NC Workers’ Compensation Second Opinions

CLIENT: “Am I entitled to a second opinion under workers’ comp law?”

ME: “Yes, but it’s complicated.”

I have this conversation at least once a month.  And it is way more complicated than it should be.  When the insurance company-loving-Republicans took over the NC legislature a few years back, they changed injured workers’ rights to second opinions.  It used to be that you just asked for a second opinion – on whatever – with whomever you wanted and then you got it.  It ain’t so easy anymore.

Now there are two types of second opinions.  97-25 allows for a second opinion on all issues, whereas 97-27 allows for a second opinion ONLY on the rating.  Well, how are they different?

97-25 FULL SECOND OPINION

With this option, you can ask a doctor about any medical issue related to your claim – diagnosis, treatment, causation, work restrictions, MMI, rating – whatever.  The trick is that the plaintiff and the insurance company have to either a) agree on a doc, or b) have the NCIC appoint a doc.  The crappy bits are somewhat obvious, and somewhat not.  When you are agreeing to a doc, you generally aren’t going to get someone who is famous for being plaintiff-friendly.  And there’s always the concern that any doc an insurance company will agree to has a “good” history with them, which should concern you.  And if the NCIC appoints one, who knows who or what you’ll get.  It’s very much a roll of the dice.

97-27 SECOND OPINION ON RATING

With this option, you can choose ANY doc you want, essentially, but you can ONLY ask his/her opinion as to your disability rating.  Of course, you should only use this one when that’s the only real dispute you have.  It’s nice to be able to choose your doc, as you can feel more comfortable about their innate prejudice/bias.  Sadly, as insurance companies are wont to do, they have found a way to stymie these.  Their current ploy is to say that they’ll only pay what the NCIC fee schedule allows for an appointment – which is like $150 or so – and they refuse to pre-pay.  Virtually no doc will agree to that.  The great irony is that the insurance companies will happily pay their own prostitutes, I mean doctors, $1600 or more for a second opinion.  Completely ridiculous.  As a consequence, docs are getting the idea that they should be getting $1500 or so for these appointments, so then even the good docs aren’t willing to play ball for anything less.

 

It’s no fun.  Once again, the law wasn’t always like this, and it’s simply another example of the legislature destroying peoples’ rights in favor of big business.  Sadly, we have to play by the rules set out by the State, though, so we’re stuck with them for now.

This is all the more reason why you need the best guidance you can get in your worker’s compensation claim.  Call me for info anytime.  919-929-2992.

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To give a statement or not, that is the question

 

 

 

Should you give a statement to the defendant’s liability carrier after your auto accident?

I should start by pointing out that there are many different points of views on this, but they fall into two categories, generally…those that don’t like statements, and those that don’t mind them so much.

But what does that tell you?  A good place to start is considering the person with whom you are speaking.  The adjuster works for the liability insurance company.  The adjuster’s job is to try to save their employer money.  You should approach each and every interaction with them with that thought in mind.

Because of their overarching goal, giving a statement to the adjuster can be dangerous to your claim.  Adjusters are trained to  ask you questions, which elicit responses that might damage your claim, so talking with them is very dangerous!  Because North Carolina is still a Contributory Negligence state, it is especially dangerous with regards to the determination of negligence, or who screwed up, in your accident.  If they get you to say something that shows you contributed to the cause of your accident, you can mangle your case with a quickness.  And even if you get by that little problem,  there are still things you might accidentally do/say to harm the value of your claim.  For example:

Adjuster: How are you doing today?

Victim: I’m fine, how about you?

MISTAKE!   You’re not “fine”!  You were just in an automobile accident!  You just got out of the hospital and full of pain meds!  But this is the danger.  We have a habit of falling into conventional conversation patters and we subconsciously say stuff that may not be true AND that they’ll use against you later:

NASTY DEFENSE ATTORNEY IN COURT: “…then why did you say to the adjuster, ‘I’m fine,’ the day after the accident, hmmmmm?”

Most of the time, for the reasons pointed out above, I shy away from having my clients make statements to the carriers.  The tricky cases, though, are when the carrier is leaning solely on your story alone to determine if they’ll accept the claim.  This mostly happens when they can’t get their own insured to give them a statement, or when their insured’s story, or a witness’ story, doesn’t jive with the accident report.   This is really frustrating because getting them to accept liability means getting your property damage claim moving, which is often the most immediate concern of most clients; everyone needs transportation in this area…public transportation isn’t the norm.  This scenario creates a very precarious position for victims.

So how can you get the claim moving without facing these perils?

