There are several subjects the claims adjuster is allowed to discuss with your doctor, but your medical care is not one of them. Unless you give the adjuster permission to speak with your doctor they may not call and ask questions concerning your care.
There are many complicated rules regarding communication with medical providers. Defendants are allowed to obtain medical records, medical bills, and address non-substantive matters, but they can not discuss important matters like treatment without authorization from you, the injured worker.
The statute is clear about the type of written communication that is allowed as well and provides specific questions that can be asked without your consent.
It can be confusing when an adjuster calls and asks if they can discuss a certain topic with your doctor. What you say in an unplanned moment may hurt your case. If you suspect improper communication has occurred you should contact an attorney to discuss the issue.
If you are considering applying for Social Security Disability, you may have many questions. One question most people have is, when will I need an attorney? My answer to that question is: immediately.
A few other common indicators for whether you need an attorney:
It is also important to tell your doctor that you’re applying for Social Security Disability benefits. It is essential to inform your doctor of all of your impairments — both mental and physical — if your doctor doesn’t know about it, it will not be in your medical records. Social Security reads your medical records to determine how your impairments affect your work, so it’s important that nothing is left out. Most doctors know what key language to write in your medical records to help Social Security find you disabled.
The North Carolina General Assembly passed a new law that will impact those who are seeking medical treatment after being injured on the job. This was done to strike down the North Carolina Supreme Court’s ruling in Wilkes v. City of Greenville. In Wilkes, the Court cited the previous version of this legislation and held “an admission of compensability…entitles an employee to a presumption that additional medical treatment is causally related to his compensable injury.” In other words, this meant that once the claim was accepted on a Form 60 or 63 section 1, the burden of proof shifted to the employer to disprove that the requested medical treatment was not related to the injury.
The new legislation now says that an accepted claim on a Form 60 or 63 section 1 “shall not create a presumption that medical treatment for an injury or condition NOT IDENTIFIED in the form prescribed” by the Commission on a Form 60 and 63 section 1 “is causally related to the compensable injury.” Therefore, if the body part that the injured worker is requesting treatment for is not listed on the Form 60 or 63 section 1, then they bear the burden of proof. This is the case even if the Defendants have been paying for the medical treatment for weeks, months, or years.
If the injured worker has been receiving medical treatment for a body part, directed by Defendants, and it is not listed on the Form 60 or 63 section 1 for an extended period of time and the Defendants deny ongoing care, the injured worker must go through the formal hearing process and prove that the body part is related to the claim. This is not only a reversal of our North Carolina Supreme Court’s ruling in Wilkes, but also causes harm to the injured worker if Defendants one day stop providing care—months or years down the road.
…su estatus migratorio, no afecta la capacidad de recibir beneficios de compensación laboral?
No importa cuál sea su estatus migratorio, en el estado de Carolina del Norte si usted se lesionó o accidentó en el trabajo, usted tiene el derecho de comenzar una demanda de compensación laboral, lo que le proporcionará tratamiento médico, y cheques semanales por su tiempo fuera del trabajo.
Además, ni la compañía de seguro de su empleador, ni el abogado que representa a la compañía de seguro, pueden divulgar su información personal, como por ejemplo: al Servicio de Inmigración y Control de Aduanas de Estados Unidos (ICE, por sus siglas en inglés). Tampoco, existe el riesgo de que su empleador lo amenace con reportarlo a oficiales de inmigración, por el simple hecho de haberse lesionado o accidentado en el trabajo. Muchas veces, esto ocurre para evitar que usted presente una demanda en contra de ellos, porque saben que usted tiene ese derecho bajo la ley.
When someone gets injured in an accident, the first thing they do is call their insurance company/insurance adjuster. They ask for help with filing a claim.
After the adjuster has done his job, he/she may send you a letter saying “We’ve reviewed your case and we’re going to deny your claim.”
I speak with clients all the time who have received calls from the insurance adjuster after their accident. They have already given a recorded statement about their accident and injuries before they have called us.
These recorded statements are hazardous because the adjuster, who has done these interviews hundreds of times knows just what questions to ask, is always looking for a reason to deny coverage or get you to agree to something that may not be true, or to something that is even damaging to your case.
What you say in an unguarded moment may literally turn a good case into a denial. My message to anyone who has been injured by the negligence of another is to consult a lawyer before speaking to an insurance adjuster. We know what questions are going to be asked and can prepare you for these conversations and help you avoid saying anything that could potentially undermine your claim.
Regardless of what kind of injury you have sustained, I recommend declining to speak with the adjuster until you have spoken with an attorney who has helped you go over the questions that will be asked.
The insurance adjuster may be insolvent. This means he/she doesn’t have enough money to pay out claims. So, when you talk to him/her, keep this in mind.
If you’re injured at work, you should contact your employer’s workers’ compensation insurance company
This is important because if the adjuster isn’t solvent, you won’t get paid. And if you don’t get paid, you won’t get the medical care you need. So, if you decide to take the settlement, make sure you understand the implications of accepting a lower amount than you’re entitled to.
If you’ve been injured at work, you may want to contact a workers’ compensation attorney right away. An attorney can help you file a workers’ compensation claim and negotiate a settlement with your employer.
Personal injury lawyers handle cases involving injuries sustained due to negligence, including car accidents, slip and falls, defective products, and medical malpractice. They may also represent clients who were not involved in an accident but suffered injuries because of another person’s actions.
The most important thing to remember when contacting a personal injury lawyer is to be honest and open with them. Don’t lie about the details of your case, and don’t try to hide anything. Your lawyer needs to know everything about your situation to properly advise you.
Don’t risk your claim being denied because of what you said in a vulnerable moment. If you have been injured in an accident, give Oxner + Permar a call for a free consultation before you speak with an adjuster.
