Yearly Archives: 2015

The doctor has ordered a test but the adjuster isn’t approving it. Why?

Workers' Compensation

There’s no simple answer to this but here are a few possibilities. First, she’s lazy or procrastinating or overworked. Maybe.

Second, she’s in denial that the test is actually necessary. She may be hoping that you spontaneously get better without the test. That occasionally happens but not often. Most experienced workers’ compensation doctors aren’t just ordering tests randomly. They don’t order tests they don’t think are necessary. But some adjusters act like they know more about modern medicine than someone who went to medical school.

Third, she may have an internal review that has to be done before the tests can be authorized. Some insurance companies have an internal “utilization review” performed by an in-house “doctor” to second guess the doctor who ordered the tests.

Fourth, the adjuster may be trying to line up a second opinion with another doctor who may say the test isn’t necessary. You may ask yourself: would an adjuster really pay an extra month of weekly benefits, pay hundreds of dollars to a rehabilitation nurse to set up a second opinion, and pay hundreds more outside of the Industrial Commission medical fee guidelines, just in the hope of avoiding a $750 test? The answer is yes.

Why does the adjuster have to get a second opinion when her own doctor has recommended surgery?

Workers' Compensation

She shouldn’t, but under the current set of laws there really isn’t much of a limit to what the adjuster can request. It rarely works to simply refuse to attend a second opinion. On the other hand we’ve had some success convincing the Industrial Commission that the adjuster is abusing her privileges. And under a law which escaped revision by Gov. McCrory if an adjuster wants a second opinion on a surgical recommendation she must move quickly. While the Industrial Commission generally grants additional time the law requires that the second opinion be scheduled (but not necessarily completed) within ten days of the original recommendation for surgery. We are very aggressive about scheduling expedited hearings over this issue.

Can the adjuster really send me halfway across the state to see a different doctor?

Workers' Compensation

Sometimes, and, if they can get away with it. A while back a well-known neurosurgeon based in Raleigh spoke at a closed-door meeting with adjusters at a meeting sponsored by a law firm, which represents mostly insurance companies and employers. During the course of his presentation he stated that he believed a lot of injured workers underwent unnecessary surgeries and ended up being out of work longer than necessary as a result. What happened next? Clients who lived in Mount Airy, in Lexington, even in Charlotte were being sent to him for second opinions.

This happens more often than you would believe. In this particular case we objected to the Industrial Commission. The defense attorney, coincidentally a partner in the firm that sponsored the private meeting, argued that the law regarding second opinions didn’t require that the doctor be fair or neutral. The only limitation was in terms of geographical reasonability. The Industrial Commission seems to have bought into this theory. Your best defenses against a second opinion are that it’s too far away and that the adjuster has already had a couple of second opinions. At some point the adjuster has to concede that she’s only shopping for an opinion that she wants to hear and isn’t really looking for sound medicine anymore. While that seems patently obvious to some people it’s considered bad form to admit to it when you’re at the Industrial Commission.

To be fair, we have our own lists of doctors as well. One advantage of our law firm is that we’ve been keeping records and notes on doctors, adjusters, rehabilitation nurses, etc., for years now. We know which ones tend to unnecessarily favor the employers and insurance companies and we know which ones put their patient’s interests first. So when it’s our turn to pick a doctor we know who we’ll recommend.

Oxner + Permar Welcomes Attorney Paul Daniels to the Personal Injury Team

Personal Injury

Oxner Permar + Richardson PLLC is pleased to announce that Attorney Paul A. Daniels has joined the firm’s Personal Injury Department. Paul is a veteran lawyer with more than 18 years experience. He began his career as an insurance defense lawyer where he litigated hundreds of cases, provided insurance coverage opinions to clients and successfully handled a large number of appeals to North Carolina appellate courts and the 4th Circuit Court of Appeals.

In 2010, Paul left the world of insurance defense and has been representing injured people since. At Oxner Permar + Richardson PLLC he will continue to represent good people who have been injured by the negligence of others in automobile collisions, tractor-trailer accidents and slips and falls. He also handles other premises liability cases such as dog bites and defective property conditions. Paul’s experience representing insurance companies for many years gives him a unique insight, and allows him to provide the highest quality representation to his clients. Paul is admitted to practice in all North Carolina state and federal courts, the 4th Circuit Court of Appeals in Richmond, and is admitted to practice law in Virginia, where he is an associate member of the Virginia Bar.

Paul and his wonderful wife, Melody, have been married for 28 years. They have two lovely daughters and two small dogs, Buttercup and Tootsie. In his non-working time, Paul enjoys spending time with his family, working in his yard, playing basketball, reading and traveling.

What is Underinsured Motorist (UIM) coverage – and do you really need it?

Personal Injury

In North Carolina, motorists are required to buy automobile liability insurance with limits of only $30,000 per person and $60,000 per accident to protect others from their carelessness. Because it’s all that is required, that’s all most people have. That means that most drivers on our highways have policies that will pay, at most, $30,000 for each person injured by that driver’s carelessness, and no matter how many people are injured, the most that the driver’s insurance company will pay is a total of $60,000. If you have been to the doctor’s office or the hospital you know how expensive modern medicine is, and it’s easy to understand that $30,000 is not a lot of money, medically speaking. Moreover, people injured in automobile collisions may be out of work and have lost wages and other expenses. It is easy to see that the insurance required in North Carolina can be woefully inadequate to compensate those injured by inattentive drivers. Fortunately, there is a way motorists can protect themselves from careless drivers who have only minimum limits policies. It’s called Underinsured Motorist (UIM) coverage.

UIM is insurance you purchase. It pays you if you are injured by another driver when that driver does not have enough liability insurance to compensate you for your injuries. UIM coverage is purchased through your insurance agent along with your insurance policy. North Carolina law requires insurers to provide UIM to drivers who purchase policies with liability limits greater than the minimum limits of $30,000 per person/$60,000 per accident. So, if you buy an auto policy with liability limits of $50,000 per person/$100,000 per accident, for example, you automatically will receive UIM coverage in the same amount.

On its face this makes no sense – the accident wasn’t your fault, why should your own insurance company have to pay? Well, this is the world we live in! One of the hardest parts of my job is telling a client that the at-fault driver did not have enough insurance to pay the bills and the client has no UIM coverage to cover the shortfall. The only prudent way for drivers to protect their families is to purchase UIM insurance – and lots of it. I recommend everyone get the maximum, $1,000,000 per person/$1,000,000 per accident. And as far as insurance goes, UIM is quite inexpensive.

Don’t wait to be injured by a driver with a small insurance policy. Talk to your insurance agent about UIM coverage today.