Change in Condition

The phrase “change in condition” has a special meaning in a North Carolina workers’ comp case. It can trigger additional wage replacement payments and may even extend access to medical benefits. But before we can talk about whether an injured worker has sustained a change in condition and what that means for the employee’s workers’ compensation claim, we need to understand a little background information.

Understanding Maximum Medical Improvement and Permanent Partial Disability

Most injured workers eventually get better with medical treatment. This typically involves surgery, followed by a period of recovery and physical therapy. But as their recovery approaches its end, injured workers are frequently unsure what will happen with their workers’ comp case. Often around this time their workers’ comp doctor will:

  • tell the worker they are at Maximum Medical Improvement (MMI);
  • assign a Permanent Partial Disability (PPD) rating;
  • assign applicable permanent work restrictions;
  • advise the worker that they are released from treatment and can follow up PRN. (I learned writing this blog that PRN is latin for pro re nata, meaning “as the need arises.”)

Around this same time insurance adjusters will often begin talking about settlements, clinchers and ratings. It can be a very confusing jumble of letters, numbers and words for the injured worker. So let’s start with a few key terms. I discuss all of these more fully at the linked page.

Maximum Medical Improvement (MMI) means the end of the medical healing period. It’s the point at which the worker is physically as good as he or she is likely to get, although frequently not back to where they were before the injury. MMI is the first point at which an injured workers can choose between electing a Permanent Partial Disability (PPD) rating and ongoing disability benefits. MMI is an important point in a North Carolina workers’ comp claim.

A Permanent Partial Disability (PPD) Rating is the percentage of permanent impairment assigned by the workers’ comp doctor to the injured body part. The rating is determined by multiplying the percentage of impairment assigned by the doctor, by the employee’s compensation rate, by the number of weeks assigned in GS 97-31 of NC Worker’s Compensation Act to the injured body part. So a worker with a 20% PPD rating to the arm (240 weeks), and a $500 per week comp rate would have a rating benefit of .20 x 240 x $500 = $24,000. Permanent Partial Disability Ratings are usually assigned by the workers’ comp doctor when the injured worker reaches Maximum Medical Improvement. For IMPORTANT information about whether to take a NC workers’ comp rating go here.

What is a Change in Condition and why does it matter?

So now, finally, we get to the importance of a change in condition. If, after careful consideration, an injured worker elects to accept the payment of an impairment rating, under GS 97-47 the worker has two years from payment of the rating to file a claim for a change in condition. The claim is filed with the North Carolina Industrial Commission. If the worker does not allege a change in condition within two years of receiving payment of a rating, the employee may lose any rights to additional wage replacement or disability benefits for their NC workers’ comp injury.

After filing a claim for a change in condition, the injured worker must prove that he or she has sustained a substantial worsening of the original compensable injury. This could include an increase in the PPD rating assigned by the workers’ compensation doctor, or increased restrictions that affect the ability to work. As you can see, an injured worker should support their a change in condition with strong medical evidence.

If an injured worker is able to successfully prove a change in condition then he or she will be eligible for additional wage replacement or disability benefits. This may include an additional PPD payment or even reinstating weekly disability benefits.

Remember, neither the payment of a rating or nor a determination of Maximum Medical Improvement terminates the injured worker’s entitlement to medical treatment for their NC workers’ comp injury. But, in certain circumstances, the payment of a rating can begin the clock ticking on the loss of medical benefits. So again, be very careful in deciding to accept a rating payment, and be fully aware of the consequences of doing so.

Contact a Lawyer

If you have questions about a change in condition or workers’ compensation laws in NC please call or email for a free consultation. Kevin Bunn is a Board Certified Specialist in North Carolina Workers’ Compensation Law. He has represented injured NC workers before the North Carolina Industrial Commission for more than 25 years.

 

 

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Top Ten Tips and Traps for North Carolina Workers’ Compensation Claims

After twenty years of practicing workers’ compensation law in North Carolina I have seen just about every mistake an injured worker can make.  These mistakes range from failing to file their claim, to settling when they should not have, and everything in between. Download my Top Ten Tips and Traps for North Carolina Workers’ Compensation Claims

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