This page discusses types of NC Workers’ Compensation benefits and the process under which one may be awarded benefits. If you are looking for a Workers’ Compensation Lawyer in Raleigh, NC and surrounding areas, give us a call today for a free case review, 919-615-3095.
Who is eligible for NC Workers’ Compensation Benefits?
Employees in North Carolina who have been injured during a workplace accident are eligible for Workers’ Compensation. Undocumented workers are also eligible for benefits. However, independent contractors are not eligible for workers’ compensation benefits. Unlike personal injury claims, the North Carolina Industrial Commission (NCIC) governs injured workers’ comp claims in NC.
In NC, businesses that employee three or more employees must carry workers’ comp insurance. Unfortunately, employers still try to classify employees as independent contractors in order to avoid paying for benefits or injury claims. Hiring a Workers’ Compensation Attorney may be your only recourse for obtaining benefits if your employee denies that you are an employee.
Additionally, you must actually be working while you are injured (not on your way to work or on your home from work). Also being injured at work while inebriated will prevent you from having a workers’ compensation claim.
What does NC Workers’ Compensation pay for?
In North Carolina, state law provides medical compensation and wage loss benefits for non-fatal injuries and death benefits for fatal injuries. Medical compensation includes medical treatment and mileage reimbursement for treatment of your on the job injury. Lost Wage benefits provide monetary compensation due to your inability to earn wages because of your on the job injury. This benefit provides compensation based on the physical impairment of the injured body part as well.
Temporary total disability compensation – Temporary total disability benefits (TTD) are the benefits owed to a NC workers’ compensation recipient when they are unable to work for a period of time that is more than 7 days. If an employee is awarded temporary total disability benefits, they will get 2/3 of their average weekly wage, not to exceed $992 per week under current law. The injured employee who is awarded TTD will also get their medical bills paid for by their employer’s insurance company. Generally, a worker getting TTD will return back to work at the discretion of their treating physician.
Temporary partial disability compensation – Temporary partial disability benefits are for injured workers who are capable of returning to work, but not for the same wages they were working for pre-workplace injury. In this case, a worker may be entitled to 2/3 the difference between their pre and post-injury wages.
Permanent partial disability compensation Permanent partial disability benefits (PPD) are assigned to workers who sustain a permanent injury and cannot return to the same work because of the injury. An injured worker who gets PPD is assigned a disability rating by a doctor which is a percentage of injury to that body part. The amount of compensation for the loss of use of a body part is defined by statute.
Permanent total disability compensation – the worker must show that he/she is totally and permanently disabled from any occupation and thus will receive medical benefits and his/her weekly compensation for life.
Death benefits may be awarded to the family members of workers who died as the result of an on-the-job injury. They are 2/3 the average weekly wage of the deceased worker, not to exceed $992 per week for 500 weeks. Burial expenses are covered as a death benefit up to $10,000.
It should be noted that Pain and Suffering is not available in NC Workers’ Compensation cases but if you are injured by a third party while at work you may have a NC Personal Injury claim as well as a Workers’ Compensation case.
Types of Workers’ Comp Injuries
Injury by accident and occupational disease are covered by NC Workers’ Compensation. Injury by accident, just as it sounds, results from an accident at work. Unfortunately, back and knee injuries occur frequently from work accidents. In addition, some NC industries like construction, manufacturing and health care are simply more dangerous jobs.
Occupational diseases can be caused by exposure to chemicals, lead poisoning, exposure to asbestos, and can even include physical injuries that come from repetitive work, like carpal tunnel syndrome. In some very narrow situations, certain mental illnesses can also be considered an occupational disease. Read Occupational Diseases and NC Workers’ Compensation.
Unfortunately, employers and insurance adjusters frequently try to deny that your injury was caused at work. A doctor’s opinion should be sought to determine the exact cause of your injury. A Workers’ Compensation Lawyer can help to attain this opinion in the language necessary to prove that your injury was caused at work.
When should you hire a Workers’ Compensation Lawyer?
The decision to hire a NC Workers’ Compensation lawyer when you have been injured at work depends on the circumstances of your case. After you are injured and file a Form 18 with the NC Industrial Commission, your employer (their WC insurance company) can accept or deny your claim. If your claim is denied, hiring a NC Worker’s Compensation lawyer may be your only recourse. Even if your claim is accepted that does not mean that the employer has agreed to pay for all your medical treatment. If your employer refuses to pay for needed medical treatment you may need legal help to obtain the treatment you need.
During the course of your NC Workers’ Compensation claim you will have to deal with insurance adjusters, nurse case managers, medical providers, defense attorneys, and the NC Industrial Commission. There are more than 60 forms that address various aspects of a Workers’ Compensation claim. Failing to use the right form or filing the right form at the wrong time, can have real implications on your benefits.
How to choose a Workers’ Compensation Lawyer?
When hiring a Workers’ Compensation lawyer, here are a few things to keep in mind:
How much experience does your lawyer have with workers’ compensation? Do they understand the twists and turns of Workers’ Compensation in North Carolina?
How is your attorney’s demeanor? You should be able to trust that your attorney will handle your claim with professionalism and respect. Being hurt at work can be traumatic and you want an attorney that can be both compassionate and give you the advice you need. Don’t forget that you can end representation at any time you are not happy with your lawyer.
