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Workers’ Comp – FAQs

Machinist working on machineYour Employer and Their Insurance

Q: What is workers’ compensation?

A: In the state of North Carolina, workers’ compensation is insurance required by all employers with three or more employees. This type of insurance offers specific benefits to injured employees. An injury can be caused by an accident on the job or because of an occupational disease. Examples of an occupational disease include asbestosis, bursitis, carpal tunnel syndrome, chemical exposure or hearing loss.

Workers’ compensation laws are different from the tort/negligence system because these laws are designed to provide coverage for economic losses. Tort/negligence, however, may award compensation depending on emotional factors, such as pain and suffering.

Q: Who is qualified for workers’ compensation?

A: Employees who are injured or disabled on the job are qualified for workers’ compensation. It’s designed so those employees aren’t forced to pay the cost of medical treatment on their own, as well as to cover employee wage losses that are a direct result of the accident or permanent physical impairments related to the accident.

Q: Where can I file for workers’ compensation in Apex?

A: The NC Industrial Commission in Raleigh oversees all workers’ compensation claims in North Carolina. You must file your injury claim with the Commission. Then they can take jurisdiction over your case. As the injured worker, you must file an Industrial Commission Form 18, while the employer must file an Industrial Commission Form 19.

Your employer is required to provide you with a blank Form 18 to complete, according to Industrial Commission Rule 04 NCAC 10A .0104. You should also receive a copy of the employer’s completed Form 19, which will help you fill out Form 18.

Workers’ compensation cases are monitored and overseen by the NC Industrial Commission and not a court, so juries are not involved. During the appeal process, if you need to appeal the ruling of the NC Industrial Commission, the claims are sent to the North Carolina Court of Appeals and then to the North Carolina Supreme Court.

Q: Am I legally required to have an attorney to file for and claim workers’ compensation?

A: No, you are not legally required to have an attorney to file for and claim workers’ compensation. As with most of your important and potentially expensive life responsibilities – from your car to your health to your home – it’s in your best interest to seek the help of a professional. You might be able to guess what’s wrong with your car if there’s smoke coming out of the hood, but a mechanic can diagnose the specific problem and offer the best solution.

It is the same with your workers’ compensation claim: You can handle it on your own, but an experienced attorney will be able to offer the best solution and help you navigate the complicated process.

Q: If I do get an attorney for my workers’ compensation case, who pays for the service?

A: The North Carolina Industrial Commission must approve all attorney fees. Do not pay an attorney for your workers’ compensation claim without prior approval from the Commission.

At Wilson & Reives, we handle workers’ compensation claims on a “contingency fee” basis. In general, we take 25 percent of any recovery (plus costs and expenses). Unless there is a recovery of benefits, you will not be charged any fees.

We also offer a free consultation for workers’ compensation cases. Wilson & Reives lawyers are here to provide you with expert, effective legal counsel. Our main focus is on your claim, which allows you to focus on recovery and moving on after a work-related accident.

Q: Who is responsible for having workers’ compensation insurance?

A: All employers with three or more employees in Apex, Sanford and throughout the state of North Carolina. The individual employee is not responsible for carrying workers’ compensation insurance.

Q: What’s the first thing I should do if I’m injured while working?

A: If you are injured while working, the first thing you should do is seek medical attention.

Do not wait to see if your injury heals on its own. If you wait even a day or two to go to the doctor, the insurance company may argue that the injury did not occur at work or even that it occurred at a different date and time.

To avoid these arguments by the insurance company, verify your claim and injury by requesting and obtaining a timely report from a doctor or medical professional. This report should include information such as the date, time and circumstances surrounding your injury.

Q: After I’m injured, can I decide which doctor to go to for treatment or should I listen to my employer as to where I should receive treatment?

A: It is best to follow the direction of your employer if you are hurt on the job. When you see the doctor, be sure to give specific details about your injury and the circumstances surrounding it to the doctor, nurse, physician’s assistant or other health care professional. Additionally, document on the intake form that your injury occurred at work. Most hospitals and doctors’ offices provide these forms.

