Who Is the Nurse Case Manager In A Workers’ Compensation Case?

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The job of the nurse case manager is to work directly with the individual patient in order to coordinate patient care. The nurse case manager is a registered nurse employed by the insurance carrier. The nurse case manager will often coordinate treatments between multiple doctors, and also keep the insurance carrier up-to-date about ongoing treatments, as well as when you will be medically cleared to return to work.

Workers' Compensation Nurse Case ManagerSince the insurance company pays the nurse case manager it is important that you and your workers’ compensation attorney scrutinize their efforts on your behalf. Too often nurse case managers try to push a treating physician into releasing an injured employee before the doctor should release them. We have also seen them try to convince a doctor not to provide certain types of treatment due to the fear it would cost too much money for the insurance company.

To try an avoid any improper actions by the nurse case manager the North Carolina Industrial Commission has set up guideline and rules they are required to follow. The North Carolina Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims guides the conduct of nurse case managers.

Because the nurse case manager is an employee of your insurance carrier, it is advisable to discuss any questions about the role of your nurse case manager with your workers’ compensation attorney.

Are Part-Time Employees Eligible for Workers’ Compensation?

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In North Carolina, employers must carry workers’ compensation insurance if they have three or more employees. If you work for a company with three or more employees, you should be covered under your employer’s workers’ compensation insurance if you are injured on the job, even if you are a part-time or temporary employee.

Father and Daughter on ComputerIf you are a part-time or temporary employee, the calculation of your workers’ compensation benefits will be the same as if you were a full-time or permanent employee. Your average weekly wage will be calculated to determine the amount of weekly benefits you should receive while your workers’ compensation case is pending.

For more information on how the average weekly wage is calculated, read our blog post explaining the process.

Who Selects the Mediator in a NC Workers’ Compensation Case?

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The short answer is the attorneys for both sides in a North Carolina workers’ compensation case will usually mutually agree upon a mediator. If not, the North Carolina Industrial Commission can appoint a mediator.

Mediator | North Carolina Workers' CompensationA mediator is a person, usually another attorney, who helps negotiate an agreeable outcome between two different parties. Mediators have been used in the legal system for an incredibly long time and usually help parties reach a mutually agreeable outcome without having to go to court or in front of a “finder of fact.”

If you have a North Carolina workers’ compensation case then you too will likely use a mediator at some point in time. The North Carolina Industrial Commission requires that a case go through mediation if a Form 33 is filed. Additionally, the plaintiff(s) and defendants can agree to have a voluntary mediation as well. The chances of having a successful mediation can, often times, depend upon the mediator. A good mediator can explain to both sides that neither will get everything they want out of a case and having a mutual agreement where neither party gets everything they want is sometimes better than running the risk of not receiving anything at all. An experienced mediator can also help both parties in a dispute get a better understanding of what the opposing party is thinking and arguing. Knowing this will allow you to better understand the other sides position and really allow the sides to focus on the areas in dispute versus every facet of a case.

In a North Carolina workers’ compensation claim, attorneys for both the plaintiff(s) and defendants will try to pick a mediator that both sides can agree upon. Experienced work injury lawyers know which mediators are best in their area. The two sides almost always agree upon a mediator. However, if the plaintiff(s) and defendants cannot agree upon a mediator for a required mediation then they would notify the North Carolina Industrial Commission and the Industrial Commission would appoint a mediator.

Most workers’ comp cases are settled at a mediation. Therefore, it is important that you have a good mediator. An experienced attorney for your injury at work will know who the best mediators in your area are and will fight to ensure you have someone that can help you resolve your case in the most efficient and fairest manner possible.

What Is A Form 63 in Workers’ Compensation?

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North Carolina Industrial Commission Form 63 is the Notice to Employee of Payment of Compensation Without Prejudice or Payment of Medical Benefits Only Without Prejudice.

