North Carolina Court of Appeals Retains Pre-Reform Definition of Suitable Employment

Suitable employment is an issue frequently litigated in workers’ compensation claims in North Carolina. Typically, a job is offered and the claimant refuses the job on the basis that it is allegedly unsuitable. For decades, this issue has troubled employers because claimants could, with seeming impunity, refuse legitimate work and continue to collect temporary total disability. Prior to 2011, North Carolina case law dictated that post-maximum medical improvement (MMI) employment
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Treatment Authorization Requests: Ensuring Proper Compliance with 12 NYCRR 325-1.4

Workers’ Compensation Law Section 13 establishes the obligation of the employer to “promptly provide for an injured employee such medical surgical, optometric or other attendance or treatment… for such period as the nature of the injury or the process of recovery may require.” When requesting authorization for treatment, the provider submits a Board form titled, “Attending Doctor’s Request for Authorization and Insurer’s Response.”  The Board code for the form is
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How To Ensure Your IME is Compliant with Section 137

In order for an Independent Medical Examination (IME) report to be compliant with Section 137 of the Workers’ Compensation Law, a copy of each report must be submitted by the practitioner on the same day and to the Board, the insurance carrier, the claimant’s attending physician or practitioner, the claimant’s representatives, and the claimant themselves in the same manner (WCL Section 137(1)(a)). “If a practitioner who has performed or will be performing
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Concurrent Employment – Limiting and Litigating Average Weekly Wage

Claimants may have more than one job at the time of their work incident. Pursuant to New York Workers’ Compensation Law Section 14(6), the average weekly wage can be increased if the claimant has two or more jobs at the time of the work injury. Therefore, this issue of concurrent employment is raised by a claimant, and not a carrier, because it can mean more indemnity benefits to the claimant.
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New Attachment for Schedule Loss of Use Stipulations

There are two types of permanency evaluations: Schedule awards for the impairment of extremities, vision loss, hearing loss, or facial disfigurement Non-schedule classification as a permanent partial or total disability. On October 4, 2019, in subject number 046-1211, the Board issued specific circumstances where a new attachment must be used when stipulating to schedule loss of use and non-schedule sites are also involved. The new stipulation must be used in
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A Quick Guide on How to Navigate Claims That Occur Outside of North Carolina

Whether the North Carolina Industrial Commission has jurisdiction to adjudicate a workers’ compensation claim can be critical to a claim’s defense. A scenario where this issue commonly arises is when an employee is injured outside of the state of North Carolina, yet chooses to file a North Carolina claim. N.C. Gen. Stat. Section 97-36 is the statute governing the North Carolina Industrial Commission’s jurisdiction over claims arising from accidents occurring
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When Does an Injury at Work Actually Arise Out of Employment in New Jersey?

For a work-related injury to arise out of employment, there must be a causal relationship between the employee’s injury and their employment. Simple concept, right? Well, maybe not. Consider the following hypothetical scenarios: A worker faints while sitting at their desk A worker is walking and, for no explicit reason, their lower back locks A worker suffers a stroke while making coffee in the office kitchen The above scenarios are
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You Down With 13(d)? Yeah, You Know Me: Responding to Health Insurer Reimbursement Requests

Occasionally, when a workers’ compensation claim is initiated, medical bills are paid by the claimant’s private health insurance. If this happens, you may receive correspondence from the health insurer asking for reimbursement. What should you do in that situation? The short answer is that you have no obligation to respond to a direct demand for reimbursement. However, there is a process for reimbursement. This is where the Health Insurer Match
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Using Labor Market Surveys to Rebut Disability

An issue that is frequently encountered in workers’ compensation claims is whether a claimant can prove disability — i.e., whether the claimant can show that they are incapable of earning their pre-injury wages at the same or any other employment as a result of their work-related injury. One tool that employers can use to rebut evidence of disability is a labor market survey prepared by a vocational rehabilitation expert. To
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Candy Cane Catastrophe: A Brief Look at Workers’ Compensation Defenses in New Jersey

With the holidays quickly approaching, it is important to keep in mind a number of issues that may arise when co-workers gather to celebrate. Many employers host year-end holiday parties to recognize another year gone by and to celebrate the many successes of the company. In the unfortunate event that an employee is injured during the most wonderful time of the year, it is important to remember the guiding principle
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