Q: Does workers’ compensation cover my medical bills?

A: Yes, as part of your workers’ compensation benefits, you may receive partial or whole lost wages, disability (temporary or permanent) payments, compensation for your medical bills and compensation for vocational rehabilitation, a process designed to help you go back to work following your injury. The benefits could also pay for medical and rehabilitative care needed to cure your symptoms related to the injury or provide relief and lessen your disability. The benefits cover diagnostic testing, doctors’ visits, physical therapy, prescriptions and even surgical costs.

Q: Can I continue to receive workers’ compensation after returning to work?

A: Yes, you can continue to receive workers’ compensation after returning to work. For example, you may be entitled to reimbursement for lost wages, temporary or permanent disability, continued medical costs and vocational rehabilitation.

Temporary Partial Disability Benefits (TPD) are paid when you can do some work but are earning less than you were at the time of your injury. These are paid weekly for up to 500 weeks.

Permanent Partial Disability Benefits (PPD) are paid to compensate for permanent physical damage caused by the injury.

Q: What are my options if I can never return to my previous job duties?

A: If you can never return to your previous job duties, you do have access to vocational rehabilitation. This is a comprehensive process during which an injured employee with a verified workers’ compensation claim receives assistance. Your assistance will come from a qualified rehabilitation professional. It’s designed to help you return to work after a disabling injury.

In workers’ compensation cases in Apex, Sanford and throughout North Carolina, the term “vocational rehabilitation” is used for the delivery and coordination of services outlined in a plan designed for each individual. The ultimate goal is to return the injured worker to “suitable employment.” Examples of the services offered in this plan include an assessment, job searching, counseling, testing, job modification and job placement.

Q: Can I file for workers’ compensation even if I wasn’t at work at the time of the injury?

A: Yes. Legally, any injury you experience at your workplace or while doing work-related activities that impairs your ability to work and to earn money should be covered by your employer’s insurance.

Work in different industries can result in varying on-the-job injuries. A few examples of workers’ compensation injuries include:

  • Head, neck and back injuries
  • Spinal injuries
  • Broken bones
  • Workplace assault
  • Strain and repetitive-motion injuries such as carpal tunnel and cubital tunnel syndrome
  • Health conditions or diseases caused by poor air quality or poor ventilation
  • Electrical injuries

Accidents that occur during traveling, between work locations or on work-related trips such as vendor meetings or office supply purchases can result in serious injuries such as:

  • Slip-and-fall injuries
  • Car accidents

Q: Can I be fired for filing a workers’ compensation claim?

A: No. Firing someone for filing a claim would be a violation of the Retaliatory Employment Discrimination Act (REDA). If you feel your employer has indeed fired you for filing a workers’ compensation claim, you should immediately contact the Employment Discrimination Bureau of the North Carolina Department of Labor at (800) 625-2267. You should file the claim with the Department of Labor within 180 days of the firing or your claim may be lost. The Department of Labor will investigate and either take your case on or issue a “right to sue” letter. If you receive a “right to sue” letter, you must file a claim in court within 90 days.

CLAIMS

Q: Can my doctor provide treatment without preapproval from the insurance carriers or employer?

A: Yes. As soon as you are injured, you should seek medical attention from a doctor or health care professional.

Q: If I file an injury report form, does that mean I’ve filed for workers’ compensation?

A: No. There is a specific form you must complete to file for workers’ compensation. That form is Industrial Commission Form 18. You must file that form with the NC Industrial Commission in Raleigh, who will review it and then decide whether to hear your case.

Q: Am I required to get a medical examination or sign a medical authorization form if requested by my employer or the insurance company?

A: No law requires you to give a statement or sign a medical authorization form for your employer. You may, however, be asked by the insurer to do either or both of those actions. There are many possible repercussions for allowing the insurer access to your records, including the invasion of your privacy and the insurer’s ability to access medical records unrelated to your accident. If you are pressured to sign a medical authorization form or give a recorded statement and do not want to do it, contact a lawyer immediately. You can ask your lawyer to communicate on your behalf with the insurer.

