Workers’ Compensation Care Reimbursement Must Follow Protocol

Filing a workers’ compensation claim in North Carolina should always be done with careful consideration for not only your immediate needs, but also with an eye on what kind of care you might require in the future.
Any changes in your medical condition may warrant an amended order with regard to the kind of care and/or reimbursement you are entitled to receive as a result of your workplace injury.

The case of Mehaffey v. Burger King is a good example of this – and also why it’s important to report these changes as soon as possible.

Court documents show that in this case, the petitioner, Mehaffey, had been employed with a fast food chain for some 18 years at the time he suffered an injury to his knee while at work. As a result, he underwent surgery on his knee, but his condition failed to improve. In fact, it worsened and he developed reflex sympathetic dystrophy. This is a condition that involves pain, tenderness and swelling of an extremity. Long-term, this condition has been known to cause loss of motion and function of the involved extremity and often is associated with the development of osteoporosis.

As the petitioner’s pain increased, he was also diagnosed with depression. He was using an assistive device to help him walk and was eventually prescribed a mobility scooter and hospital bed.

Since the time of the petitioner’s injury, his wife had been caring for him for about 4 hours daily. However, as his condition worsened, she increased the amount of time she devoted to his care, ultimately quitting her job and acting as a caregiver for him 16 hours daily.

This care included tasks such as helping him in and out of bed, helping him into and out of his scooter, helping him with restroom duties, preparing meals, as well as bathing and dressing him.

This level of care was later deemed necessary both by his doctors and the North Carolina Industrial Commission. However, when the petitioner’s wife sought reimbursement for this care, she and her husband learned that certain kinds of attendant care services – these being included – are only paid for after the approval of the industrial commission has been obtained.

The industrial commission had tried to apply the reimbursement retroactively to the beginning of the petitioner’s injuries. However, the defendant and its insurer appealed, and the case ultimately went to the North Carolina Supreme Court. There, justices determined that a retroactive application of reimbursement for a spouse’s attendant care was an overreach of the commission’s authority.

Further, the defendants in this case challenged the reasonableness of timing with which the petitioners filed their claim for attendant care services, asserting that such a claim should have been filed much sooner had it been necessary.

That doesn’t mean the petitioner could have filed the claim a whole lot sooner. But all workers’ compensation petitioners need to be aware that defendants will use any argument to minimize liability.

That means the sooner you inform your attorney of possible changes in your case, the sooner a modification can be requested and the greater your chances of maximizing your benefits and reimbursement.

If you have been injured at work in North Carolina, contact the Lee Law Offices at 800-887-1965.

Additional Resources:
Mehaffey v. Burger King, Nov. 8, 2013, In the Supreme Court of North C lina

More Blog Entries
Work Accident Reporting Critical to On-the-Job Safety, Dec. 1, 2013, Charlotte Workers’ Compensation Lawyer Blog

Contact Information