Articles Posted in Denial of Claims

Although occupational illness isn’t specific to any industry, there are inevitably some professions that are at higher risk for exposure to certain toxic substances or materials that can be harmful. One of these dangerous jobs is firefighting.firefighters

Not only are firefighters exposed to intense heat and smoke, but also they have direct exposure to the public. Additionally, they may have direct exposure to harmful building materials, such as lead and asbestos, that are known to cause debilitating conditions – even cancer.

Firefighters, police officers, and other first responders and government workers seeking workers’ compensation should speak to an attorney, since there may be some special considerations. Even volunteer firefighters and first responders are covered under state statute, although there are sometimes challenges in ensuring there are adequate funds to pay these claims.

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In an appellate case before the South Carolina Court of Appeals, a construction worker fought against the workers’ compensation commission’s ruling to deny him benefits after he was injured at work. Unfortunately, the appellate court affirmed that ruling. The court found the commission did not err in finding that the plaintiff failed to apply the presumption the injury in question arose out of and occurred in the course of employment and that the worker didn’t establish a cause for the injury. truck wheel

According to court records, the plaintiff began working for the defendant construction company in 2007 as an operator of heavy equipment. The accident happened five years later, in the spring. His co-workers discovered him lying motionless on his back next to his dump truck. He would later testify he had no knowledge of what happened or how he came to be on the ground. Two co-workers testified they didn’t see him in or near the truck prior to the fall, but he insisted that he was up in the truck at some point before he fell and that he was seen by at least two of his co-workers.

One co-worker testified the plaintiff washed his truck with a pressure washer and then went into an adjacent building to retrieve his backpack and cooler. It was shortly after this time the plaintiff was discovered supine on the ground. It was unclear for exactly how long he was there, although one co-worker testified it couldn’t have been more than four minutes. His backpack and cooler were found on the seat of the truck with the door still open.

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It’s not uncommon in workers’ compensation claims for the insurance carrier to resist the payment of benefits. It’s important in these cases for employees to know their rights – and consult with an experienced workers’ compensation attorney. fence

In Bockus v. First Student Services, a school bus driver injured his back at work while moving a gate. As a result of this injury, he needed to undergo two spinal surgeries and later needed a third surgery.

The issue was that while the third surgery was pending, his employer, which had paid for his medical coverage up until then, requested a medical evaluation. The doctor wouldn’t go forward with the surgery while the evaluation was pending. At that point, the employee filed a workers’ compensation claim.

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It’s been a little more than a year since gunfire ripped through an office building in San Bernardino, California, where workers at the local health department had just finished hosting a holiday party. The terrorist attack, carried out by a former employee and his wife, happened on Dec. 2, 2015, and it resulted in 14 deaths and 22 serious injuries. The assailants escaped in a sport utility vehicle but were later shot and killed by police. gun

Today, neither the physical nor the emotional trauma has greatly subsided. Victims say it is further compounded by the fact that they are having to fight for full and continued workers’ compensation benefits. One woman says she has had numerous surgeries and subsequent infections. Her left hand is paralyzed. She has bullet fragments in her pelvis. She has suffered permanent tissue damage and scarring. The psychological trauma is intense. She needs more surgeries. A home health aid helps her with basic tasks. She can’t put on a bra. She can’t type. She can’t drive. She can’t do laundry. She can’t cut her own food. She can’t put on her socks and shoes.

Yet her visits from the home health aid have dwindled, and she is told they will likely end soon altogether. According to the Seattle Times, her requests for continued occupational and physical therapy have been denied. She was also denied continued use of her antidepressant medications. These are reportedly not the result of a conflict with her health insurer but instead with her employer. That’s because this incident was considered a form of workplace violence, and thus it falls under the umbrella of workers’ compensation.

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The U.S. Labor Department, in a new report released this month, calls for an “exploration” of federal oversight and possibly federal minimum benefits for injured workers who seek a remedy through the state workers’ compensation program. Congress

The report asks, “Does the workers’ compensation system fulfill its obligation to injured workers?” In short, the agency says, workers who are hurt on the job are at serious risk of slipping into poverty.

