Workers’ compensation for doctors, nurses, and other healthcare workers

While North Carolina workers’ compensation benefits apply to most healthcare workers, folks often don’t understand what those benefits are and how to go about obtaining them.

The North Carolina Industrial Commission, created by the North Carolina Workers’ Compensation Act (NC General Statutes §97.1 et seq), requires most employers to carry workers’ compensation insurance if they have 3 or more employees.

The insurance benefits for an employee include the following:

• Medical treatment. All necessary medical expenses are covered under workers’ comp, including hospital stays, doctor and emergency room visits, surgeries, medication, rehabilitation and medical supplies.
• Lost income. For restoration of lost income, a worker is entitled to two-thirds of their average weekly or monthly wage each week while they are unable to work.
• Death benefits. If a worker dies from a work-related illness or injury, their dependents are entitled to certain benefits to cover funeral expenses and lost wages.

These benefits only cover losses incurred while performing assigned job duties during assigned work hours. They don’t cover unassigned duties outside assigned work hours or activities during lunch or breaks.

What to do if you’re hurt as a healthcare professional

If you are injured or contract an illness on the job, take the following steps to obtain your workers’ comp benefits:

1. Get medical care. In order to receive workers’ comp benefits, you must be able to tie your work injury or illness to your job, so it’s imperative that you see a doctor as soon as possible.
2. Report your injury or illness to your employer. Your report should be in writing. Whatever you say in your report could become important later as your case proceeds. Therefore, you should bring a workers’ comp attorney into the process at this early stage.
3. Follow the doctor’s orders. You will be required to be examined by a physician that the employer or insurance company selects. You can petition the Commission for permission to change doctors if you’re unsatisfied with your care. Be sure to follow your doctor’s instructions. Failure to do so can jeopardize your benefits.
4. File a claim. Within 2 years, you must file a claim via the North Carolina Industrial Commission Form 18 Notice of Accident to Employer and Claim of Employee, Representative, or Dependent. Your attorney should assist you with your report.

Your employer might “invite” you to return to work during your treatment and recovery. Your doctor will produce a report that might include a prescription for work restrictions on the physical activities, if any, that you are capable of performing during your recovery. Alternatively, your employer might present a job description to your doctor, who will determine if it is physically “suitable” depending on your condition.

Your employer can contact you directly about returning to a suitable job, provided they also notify your attorney. You should consult your attorney before accepting or refusing such employment.

What constitutes “suitable employment” will depend on where you are in your treatment or recovery process. If you are still being treated, it’s any employment within the restrictions and authorized by the treating physician.

If you have completed your treatment and are released by your physician, it includes employment you can perform after taking into account your physical and mental limitations. This is a subjective determination, and your attorney will review with you all the considerations.

If you refuse to accept suitable employment, your compensation will be terminated. However, you can petition the Commission for a determination if your refusal is justified.

Common injuries and illnesses for healthcare workers

Healthcare workers have one of the highest rates of injuries in the workplace. In fact, one study by the Occupational Safety and Health Administration (OSHA) found that healthcare workers are 3 times more likely to experience injuries than other workers in other sectors.

Some common injuries and illnesses for healthcare workers include the following:

• Sharp injuries. Healthcare professionals who handle needles, scalpels, and other sharp tools are vulnerable to sharp injuries, including cuts, punctures, and scrapes that can lead to exposure to pathogens such as HIV and hepatitis B and C.
• Violence. Many healthcare workers are exposed to violence in their work environment. In fact, workers in the healthcare industry are 5 times more likely to experience an injury due to violence at work compared to other workers.
• Back injuries. Most healthcare workers must lift patients, equipment, and supplies regularly. They also may spend long hours standing or walking without taking proper breaks for exercise or stretching. These factors can lead to back pain and injury.
• Infections. Healthcare workers can be exposed to various infections while caring for patients, such as influenza, tuberculosis, and methicillin-resistant Staphylococcus aureus (MRSA). Exposure to these infections can lead to severe illness or even death.
• Chemical exposure. Hazardous chemicals are found in hospitals and other healthcare facilities. Nurses, pharmacists, and others who handle chemicals may be exposed to harmful substances that cause dermatitis, asthma, burns, or other complications if not adequately protected by gloves and masks.
• Burn injury. Healthcare workers are also at risk of suffering from burn injuries, which can be caused by hot liquids, chemicals, electrical equipment, and more. These injuries can be extremely painful and can result in significant physical and emotional trauma. In severe cases, burn injuries may require long-term medical treatment and rehabilitation and can even lead to permanent scarring or disability.
• Latex allergy. Products such as rubber gloves, IV tubing, catheters, and syringes often contain latex. Healthcare workers are at risk of an allergic reaction to the substance if exposed to it over time. A latex allergy can cause symptoms such as swelling, hives, or breathing problems.
• Stress and burnout. The demands of the healthcare profession can be physically and emotionally taxing and lead to high levels of stress and burnout.
• Overexertion injuries. The most common injury for healthcare workers is overexertion or strain, which accounts for more than half of all injuries. This type of injury can occur from lifting patients or equipment, pushing patients in wheelchairs, and other activities that require repetitive motions that put a strain on muscles, joints, and tendons.
• Falls. Another common cause of workplace injuries is slip-and-fall accidents. Hospitals often have wet floors, cluttered hallways, and workers moving about quickly, which can lead to injuries, including broken bones (especially wrist, hip, and ankle), traumatic brain injuries, and spinal cord injuries. According to the Bureau of Labor Statistics (BLS), 25% of workplace injuries among healthcare workers are caused by falls and slips.

