It’s a jungle out there, folks. North Carolina’s workers’ compensation adjusters are expected to manage loads of workers’ compensation cases spanning many legal issues – and of course, do so without making mistakes. The Workers’ Comp Act is hundreds of pages long and adjusters handle hundreds of cases, so there is plenty to say, but let’s focus on the basics – the Top 3 Workers’ Compensation Goofs to Avoid in 2020:
Filing a Form 60 Admission prematurely
We get it. You need to clear your desk and move on to the next stack of files. Sometimes the easiest way to quiet a persistent claimant is to JUST CAVE…file the Form 60 and call it a day. Not so fast! Resist the urge to admit the claim before properly researching. The law gives you 30 days to investigate, so use that time to interview the claimant and employer, asking about:
- Credibility issues
- Employment relationship
- Whether the accident arose out of the employment
- Whether the accident occurred during the course and scope of employment
- Whether (except for a back or hernia claim) anything unusual occurred
- For a disease, whether other workers have developed symptoms
If your investigation yields red flags, following up with co-workers and supervisors may pay off. You may even find a strong reason to deny the claim.
Communicating improperly with doctors/nurses
You’re selecting the doctor, directing the care, and paying the bill, so you should at least chat with the nurse or doctor, right? Be careful here! When requesting medical records or asking for additional information about treatment or causation, you must provide the employee with contemporaneous notice of any written request. If the request is by phone and seeks anything besides medical records, you must FIRST give the employee notice and an opportunity to participate in the call. Communication rules apply to nurse case managers, too! Many claimants seize on adjusters’ improper medical communication, using it as a reason to request transfer of care to their own selected physician, so remember to check the statute before making that call.
Using less-than-perfect bedside manner
If the goal is to resolve claims quickly, charm it up. Injured workers are often intimidated by adjusters – after all, they are legally savvy and hold workers’ fates in their hands. If workers feel dismissed, they are prone to use the tiniest adjuster misstep as justification to retain counsel. To increase your chances of resolving a claim without litigation, the best practice is to prioritize top-notch communication:
- When a claimant calls, answer.
- Aim to return voice mail messages by close of business.
- Answer claimant’s questions clearly and in simple terms.
- Fill prescription refills promptly.
- Pay mileage reimbursements immediately.
The little things go a long way in keeping claimants happy, and in turn, keeping litigation costs down.
Here’s hoping 2020 brings you many easy workers’ compensation claims! If you stumble across a question, though, feel free to call an Anders Newton attorney any time at 919-516-8400.
Disclaimer: The information on the blog is provided for informational purposes only and does not constitute legal advice. Cases referenced do not represent the law firm’s entire record. Each case is unique and must be evaluated on its own merits. The outcome of a particular case cannot be based on past results.