After you are injured at work, you should inform your employer of your injury verbally and in writing (within 30 days) and seek medical treatment immediately for your injury. Your employer’s worker’s compensation insurance company will contact you to ask questions. They may also want you to do a recorded statement.
Your claim can be accepted or denied. In accepted cases, you will receive weekly workers compensation benefits when written out of work by your doctor and the employer should pay for medical treatment. In denied cases, you will not receive any monetary benefits or payment for medical expenses.
Even in accepted cases an attorney is useful if there are issues with how much they are willing to pay you and what medical treatment they are willing to cover. The employer controls the medical treatment in accepted cases. In denied cases, the employer is denying that you have a workers’ compensation case at all, so seeking an attorney is your best move.
An attorney will collect all your medical records and bills, negotiate any outstanding liens, and maximize your settlement value. They will also evaluate whether your case is worth taking to hearing or resolving pre-hearing if the employer refuses to pay for treatment or accept responsibility.
If you and your attorney decide that you are likely to have a better outcome at hearing, your attorney will file a claim with the North Carolina Industrial Commission (NCIC).
How long it takes to resolve your case depends on several factors. If you are done with your medical treatment, the case will go faster, but a lawyer does not want to settle your case before you are done treating as it will bar any coverage for medical costs you are still incurring.
The workers’ compensation case in NC can take a year or more to resolve. It may go faster than this, but it depends on how reasonable the insurance company is, how long you treat, whether Medicare/Medicaid liens must be paid back, and whether your attorney has to file a claim with the North Carolina Industrial Commission to resolve your claim.
Attorney fees for NC workers’ compensation cases 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.
No, if you hire an attorney, the attorney will order all your medical records and bills. The medical records and bills needed to prove your case are more detailed than the medical records that most providers give to their patients.
Some employers are less likely to fire you if they know an attorney is watching their actions. North Carolina is an at-will state, which means your employer can fire you for almost any reason, but having a disability is not one of them. The Americans with Disabilities Act is a Federal Law that preempts state law. However, not all injuries are considered covered disabilities under this act. An experienced attorney can guide you through what your options are and remind your employer that they have a duty under the law to provide light duty work for you to accommodate your injury if it is available.
In accepted NC Workers’ Compensation claims you will receive weekly compensation benefits but you will not if your claim is denied. If you are unable to work because of your injury, whether your employer is willing to voluntarily provide you a weekly benefit check or whether they will only do so with pressure from a lawyer depends upon who your employer is and which workers’ compensation insurance company they use. Sometimes even with a lawyer, the employer refuses to give you weekly benefits, and your attorney will have to go to hearing to seek compensation for you.
You can receive medical expenses (including future medical expenses), temporary total disability benefits (TTD), temporary partial disability benefits (TPD); permanent disability or permanent partial disability benefits (PPD) as well as death benefits for your family in the event of your death. Also read our post: Types of NC Workers’ Compensation Benefits.
Medical benefits cover an employee’s medical costs stemming from their work-related injury or illness. Medical benefits will either be allowed and paid for by your employer at the outset of your claim or will be awarded later if your attorney is successful in having the Industrial Commission recognize the validity of your claim. Your attorney may also be successful prior to an Industrial Commission hearing in getting your employer’s insurance carrier or defense attorney to recognize the validity of your claim and award benefits. Sometimes an employer will pay medical benefits without agreeing to pay indemnity benefits at the beginning of the claim.
It depends. If your workers’ compensation claim was accepted by your employer, they have the right to send you to medical providers of their choice. If you do not think you are getting good medical care, call your lawyers and ask if they think it is appropriate to request of the Industrial Commission permission to go to a different doctor.
If your workers’ compensation claim was denied, you have the right to go to any doctor to treat your injuries, but you and your health insurance company will have to pay for it. Whether you will be reimbursed for these expenses depends upon whether your lawyer is successful in getting your claim accepted, or your employer is willing to pay these costs as a condition of settlement.
