Change of Condition in North Carolina Workers’ Compensation Claim May Warrant Benefit Modification

In filing a Charlotte workers’ compensation claim, the extent of a person’s injuries or illness may not be fully realized right away. It’s entirely possible that one’s condition could worsen over time. gavel2.jpg

Benefits are based on the extent of a person’s illness or injuries at the time the case is heard. But a worker may be justified in later seeking a modification to those benefits if it’s proven their medical condition, resulting from an on-the-job incident, has significantly deteriorated.

Article 1, Section 97-47 of the North Carolina Workers’ Compensation Act holds that any interested party to a case – the worker, the employer or even the North Carolina Industrial Commission itself – can initiate a review of the benefits previously awarded. A “change of condition” claim has to be filed with the commission within a two-year period. The end result of a review can be that benefits are increased, decreased or ended, depending on the ultimate findings of the commission.

The exception to this would be if the worker previously settled the claim under a “clincher” agreement. In these cases, the claim is permanently closed. This is why our attorneys recommend very careful consideration of such agreements, ensuring that the settlement includes enough money to account for all future medical treatment and wage loss.

If your claim didn’t involve a final settlement, you are within your rights to seek a review. In choosing to go this route, make sure you also choose an attorney with ample experience in this area of law, as your employer and/or insurance firm is likely to fight any requested increase of benefits. (Maximum weekly benefits as of Jan. 1, 2014 have been increased to $912, up from $884 in 2013.)

No one should expect this process to be easy, as the case of Rader v. Speer Auto illustrates. This case, reviewed recently by the Nebraska Supreme Court, involved a request to modify benefits, which was ultimately denied by the court.

Here, a female employee suffered a work injury to her lower back while she was employed by an auto company. That state’s workers’ compensation court deemed her injury compensable, as it had arisen in the course and scope of her employment, and she was awarded workers’ compensation. The compensation order awarded her an average weekly wage of about $630. The court found she was temporarily totally disabled for a period of 2.5 weeks, although she failed to provide enough evidence that the injury was compensable for a full six weeks, as she claimed.

She did, however, receive partial disability benefits for 300 weeks.

The following year, she filed a petition to modify the award, arguing that her condition had worsened and she sustained a loss earning power of 50 percent. She had undergone surgery, and her ability to stand, bend and stoop had significantly decreased as a result.

However, her doctor issued a report indicating that the surgery was to address an issue unrelated to the back injury she sustained at work, and was instead necessitated by an earlier motor vehicle accident.

The compensation court further determined that a psychological condition was a contributing factor to her pain, and that, based on her medical records, the surgery wasn’t even medically-warranted.

The worker appealed that decision, but it was upheld by the state supreme court.

Worker compensation benefit modification requests can and often are successful, but they do require a great deal of preparation and the assistance of an experienced legal team.

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

Additional Resources:
Rader v. Speer Auto, Dec. 27, 2013, Nebraska Suprem Court

More Blog Entries
Welder Injuries in North Carolina Often Substantial, Dec. 24, 2013, Charlotte Workers’ Compensation Lawyer Blog

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