Over the years, there have been numerous changes to workers’ compensation laws across the country. This is not a coincidence, but instead, as ProPublica reported in its excellent series, “The Demolition of Workers’ Comp.,” part of a calculated effort by large businesses to lobby state legislators for lower benefits or tougher access for injured workers. This effort has largely been successful, as evidenced by the fact that workers face more barriers to benefits than ever before. In fact, while employers are paying the lowest rate for workers’ compensation coverage, and insurance companies are turning an 18 percent profit, injured workers are turning to taxpayer-funded programs like Social Security Disability Insurance (SSDI) and Medicare to recover lost wages and medical costs they are no longer receiving through their workers’ compensation plans.

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If you have suffered either a North Carolina work-related injury or an occupational disease or illness, you need to file a claim for workers’ compensation benefits as soon as possible. It will cover not just the immediate expenses, but those that may develop in the future, including lost wages and medical bills. tires

Unfortunately, too many workers try to “tough it out” when it comes to job-related illness. It’s one thing to have a workplace accident that causes immediate and serious injury requiring timely medical intervention. But when injuries occur over time, it can be tougher to ascertain when it’s best to come forward.

In general, it’s advised that you report pain/ discomfort/ injury/ illness to your employer as soon as possible and explore filing a workers’ compensation claim as soon as possible. In North Carolina, the law only allows two years from the date of injury to file a workers’ compensation claim.  Continue reading

The U.S. Department of Labor has filed a lawsuit against U.S. Steel Corp., demanding the company change its workplace injury reporting policy, which currently mandates workers immediately report incidents when they occur. The company has taken disciplinary action against workers who don’t immediately file. steelbeam

Although this kind of policy may at first seem like a way to protect workers – after all, it may be in their best interest to report a work accident with injuries immediately – the problem is not all injuries are immediately apparent. A worker who doesn’t suffer any problems until days later will be discouraged from reporting the injury, due to the policy.

That fear would be with good reason, given what recently happened to two of U.S. Steel’s employees.  Continue reading

If you have been injured at work and file for workers’ compensation benefits, know there is a good chance employer’s insurance company has hired a private investigator to follow you.lens

That’s right: You have to steel yourself for the possibility you may be watched – and this is totally legal. It’s justified by companies who say they just want to make sure the worker is telling the truth about the extent of his or her injuries.

Of course, this idea that workers’ compensation fraud is rampant is a myth. National studies have shown repeatedly that only about 1 to 2 percent of all workers’ compensation cases are fraudulent. It probably seems like it’s much higher than that because media is complicit in helping insurance companies blow these cases out of proportion to justify these tactics. Continue reading

Permanent total disability benefits in North Carolina are only awarded in limited circumstances. Those who qualify may be entitled to a lifetime of disability benefits, but the criteria is strict. catscan

For a worker hurt prior to June 24, 2011, permanent total disability benefits may be paid upon determination that worker is unable to ever find suitable employment due to work injury. However, workers injured after that date have to show they have one of the following conditions:

  • Loss of both hands, both arms, both feet, both legs, both eyes or any combination of any two listed body parts;
  • Spinal injury involving paralysis of both legs, both arms or the trunk;
  • Severe closed head or brain injuries;
  • Second-degree or third-degree burns on 33 percent or more of the total body surface.

Many states have similar – and increasingly strict – criteria for permanent total disability benefits.  Continue reading

Heart disease is the No. 1 cause of death in the U.S., according to the Centers for Disease Control and Prevention. It’s estimated that 720,000 people in this country suffer a heart attack each year, which works out to about one every 34 seconds.heart

The question of whether a heart attack is compensable under the South Carolina Workers’ Compensation Act is a complicated one. Under Section 42-11-10, in order for a heart attack to be compensable, the claimant needs to show:

  • Extraordinary or unusual physical exertion, strain or unusual condition occurring in the course of employment;
  • A causal connection between the exertion, unusual condition or strain and the heart attack.

Claimants aren’t necessarily going to be able to succeed in a case simply because a heart attack occurred at work. However, if there is evidence of exceptional circumstances relating to the job that caused or significantly contributed to the heart attack, the claim could be successful. Continue reading

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