You may be best off speaking to an attorney first, particularly one that actually does personal injury law.  If there are concerns about liability (could you be at fault, maybe?) in your case, speaking to the adjuster may do more harm than good.  This is especially true in stop sign intersection cases, or any intersection case for that matter.

After you consider the facts in your specific scenario and IF you decide you REALLY want to just move forward with the statement (which I normally would try to avoid!) then follow these guidelines:

  • Ask questions:   Why is the statement necessary?  Is the accident report available?  Why is it not good enough?  Is there a way you can help him to meet his goals to reach a liability decision without subjecting you to a recorded statement like a criminal defendant? If you are nice but firm, this might get you out of the statement, or might lead to an alternative.
  • Watch the small talk.  Just because he’s talking to you about sports and your favorite UFC fighter doesn’t mean he’s a good dude.  He’s taking notes on everything you say, and you can do lots of harm when you’re talking but not thinking about what you’re saying.  Try to avoid the small talk and get to the point.
  • If you ask for the statement not to be recorded, they might agree (or they might pretend not to be recording). Still, the problem with recorded statements is what you say, and how you say it, is preserved forever.  It’s that inability to be flexible in your narrative later down the road that creates issues.  So if you can have an informal discussion, that’s better.
  • Keep it simple.  People are generally not very good at this.  Still, try!  Don’t give any more details than necessary.  “I was stopped for traffic in front of me and she hit me from behind.”  Boom.  There’s your story.  There’s no need to elaborate.
  • DO NOT DISCUSS  injuries or treatment.  If you are injured, tell them you are injured and that’s all you’re telling them.  You will discuss injuries and treatment AFTER you’re done recovering.

In my experience, if you can avoid the statement without creating too many secondary issues for yourself, that’s the best strategy. But under some circumstances you might be stuck.  The best thing you can do for your claim is speak to an experienced attorney.  I know one that can help!  THIS GUY!  Call me at 919-929-2992.

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Creditors for Medical Bills In Personal Injury Claims

One of the main questions people have after getting hurt in an auto accident is how they go about paying their bills.

So what’s the answer?  As usual, it’s complicated.

For whatever reason, a lot of people think that there is a different billing and collections system for auto accident-related medical bills.  They often think that the liability carrier will just start writing checks for their bills, or that the hospitals/other providers will just hold off collecting those bills until they clam is done.  None of those things are true.

The main thing (and it’s a hard thing) to take away from this post is that your bills are your responsibility.  Period.   Even if it wasn’t your fault that you incurred them, it’s you that owes them.  That’s our system, believe it or not.

Of course, MY JOB is to make that not so painful for you.  In handling the claim, my goal will be to get you a sufficient recovery from whatever insurance carriers are out there so that you won’t lose money on medical treatment costs, and hopefully I’ll be able to get you something for your pain/suffering/inconvenience.  Obviously, our ability to recover for any and all of those things are affected by many factors, including but not limited to liability issues, damages, causation, etc.

You get it now, if you have bills, you have to pay them.  But what if you can’t?

Here’s the best advice I can give on medical bills after an auto accident:

  1. If you have health insurance, use it!  This is what it’s for!  Insist that the provider bill your health insurance.  This will reduce your overall costs in most situations, depending on your policy, and will slow that collections process down, too.
  2. Whether we are talking balances, co-pays, or the whole bills, IF you can pay them now, PAY THEM NOW!  That will totally stifle credit reporting concerns down the road, and we’ll do our best to get you paid back.
  3. If you can’t pay all the bills now, MAKE SOME SORT OF PAYMENT PLAN!  Even if it’s just $10/month, that will help, and most hospitals would rather get that than nothing, AND that will hold off credit reporting, too.
  4. If you can’t make payment arrangements, send me copies of the bills with collections warnings and I’ll ask them to hold off.  There’s no law that says they have to, but in many circumstances, if they know you have an attorney, they’ll be more patient.

This can be confusing, mostly because of our inability to toss pre-conceived and inaccurate notions.  But I’m here to help.  Call me for any accident injury questions at 919-929-2992.

 
 
 
 

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The Key to Injury Claim Success

What’s the best thing you can do to help your claim? Listen to the advice of a good lawyer

I have been doing this for over 16 years as of the time of this post.  And I can’t tell you how many times I’ve been hired by an injury victim only to have my advice – for which they are paying! – ignored by the client.  Why?  How? What’s the point?

