Importance of a Change in Condition in a NC Workers’ Comp Case

The purpose of North Carolina workers’ compensation is to support employees while they recover from workplace injuries or illnesses. The goal is for the worker to get better and return to work. Most do return to work, but others have disabling conditions and are unable to return to work. 

Some injured workers who are receiving workers’ compensation see their condition change for the worse. This becomes an issue if their workers’ compensation claim has been settled but they need further medical treatment.

If an injured worker’s NC workers’ comp benefits need to be adjusted because of a change in condition, the employee may find their employer and/or employer’s insurer reluctant to increase payments. The worker may need a knowledgeable Raleigh workers’ compensation lawyer to reopen the workers’ compensation case and present medical evidence of a change in condition to justify an increase in workers’ comp benefits. 

In the Raleigh area, the workers’ compensation attorneys of Younce, Vtipil, Baznik & Banks, P.A. can help you seek an adjustment of benefits based on a change in your medical condition. We can work to ensure that workers’ comp continues to pay for your medical care and replace lost wages and that your disability rating accurately reflects your condition.

Understanding ‘Maximum Medical Improvement’ and ‘Permanent Partial Disability’

Workers’ compensation benefits may be terminated once the doctor determines that a patient has reached “maximum medical improvement.” This is the point at which the worker has recovered as much as they can be expected to through medical care.

When the worker’s doctor declares the patient has reached maximum medical improvement, or MMI, the worker is either released to return to work and benefits end, or they are assigned a Permanent Partial Disability (PPD) rating or a Permanent Total Disability (PTD) rating. The rating reflects the severity or type of disability.

A worker with a PPD may return to their old job with accommodations for their disability or may take a different job. If the worker must take a job that pays less than he or she earned before being injured, workers’ compensation should pay wage replacement benefits to make up a portion of the lost wages. There are also specific scheduled payments for certain specific types injuries, such as the loss of the use of an arm or leg.

A totally disabled worker would receive benefits based on their PTD rating.

Reaching maximum medical improvement and receiving a PPD rating typically establishes whatever ongoing benefits or lump sum settlement the worker will receive and closes a workers’ comp claim. But, if the worker’s medical condition changes, these benefits may no longer be proper and, if that’s so, they must be adjusted.

How a Change in Condition Affects Your NC Workers’ Comp Claim

Let’s consider a back injury, perhaps the most common cause of missed workdays among American workers. You could injure your back in a workplace accident, such as in a fall, or a bad back could be a cumulative injury caused by years of lifting, bending, stress and strain while on the job.

A back injury may be treated with anything from bed rest and pain relievers to surgery and physical rehabilitation. But back injuries can be degenerative, meaning they may grow worse over time, and back surgery can easily fail to achieve significant pain relief.

If you are out of work with a job-related back injury or any occupational injury, you could face a change in your medical condition and a need to adjust your workers’ comp benefits, even after receiving a disability rating.

North Carolina’s workers’ compensation law gives you only a limited amount of time after the last time workers’ comp has paid a medical bill for you to claim a change in condition and seek additional workers’ compensation benefits. A change of condition claim would require medical evidence that demonstrates substantial worsening of the original occupational injury for which benefits were paid.

When considering a request to modify workers’ comp benefits, the Industrial Commission may increase, reduce or terminate the benefits being provided to an injured worker. Our attorneys can review your circumstances and offer guidance about whether a petition for a change of condition is in order in your case. 

You would need to be ready to rebut any allegations that you did something to exacerbate the injury or to re-injure yourself, which an employer or insurer might try to claim to avoid paying additional benefits.

Conversely, if your condition gets better and you are no longer disabled, you must report this to your employer or the N.C. Industrial Commission, which administers workers’ compensation programs. 

How a NC Workers’ Compensation Attorney Can Help

The workers’ compensation attorneys of Younce, Vtipil, Baznik & Banks, P.A. can help you file for a change in your workers’ compensation benefits based on a change in your medical condition. We can handle all of the paperwork and ensure that your filing meets deadlines and other requirements of the N.C. Industrial Commission. We can serve as your legal counsel and advocate if your claim has advanced to the appeals process.

While workers’ comp rules require you to see the doctor assigned to your claim, you can also see another doctor for a second opinion. If needed, our firm can refer you to physicians in the Raleigh area who we consult with and who understand what information the Industrial Commission will consider about a claimant’s medical condition. 

The North Carolina workers’ compensation system is extremely complex. Most injured workers are not fully aware of their rights or how to enforce them, but they face attorneys for their employer and the workers’ comp insurer who work the system every day.

Let the lawyers of Younce, Vtipil, Baznik & Banks, P.A., protect your benefits and deal with the insurance company if there is a change in your medical condition that warrants an adjustment to your workers’ compensation claim or settlement. Phone us at 919-661-9000 or contact us online to get started with a free initial consultation about your case. 

 

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