Reasons a workers’ comp claim might be denied

There are several reasons a workers’ comp claim might be denied.

Some of the most common reasons include the following:

• Lack of evidence. To be eligible for workers’ compensation benefits, you will need to provide evidence that your work duties caused your injury or illness. If you are unable to provide sufficient evidence to support your claim, it may be denied.
• Pre-existing conditions. In some instances, your workers’ compensation claim may be denied if you have a pre-existing condition that caused your injury or illness.
• Failure to report the injury. You must report your injury to your employer as soon as possible to be eligible for workers’ compensation benefits. If you fail to do so within 30 days in North Carolina, your claim will be denied.
• Failure to follow medical treatment. If you fail to follow the medical treatment prescribed by your healthcare provider, your workers’ compensation claim will likely be denied.
• Intentional self-inflicted injury. If you intentionally caused your injury or illness, your workers’ compensation claim will likely be denied.
• Substance abuse. If you were under the influence of drugs or alcohol at the time of your injury or illness and later failed your employer’s drug testing, your workers’ compensation claim will likely be denied.

It’s important to remember that the specific reason for the denial of a workers’ compensation claim will vary depending on the circumstances of your case. If your claim is denied, you can appeal the decision, but you should contact a workers’ compensation attorney to ensure your rights are protected.

How do I file an appeal if my workers’ comp claim is denied?

The workers’ compensation appeals process in North Carolina allows employees to challenge denied claims by having them heard by the North Carolina Industrial Commission (NCIC).

The process for appealing a denied claim in North Carolina is as follows:

• File Form 18. Your first step is to file Form 18 with the NCIC, which notifies the Commission that you intend to appeal your denied claim.
• File Form 33. This form is needed to request an official hearing of your appeal.
• Attempt negotiations. Next, you’ll be required to participate in negotiations with your employer through a mediator.
• Attend a hearing. If an agreement cannot be reached or if you disagree with the mediator’s decision, you can attend a hearing where you’ll be required to present evidence to a Deputy Commissioner.
• Appeal your case. You can also appeal to a 3-judge Commission if the Deputy Commissioner denies your appeal.

It’s important to remember that the appeals process can be complex and may require the assistance of an attorney. If you are considering appealing a denied workers’ compensation claim in North Carolina, it’s highly recommended that you seek legal advice to help you navigate the process.

How can an attorney help with a workers’ comp claim?

Workers’ compensation is a complicated area of the law. There are many rules and regulations to consider, and many factors go into determining whether or not you have a valid claim.

If you are injured on the job, an attorney can help determine if you have a valid claim, gather the evidence needed to support your claim, and fight for the compensation you deserve.

Other attorney benefits include:

• Knowledge of the process. An attorney specializing in workers’ compensation law will thoroughly understand the laws and regulations that apply to your claim. They can help you understand what to expect and guide you through each step of the process.
• Make a valid claim. A good workers’ compensation attorney will evaluate your case and determine if you have a valid claim for benefits under the law. An attorney will know what kinds of evidence is required and how much proof needs to be provided to establish that you’re entitled to benefits.
• Help when the claim is denied. In some cases, employers will try to deny claims to avoid paying the required amount of money they owe their employees when they get injured on the job. When this happens, employees need to know their rights under state law to fight back against these attempts at fraud by their employers.
• Help with medical treatment reimbursement. An attorney can also help ensure that all medical providers and treatment are covered under your policy so you don’t end up paying out of pocket.
• 3rd-party claims. In North Carolina, employees injured on the job cannot sue their employer for compensation. Instead, they must file a workers’ compensation claim to seek compensation from their employer for their injuries.

However, North Carolina law does allow injured employees to bring a lawsuit against a 3rd party through a personal injury lawsuit if a 3rd party’s negligence contributed to their injury. (For example, if a defective product caused your injury or you were injured in an accident because of someone else’s negligence while driving for work).

It’s advisable to consult with an experienced attorney to evaluate and investigate all potential avenues for recovery related to a work-related injury.