Does your lawyer have the necessary resources to represent you? Workers’ Compensation claims have a lot of moving parts and require a lot of attention. Ask your friends, family, co-workers, or those in your social network for recommendations. You can also read reviews of lawyer online before you hire.
How much are NC Workers’ Compensation Lawyer Fees?
Fees for NC Workers’ Compensation Lawyers cannot be in excess of 25% of the total recovery amount. If no recovery is made, attorneys do not charge a fee for the legal services they provided. This also minimizes risk to the injured worker.
How to file a NC Workers’ Compensation Claim
Notifying Your Employer
If you have suffered from a spine injury or hernia or occupational disease while at work or have been injured on the job through an accident, then the first step you must take is to notify your employer about your injury. Notifying your employer is a critical step towards receiving workers’ compensation benefits.
The law requires that injured employees notify their employer about their work-related injury verbally and in writing. That means, you must tell the employer about your injury immediately and send a written letter or email to the employer about your injury within thirty (30) days after the accident or when you first become aware of the injury.
Immediately after your injury, you need to seek medical treatment. If your employer tells you where to go to get medical treatment, you should go there. If, after informing your employer, they do nothing or do not tell you where to go for medical treatment, you still need to seek medical treatment.
It should be noted that you still have the right to file a WC claim even if your employer tells you that they will pay for your medical treatment and time. Unfortunately, many of these promises go unfulfilled. After seeking medical treatment, you should follow all medical advice.
Filing with the North Carolina Industrial Commission
The North Carolina Industrial Commission (NCIC) handles all NC Workers’ Compensation claims. You must inform the NCIC about your claim by filing an I. C. Form 18 online, or with the assistance of the employer, or having your Workers’ Compensation Lawyer file on your behalf. All North Carolina Industrial Commission forms can be found on their website.
State law requires the I.C. Form 18 must be filed with the Industrial Commission within two (2) years of the date of the accidental injury or the date that the worker learns that he has an occupational disease. This step in the process gives the Industrial Commission authority over your workers’ compensation claim. You cannot sue an employer in the North Carolina court system for an accidental injury sustained or developed on the job.
Acceptance or Denial
Now that you have given notice your employer about your accidental on the job injury and filed a claim with North Carolina Industrial Commission, two main things can happen. 1) Your workers’ compensation claim is either accepted by your employer’s workers’ compensation insurance carrier/and or employer; or 2) your claim is denied. There is also a third option which my firm sees where the employer pays for medical treatment (which would seem to be a accepted claim) and then later denies the claim as noncompensable.
Accepted Claims – The employer has agreed that you were injured at work and they will pay you weekly benefits as well as for your injury-related medical treatment. The employer controls all medical treatment in accepted claims. However, this does not mean that the employer has agreed to pay for all your medical treatment.
Denied Claims – The employer is denying that you were injured at work and will pay you nothing. You can go to any medical provider that you chose but if you do not eventually win your case, you or your health insurance will have to pay for the medical treatment you received.
In denied claims, hiring a Workers’ Compensation Lawyer may be your only recourse for obtaining benefits.
If the employer denies your claim or refuses to pay for needed medical treatment, you will have to file for a hearing with the NCIC in order to be paid for your medical treatment and wage loss. To request a hearing, you must file a Form 33, Request That Claim Be Assigned for Hearing. Once a Form 33 is filed, the parties must participate in a mandatory mediation to attempt to resolve the dispute without a hearing.
Over 70% of NC Worker’s Compensation cases settle at mediation. If the injured worker is unrepresented, mediation is usually bypassed unless all parties agree to mediate. Please remember that at this stage and at any stage, the employer has the ability to approve your claim or settle.
Hearing with Deputy Commissioner
If the parties are unable to come to a full agreement at the mediation, the remaining dispute moves on to the hearing. It generally takes two to three months after the mediation for the dispute to be assigned a date for the hearing.
Please remember that the hearing is your opportunity to tell the NCIC why you should be awarded Workers’ Compensation benefits and is not the time to air your grievances with your employer. As a common sense matter, aggression towards your former employer or opposing counsel will not help you prove you deserve help. Read Five Tips to Prepare for Your NC Workers’ Compensation Hearing.
In the months after the hearing, your Workers’ Compensation Lawyer and the defense attorney will depose your treating physicians. Once the depositions are complete, then your attorney and the defense attorney will draft briefs arguing the different sides of the dispute.
The Deputy Commissioner assigned to the case then reviews the medical records, the transcript from the hearing, the transcripts from the depositions, and the lawyers’ briefs. The Deputy Commissioner’s decision will be based on all this information and can take several weeks to be finalized. Either side may appeal the decision from the Deputy Commissioner to the Full Commission.
Hearing with Full Commission
If you are unsuccessful at your hearing in front of the Deputy Commissioner or if your employer appeals your award, you will have to have a hearing in front of the NCIC Full Commission. The Full Commissioners of the NCIC sit in panels of three to represent the Full Commission as the quasi-judicial appellate level of the NCIC.
These Full Commission panels, like the Deputy Commissioners, resolve claims coming before them through Orders, Opinions, and Decisions. Hearings before a Full Commission panel are generally held in the State capital.