Of course, this is by no means the majority of my clients.  The overwhelming majority of my clients know and understand the value of what I bring to the table in this relationship and they heed my advice as best they can.  But there are always outliers.  And I think they fall into two categories:

The first category are those people who didn’t want to get a lawyer in the first place, felt like they knew it all to begin with, and are only hiring me because someone is bullying them into it. It’s really hard for me to get past that.  It reminds me of the Zen koan where the teacher shows that a cup full of tea cannot receive more tea, the lesson being that you must first empty your cup and acknowledge your ignorance before you can learn.  I try to be a good and patient teacher with these folks, but when someone doesn’t want to learn, then I can’t make them.

The second category are those people that would otherwise be willing to learn, but for whatever reason have a certain deficit with regard to maintaining successful communications links.  My preferred method of client contact is email.  It’s immediate and is easily preserved for future reference.  Some people prefer phone calls, or texting, or even letters.  Whatever!  As long as you’re communicating, it should work out.  But some folks just can’t do that…I don’t know why.  Maybe they have a fear of computers, or don’t have one.  If that’s the case, TELL your lawyer and then choose another method.  But the main point is that whatever method you choose, engage in it!

The number one downfall of most clients’ cases is their failure to respond to or engage in communication with their attorney. 

If you aren’t hearing anything from your attorney, reach out.  That won’t be the case with me because I ALWAYS reach out to clients every two to three weeks unless there’s a reason not to, which I’ll then share with the client so they know.  If you aren’t hearing from me, then it’s because something is wrong.  Your spam filter is eating my emails, maybe you moved and forgot to tell me, or you changed numbers.  But you can rest assured that I’m trying!

So what have you learned here?  Listening to your lawyer will help your claim.  Seriously,  you’re paying your lawyer for his or her advice, so it only makes sense to at least consider it when making your decisions.  Make sure to keep an open line of communication with your lawyer, and if you aren’t hearing from him or her, find out why!

Now you know, and knowing is half the battle.

Yo, Joe!

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Traffic Tickets and Insurance Rate Hikes

What’s that ticket going to cost you?

That’s a good question, and the answer isn’t as simple as you think.

Some people think that the cost of the ticket is just what they pay to the court, but many times that is not the total cost.  Once you pay the cost of court/fine, you’ve plead guilty to whatever that charge was.  At that point, DMV is notified of your conviction, and eventually your automobile insurance carrier finds out about it.  Each moving violation in NC carries certain insurance points under the SDIP or Safe Driver Insurance Plain (or does SDIP stand for Steal De Income of the Poor?).  Check it out:

How does a traffic conviction affect my insurance costs?
Traffic Violation Conviction License Points Insurance Points Rate Increase
Speeding 76 mph in a 65 mph zone 3 4 80%
Speeding 82 mph in a 70 mph zone 3 4 80%
Passing a stopped school bus 5 4 90%
Reckless driving 4 4 90%
Illegal passing 4 2 45%
Running stop sign/red light 3 1 30%
Driving While License Revoked 3 8 195%

*Credit to Dan Hatley for this awesome chart (https://www.iticket.law/traffic-tickets/).  There are other versions of it, but this one does a great job of pointing out the ones that really get ya. 

Yep. And that rate increase is for 3 years!

So you might think that paying that $213 or whatever to just pay off the ticket is a good idea.  It’s certainly the path of least resistance.  But when you end up with doubled insurance rates for three years (or maybe a revoked license?) then it’s not going to seem like such a good idea.

Do yourself a favor.  Call an attorney who practices traffic ticket law in the area in which you got your ticket.  Get some good advice and quality representation.  It will probably pay off in the end.

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Don’t Miss Your Traffic Court Date!

Traffic Attorney

I see it ALL THE TIME…

Someone gets a traffic ticket, they slam it in the glove compartment with a, “I’ll deal with it that later,” attitude, but they totally forget about it.

The next  thing they know they have lost their license, or are maybe in jail!  How can this happen?

For some reason completely unknown to me people sometimes think that missing a court date for a traffic ticket isn’t a big deal… “it’s only a traffic ticket!”  Clearly that sort of attitude will have negative consequences.

Yes, a traffic ticket isn’t like a first degree murder charge, I agree, but it can have a huge impact on your life.  Even if it’s “just” speeding, here’s what you have to remember:  A ticket is a summons to court, and failing to deal with court matters correctly can be costly at best, and missing your court date altogether can be disastrous.

 

Almost invariably, a fact that often complicates this sort of situation is when the person who missed their court date moved at some point in the process (shortly before or after)and failed to update their address with DMV.  How does this make it uglier?

