consider experience, adaptability, ability to learn quickly, and have them verbally solve a problem that might occur in the workplace. While you will provide training, new hires are always the most susceptible to injury because they’re not familiar with the way you do things. Depending on the type of business you run, they will have a number of different responsibilities. Make sure you are hiring proper candidates that will be able to perform job duties safely and will bring a diverse skill set to the team. As well as providing proper training.
Promote A Strong Manager From Within
As a business owner, you have a lot of responsibilities. That means you will likely have to hire someone to handle your worker’s from day to day while you handle the back-of-house stuff. While you might think the promoting your longest running employee is the way to go— consider other candidates. Hiring from within the company is always a good idea. Doing so encourages employees to work hard, show initiative, and empowers them to work hard and safe. Not to mention, those inside hires already know how the business works. Therefore, you can provide quicker, more efficient training on the job.
While you will be hiring someone else to take some responsibility, your engagement is extremely important
While you might not think this has anything to do with avoiding worker’s comp claims— it does. Good managers will keep worker’s in check, but your involvement keeps workplace morale at a high. Setting high standards, and making sure your employees respect you, as well as the workplace, prevents careless mistakes.
Anything can happen, and it’s important to remember that. But, a small business will be hit much harder by workplace accidents than a large corporation would. For a large company, the money that goes out for worker’s compensation will not hit quite as hard. So, hire smart and enforce the appeal of a safe work environment.
When you think about what the workers compensation system should cover— you likely think of physical injuries. Someone falls, breaks a bone, cuts themselves, or has any other type of accident. But what you might not consider are those injuries that you cannot see. Sure, there are occupational diseases, lifetime impairments, even arthritis— but there is also PTSD. PTSD can stem from a number of occupations; but the one were focusing on today is for a first responder.
First Responder PTSD and Worker’s Compensation Claims
A first responder comes to the scene— no matter the accident, and no matter the victim. Imagine that. Every day you treat severely injured or fatal children, mothers, fathers, friends… When they report to the scene, they have to distance themselves and get the job done. But what about when they go home? PTSD for first responders is extremely common. But when it comes to workers compensation, the lines become blurry, and paid treatment is often difficult to come by.
But, Why is That?
The system for workers compensation can be tricky sometimes. When it comes to North Carolina law, specifically, the law states that an injury is only eligible when the ‘injury by accident arising out of and in the course of employment.’ But especially when it comes to first responders— the specific incident is difficult to point out. As we’ve said, every day presents it’s own challenges and difficult situations. Ultimately, you must have the ability to be extremely specific about what’s causing your PTSD.
Why Should It Be Otherwise?
For plenty of jobs, but especially that of a first responder, they are performing a duty that is often thankless. First responders see the worst of the accidents we see on the news. They endure, push through, and save lives. In doing so, they often sacrifice their own well-being, both mentally and physically.
How to Receive Worker’s Compensation for PTSD
Most denied claims for mental ailments come from their lack of clarity on the exact moment their problem began. While it’s hard to pin down a moment for most, consider beginning to write them down. Something sticks out to you, document it. Keeping a journal or log of what happens, how it affects you, and the dates— you have a much more likely chance of being accepted. These claims are tough to get through, but the more detail— the more likely. We wish you luck as you fight for your right to quality treatment, and we are here if you need us.