This form is submitted to the NCIC when an employer provides payments and/or medical benefits to an employee.  By filing this form, the receipt of payment or medical benefits from the employer does not necessarily end the investigative process or mean that the employer accepts liability. The benefits can be provided while an investigation is still ongoing. By submitting this form, an employer is not automatically accepting guilt or liability by providing benefits to the employee.

What is a Form 61 in North Carolina Workers’ Compensation?

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North Carolina Workers' Compensation Questions

North Carolina Industrial Commission Form 61 is the Denial of Workers’ Compensation Claim. If the employer finds reason to deny the employee’s workers’ compensation claim, this form must be submitted to the North Carolina Industrial Commission (NCIC) as well as providing copies to the employee, the employee’s attorney (if applicable) and any healthcare providers that have submitted medical bills to the employer.

The employer must be very specific in providing the reason for their denial of the claim. If certain reasons are omitted from the form and the denial is then challenged, those reasons for denial that were not reported may be excluded from the challenge hearing. If an employee receives a Form 61 from their employer and wishes to challenge the decision to deny their claim, they may do so by submitting a Form 33.

What is Form 60 in Workers’ Compensation?

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Father and Daughter on ComputerNorth Carolina Industrial Commission (NCIC) Form 60 is the Employer’s Admission of Employee’s Right to Compensation. This form is completed by the employer in order to specify the injuries that they are assuming responsibility for and the amount of compensation that they agree to pay. In the form, the employer will detail the date of the injury or occupational disease in question, and the body parts affected. The employer will also report whether or not the employee was paid for the entire day on which the injury occurred. The employer must report that employee’s average weekly earnings. It is very important to note that this amount must include overtime pay and also account for additional compensation such as fringe benefits. If the insurance company does not accurately reflect your average weekly wage then you should have your attorney request the insurance company to fill out a Form 22. The employer must provide the NCIC with the original copy of a Form 60 and also must provide the employee and his/her attorney, if applicable, with a copy. Having a Form 60 filed in your workers’ compensation case means the employer’s insurance company has accepted your workers’ compensation claim.

What is a Functional Capacity Evaluation In A North Carolina Workers’ Compensation Case?

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A Functional Capacity Evaluation (also called a FCE) is a test performed by a physician or other health care professional to determine an injured worker’s ability to perform a job and to determine their limitations after having been injured on the job. Healthcare professionals perform this standardized test to determine the worker’s functional impairment, assess the success of treatment, and to determine their ability to perform at a job in the present or future. However, completing a FCE without being represented by an attorney may put you and your case in a difficult situation.

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Will the Insurance Company Provide me with Transportation in a Worker’s Comp Claim?

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Yes, the insurance company can provide you with transportation to receive medical care that is approved by the insurance company or the North Carolina Industrial Commission. Usually you must provide your own transportation, but the insurance company will reimburse you the expenses.  However, if your injury makes it difficult to drive to and from your medical treatment then the insurance company may be compelled to provide you with transportation by the Industrial Commission.

Doing Workers' Compensation Research on a ComputerCurrently the North Carolina law requires the worker’s compensation to reimburse you $0.565 per mile as of January 2013. This amount may change as the cost of gasoline changes.  To be reimbursed, your trip must be more than 20 miles round trip. Normally you will not be reimbursed for medication and supplies on a separate trip in which you did not receive medical care.  These medications and supplies must be purchased on the same trip you are receiving your medical care.

Special consideration will be provided to persons that are unable to drive to receive their medical treatments. The worker’s compensation insurance company, on the orders of the Industrial Commission, may provide special transportation for those injured workers, such as a special van for wheel chairs, etc.

In the event you must stay overnight for your medical care, certain expenses are covered.  These are normally hotel rooms up to $45 per day.  You may receive up to $28 per day for food. You can also be reimbursed for parking and cab expense for your medical treatment.  However, you must provide actual receipts as proof of your expenses that will be reimbursed to you.

To be reimbursed for your travel expenses, you must complete, sign, and submit North Carolina Industrial Commission Form 25T and your receipts to the worker’s compensation insurance company for reimbursement. Be sure and keep a copy of the form and your receipts for your own records.