When you miss your court date, eventually DMV will get wind of it and they’ll send you a very helpful notice reminding you of the ticket and giving you a deadline to get it fixed before they revoke your licnese.  When DMV sends their warning letter about the FTA and impending revocation, the person doesn’t get it because DMV doesn’t have the right address!  I hear ya, but this is NOT the fault of DMV. Consequently, the missed court date just continues to escape the person’s mind and they are driving on a revoked license for who knows how long.  Then they get pulled over again and BOOM!  Driving While Licensed Revoked (DWLR) is a Class 2 Misdemeanor in North Carolina, and you can go to jail for it.  In the business, we call this snowballing, because what starts out as an easy ticket to handle starts rolling down the hill and turns into a much bigger and more dangerous problem, just like the snowballs rolling downhill turn into snowboulders in cartoons.

In summary, in addition to costing you more money in court costs and fines, missing your court date can also revoke your license, can maybe get you in jail, AND the deeper that goes the higher the costs of fixing the entire mess! As attorneys we have to charge you more when we have to do more.  What would have been a small-ish fee on a current ticket turns into $1000 or more because we have to do more work to  dig you out of the mess you made.

Don’t let this happen to you!  If you have an Orange County, Alamance County,or Chatham County ticket, and you don’t want to go to court (or forget to go to court!) find someone to help.  Call me at 919-929-2992 or 888-929-5241 and I’ll be glad to help.

Don’t let a little problem turn into a big one.  Call me now if you have a ticket!

 

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Med Pay Coverage in NC Auto Accidents

Automobile insurance coverage is a somewhat complicated situation in North Carolina.  Most auto accident victims in North Carolina tend to focus on what the at-fault party’s insurance company will pay for the treatment of the victim’s injuries.  And the primary focus should be there.

But if victims look closer at their situation, they might have thousands of dollars of medical coverage that they’ve been paying for, in addition to the liability coverage for the bad guy!

Medical Payments coverage, or “Med Pay” as we call it in the business, is optional extra coverage you can purchase with the liability policy that you have to buy.  Many people have Med Pay coverage but – believe it or not – most people that I speak with don’t even know whether or not they have it!

This coverage no-fault coverage – meaning it doesn’t matter who is at fault – and is designed to pay for any and all medical expenses, up to the policy limits of the Medical Payments policy, incurred as a result of injuries sustained by any person riding in the car which is covered by that policy of insurance. I see policy limits vary a lot.  I see little policies at $500, and I once saw one for $1 million.  Most Med Pay policies in NC are $1000 or $2000.  Any victims in the covered vehicle can be covered by the policy; they do not have to own the car and do not have to be a named insured under the policy. Anyone who is injured while riding in the car at the time of the accident and incurs medical treatment costs can have all of their reasonable medical bills paid up to the amount of the Med Pay coverage.

The big hesitation I see from clients is a concern that using their coverage might raise their rates.  Med Pay coverage is optional “no fault” coverage, so it doesn’t matter who caused the accident.  If you were in a covered vehicle and were injured in an accident, regardless of who caused it, you have access to that vehicle’s Med Pay.  Moreover, if your treatment costs exceed that vehicle’s Med Pay limits, you may have access to another Med Pay policy of a different vehicle’s policy, depending on the circumstances.  This is a tricky topic and you’d do well in seeking legal counsel for coverage questions.

Med Pay coverage is available in addition to the coverage you’re seeking through the at-fault party’s liability coverage (assuming we’re talking about the Med Pay for the car you were in and the driver of that same car wasn’t at fault…).  Med Pay coverage is available in addition to your health insurance.

Maybe the most important thing about Med Pay is to know is whether or not you have it!  Check out your policy or talk to your insurance agent.  And remember, if you have it, use it!  You’re paying for it after all, right?  Otherwise, why would you be paying for it?

When I represent an auto accident victim I help to process the Med Pay coverage free of charge.

Remember, if you are in an automobile accident in North Carolina and want to talk to an attorney about your options, call me.  919-929-2992.

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PROTECT YO NECK!

North Carolina is a “liability” state, meaning that drivers must have liability insurance to legally operate a motor vehicle on the streets and highways of our fair state.  Liability insurance pays out, theoretically, for the losses caused by your negligent operation of a motor vehicle.  This works out, in general.

But, as with all systems, there are gaps.

The main gap in our liability system is that NC minimum liability insurance is $30,000.  That means someone could run you over and chop off both of your legs and the most you’d likely ever see from them is a whopping $30,000.

How do you protect against that kind of catastrophic loss?

First, you should have health insurance.  I know, it’s not cheap.  Believe me, I personally pay for 4 people and get no help with that.  BUT it’s worth it!  Your health insurance should cover what might be the biggest part of your loss – health care expenses – AND unless you have an unusual policy, they shouldn’t have any right to dip into your liability award.

