If you have been approved for weekly workers’ compensation checks, you should be aware that most workers’ compensation insurance companies want to get you off of weekly benefits as soon as possible. Once you are on benefits, the WC insurance company will (in many situations) file a Form 24 (Application to terminate or suspend payment of compensation) to have your benefits terminated. Essentially, the insurance company (or their attorney) is trying to prove that you are no longer disabled because of your work injury.
NC Workers’ Compensation Form 24
In order for the WC Insurance Company to file a Form 24 with the NCIC (North Carolina Industrial Commission), one of the following must be true about the employee:
- The employee has been returned to full duty work without restrictions by the authorized treating physician (the doctor that WC is paying for you to see).
- The employee has refused suitable employment
- The employee refuses medical treatment or participation in vocational rehabilitation
- The employee fails to return the Form 90
- The employee is incarcerated.
The above list, while it seems straightforward, is anything but. It should be noted that the employee must be returned to full duty for all their impairments.
If a worker has two injures (for example, left arm and low back), his/her weekly benefits should not be terminated if they are reduced for full duty for only one of their impairments. It must be a full release to duty of all injuries by all authorized treating physicians. The NCIC prefers to see an office visit, not simply a one sentence note that says “full duty release.”
A major issue with a full duty release by an authorized treatment physician occurs when a client continues to have pain and limitations from their injury. Apparently, the doctor and patient have a different view of the injury.
Despite this, the doctor releases them to full duty with additional Physical therapy only. In accepted NC Workers’ Compensation cases, the employer (or really their Workers’ Comp insurance) controls the medical treatment so a 2nd opinion should be sought as soon as possible.
If the authorized treating physician has released you with restrictions, those restrictions should be sent to your employer. Most employers will try to accommodate those restrictions and offer you “suitable employment.” If you do not go to work after being offered suitable employment, your weekly benefits can be terminated.
The most common issue here is if the employment is really suitable (does it comply with the doctor’s restrictions?). In the very least, you should try the job.
Noncompliance with medical treatment or vocational rehab can also result in benefit termination. Remedying non-compliance should be a priority.
An incarcerated person can not receive benefits but may be able to restart their benefits once released (See NCIC Form 23).
After Form 24 has been filed
After the insurance company files a Form 24 with the NCIC (North Carolina Industrial Commission), you must file a response within 17 days if you want to have a telephonic hearing on the matter.
If you do not file and inform the NCIC that you want a hearing a decision will be made without one. Attorneys usually send two statements to the NCIC, one requesting a hearing and the second containing an argument as to why their client’s benefits should not be terminated.
A short time later, a telephonic hearing is scheduled with a Special Deputy Commissioner (SDC). Each side has roughly 10-15 minutes to present their arguments as to why benefits should/should not be terminated. The SDC usually makes a decision within a few weeks.
This decision by the SDC can be appealed by either party. If the SDC determines that the employer is correct they will receive a credit of the disability benefits paid to the employee as of the date that the NC Form 24 was filed and benefits will be terminated.
If the SDC finds that the employee is still disabled their benefits will continue. If the NCIC finds that benefits should be terminated due to noncompliance, the decision must include what action the employee must take to attain compliance.
NC Workers’ Compensation benefits are available for workers but it is not always easy or straightforward for an injured worker to get help or keep it, for that matter.
The Bishop Law Firm represents injured workers in Raleigh, Cary, Fayetteville, Durham, Rocky Mount, Wilson, Smithfield, Louisburg, Chapel Hill, Roanoke Rapids, Greensboro, Winston Salem, Greenville and surrounding areas in North Carolina.