The North Carolina Industrial Commission (NCIC) is the governing body that resolves workers’ compensation claims. Instead of going in front of a judge to decide your claim, you will go in front of a Deputy Commissioner who works for the NCIC. If you are not satisfied with the outcome at the Deputy Commissioner level, you can appeal to the Full Commission, which is made of up a panel of three commissioners who will decide your case. If you are still not able to get the relief you need, you can appeal the Full Commission decision to the North Carolina Court of Appeals, where three judges in the regular judicial system will hear and decide your appeal.
The reality is that many workers’ compensation claims are resolved between your lawyer and a lawyer for your employer long before you ever go to a hearing at the NCIC. Whether your case is resolved early or goes to hearing is very case-specific.
No, you cannot get payment for pain and suffering on a NC workers’ compensation claim. How much your workers’ compensation claim is worth is driven by NC Gen. Stat. 97 and this law does not allow for payment of pain and suffering.
You can get payment for pain and suffering if your claim is both a tort claim and a workers’ compensation claim, but in this case, you’d be entitled to pain and suffering from the tort-feasor, not your employer. For example, if you are driving a work vehicle for work purposes and a third party hits you, you can recover from both the third party for their negligence and your employer is required to cover your workers’ compensation claim. However, anything your employer paid for your medical expenses related to the accident that you are able to recover in a personal injury lawsuit against the negligent driver would have to be paid back to your employer.
A recorded statement is a recorded interview of you taken by the insurance company hired by your employer to handle workers’ compensation claims. The insurance adjuster assigned to the case will ask you questions about your injury and prior injuries and use that to determine whether you have a compensable claim and what the strengths and weaknesses are of your claim.
No, you do not have to give a recorded statement, and sometimes it is your best interest not to. Your attorney can prepare you for giving a recorded statement if they think it is in your best interest. Statements made in a recorded statement can be used against you to deny your claim or pay out less on it.
You have to do a mediation because the North Carolina Industrial Commission requires it before the case is allowed to go to hearing. It is often in both the employee and employer’s best interest to do a mediation. Many cases settle in mediation. The employer is looking to reduce the risk of losing big at hearing and the employee is looking to recover money and eliminate the risk of having the Industrial Commission deny their claim completely. A skilled mediator knows how to promote compromise and can effectively show both sides the position of the other side and risks they may not have considered prior to mediation.
If you not satisfied with the proposed settlement amount offered by your employer’s insurance at mediation, you can continue your claim to hearing. Sometimes after a mediation, but before a hearing, a claim will settle.
If your claim is accepted by your employer’s insurance, your medications are paid by the employer’s insurance carrier. If your claim is denied, you and your health insurance are responsible for your medications coverage, but you can be reimbursed for these expenses if your claim is later accepted, or you win at hearing.
Your doctor may say you are fully released from any restrictions, and can work your regular job, or they could put you on light duty with lifting restrictions or time restrictions.
If the doctor says you can go back to work, go back to work if you can. If you are unable to go back to work an attorney can help you with trying to obtain a second opinion. Read also NC Injured Worker’s Right to a 2nd Opinion.
Yes, it is possible that the insurance company hired by your employer will get video surveillance of you to try to cut off your benefits. This does not always happen, but it is something you should be aware of.
It is best not to use social media while you have an open workers’ compensation claim, but many people are unwilling to close their social media accounts. Anyone using social media should understand that anything they post is discoverable information to the other side, so do not post anything you do not wish to share with everyone. Even though pictures can be misinterpreted, they are powerful evidence as to the extent of your injuries and what you are able to do in spite of your injuries. If you say in a deposition that you can no longer exercise because of your injury, and there are photos of you exercising, the defense can use this to impeach your character and cast doubt on the merits of your entire claim.
No, generally speaking, you do not need to claim workers’ compensation income on your taxes (See IRS Tax Publication 525, under Workers Compensation Section). However, your retirement plan benefits are taxable if you retire because of a workers’ compensation injury or illness. Your workers’ compensation income may be taxable if it reduces your social security benefits. You may also need to claim workers’ compensation income if you have deducted medical expenses on your taxes. To be sure, it is best to speak with a tax attorney or another tax professional.