Second, you should have as much UNINSURED/UNDERINSURED MOTORIST COVERAGE as possible.  That coverage, which you have on your auto policy, will help cover you in a situation where there is no liability insurance, or there isn’t enough to cover your losses.  Of course, it has limits, too, which is why I say you should get as much as you can. Here’s an example:

Fred runs me over and chops off my legs.  Fred has $30,000 in coverage.  I have $100,000 in UIM (underinsured) coverage.  That means I can get $30,000 from Fred’s carrier AND $70,000 from mine, for a total amount of my UIM coverage of $100,000.  If in that scenario, Fred had NO coverage, then I could use my UM (uninsured) coverage up to $100,000 from my own carrier.  What happens between Fred and my carrier afterward is another story.

Third, heaven forfend that you die in an auto accident, but it can happen.  Given that the survival rate for all of us is 0% on a long enough timeline, you should have life insurance. If Fred killed me in one of the above examples, my estate should be able to get up to my UM/UIM limits AND my life insurance would pay out to the beneficiaries, too.

It would be great if everyone had $1 million or more in coverage, but the reality is they don’t.  The moral of the story is that you should do your best to insure yourself against these sorts of losses by getting as much coverage for all eventualities as you can.   Do it.

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Why You Need Auto Insurance

https://www.jeffreyhowardlaw.com/auto-insurance-in-a-nutshell-liability-um-uim-med-pay-no-faultpip/

Insurance always sounds complicated.  Automobile insurance in NC can be especially complicated.

The little video I’ve linked above tells you, briefly, what our auto insurance policies in NC tend to cover.  It’s not exhaustive, but gives you some ideas as to what you’re buying.  I don’t really want to talk about all the types of coverage today, but I just want to get a few messages across.

The message for today is that you NEED to have adequate insurance!  Why?  I’m glad you asked!

First, it’s the law,  You are required to have liability insurance.  That’s the coverage that will pay your victims, up to the limits of your coverage, if you screw up and hurt someone or their stuff.  Get it!

Second, when you buy liability insurance in NC, you automatically get uninsured and underinsured motorist coverageThis stuff is worth every penny you’re paying for it.  In fact, I think you should go buy extra if you can.  Uninsured coverage helps cover your damages if some knucklehead hits you and didn’t have liability insurance.  Second, if some knucklehead with insurance screws up so bad that their liability coverage isn’t enough to cover all of your damages, YOUR underinsured coverage can fill in the gap up to the amount of your policy limits.  I can’t tell you how many times these two types of situations have come up in my practice.  If you’re in an automobile accident in NC you DO NOT want to be in a position where you have either no coverage for your injuries or you don’t have enough coverage for your injuries.

So, call your insurance agent now and get as much UM/UIM coverage as he or she will let you buy.  I promise you they’ll let you buy a lot.

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Treatment in Injury Claims

 

 

You’re hurt.  You want to get better.  The obvious next step is to go get treatment.  But where? With whom?  What kind?  How much?

These are easy questions for me to answer: I don’t know and am not qualified to say!  Unlike a lot of attorneys, I’m not going to tell you where to go, whom to seek out, what treatment modality is best for you, or how much you should get.  That’s just not what I’m trained to do.

What I am trained to do is to tell you how these decisions can affect the value of your claim.

Personally, I’m not as worried about where/what you’re doing with regards to treatment, but I’m more concerned that you ARE IN FACT GETTING SOME KIND OF TREATMENT.

The best way to articulate this concern is this: Injury claims are judged on many things.  One of the main factors is your pain and suffering.  Whether it’s right or wrong I can’t say, but one way to measure this is how much treatment you’re suffering through.  Your pain and suffering argument is intrinsically linked to how much treatment you’re getting.

So if you aren’t getting any treatment, that is going to drastically and negatively affect the value of your claim.

Conversely, if you are getting ALL the treatment, as the kids say these days, then that just looks like you’re running up an unnecessary bill, and you don’t want to do that.  That doesn’t help anyone.

The moral of the story is that if you’re hurt, get appropriate treatment.  Trust your health care providers to tell you what that is, and keep me posted as to what’s going on throughout your recovery.  If you do those things, you really help your chances of getting a reasonable outcome in your claim.

 

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Contact Jeffrey

Jeffrey Allen Howard, Attorney at Law, PLLC
1829 E. Franklin St. - Bldg 600
Chapel Hill, NC 27514

(P) 919-929-2992
(F) 919-636-4779

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