Q: Can the insurance delay or stop payments for workers’ compensation?

A: Yes, the insurance company can delay or stop payments for workers’ compensation if they feel they have reason to doubt your injury. That’s why it’s important that you report your injury immediately and file a claim as soon as you realize you need benefits. By doing this, your attorney will have an increased chance of securing your benefits quickly.

Q: What if I’m permanently disabled?

A: If your work-related injury caused permanent disability, the North Carolina Industrial Commission will work to understand the extent of your injury and the benefits you should receive. The degree of your permanent impairment is based on a rating guide called the schedule of injuries.

The schedule of injuries assigns a value to all your body parts. The value assigned is for 100 percent loss of a body part.

The schedule of injuries is:

  • Back – 300 weeks
  • Arm – 240 weeks
  • Hand – 200 weeks
  • Foot – 144 weeks
  • Leg – 200 weeks
  • Eye – 120 weeks
  • Thumb – 75 weeks
  • First or index finger – 45 weeks
  • Second or middle finger – 40 weeks
  • Third or ring finger – 25 weeks
  • Fourth or little finger – 20 weeks
  • Big toe – 35 weeks
  • Any other toe – 10 weeks
  • Hearing (both ears) – 150 weeks
  • Hearing (one ear) – 70 weeks

For example, 100 percent loss of the use of your hand results in 200 weeks of benefits at your weekly rate.

With a partially permanent disability, such as if you regain 90 percent use of your hand but still have restrictions and limitations, the doctor would assign a 10 percent PPD rating. That means you could decide to receive 10 percent of 200 weeks, or 20 weeks, of additional compensation for your injury.

Q: Is it possible to file for both personal injury and workers’ compensation at the same time?

A: Yes, this type of claim is known as a third-party lawsuit. For this to occur, your injury needs to be caused by an accident that is covered under workers’ compensation and is also a result of the negligence of a third party.

Q: When could my case be considered a personal injury/workers’ compensation?

A: There would need to be suspicion or evidence that a third party was involved in your accident and resulting injury. The third party is not your employer in this case; for example, it could be the manufacturer of faulty equipment. If there is a third party that caused your accident, you may be able to file both a personal injury lawsuit and a workers’ compensation claim. An experienced attorney will be able to guide you through this complicated process.

Q: What are some examples of personal injury/workers’ compensation cases?

A: Examples of personal injury/workers’ compensation cases include:

  • Gross negligence – You may be able to sue your employer for a work-related injury as a personal injury if you can prove it was caused by your employer’s willful, wanton, gross or reckless negligence.
  • Car accidents – Any time you drive while performing work-related duties and are involved in an accident, you could receive benefits. Examples of when a person may be in a car accident that may qualify for a personal injury/workers’ compensation case include professional drivers or people who deliver products or services, or car accidents that affect people traveling between work locations or on work-related errands such as visiting a vendor or purchasing office supplies.
  • Electrocutions – This type of accident is often specific to people who work with the installation and maintenance of cable, lighting, internet and other people who may encounter electricity from exposed high-voltage wires.
  • Products or machinery that is faulty or defective
  • Toxic substance exposure – If your job requires you to be exposed to toxic substances, and your employer is aware, they need to provide you with adequate physical protection. If your employer doesn’t provide you with protective clothing or gear, you may be able to file a civil lawsuit for gross negligence.
  • Workplace assault or negligence

Q: What happens if my employer doesn’t have workers’ compensation insurance?

A: It is possible that your employer, although required by law to carry workers’ compensation insurance if they have three or more employees, doesn’t have it. If that’s the case, you have two options:

  1. File a claim with the North Carolina Industrial Commission
  2. File a civil lawsuit

Both processes can be difficult to navigate, so you should hire a workers’ compensation lawyer in either case.

Q: How do I file a claim with the North Carolina Industrial Commission?

A: This is the most common choice for injured people who need to recover damages, costs and losses associated with injuries on the job. This is also the approach that we and many other experienced workers’ compensation lawyers recommend. If you’re the injured employee, you could be filing a claim against the uninsured company or the uninsured entity employing you.

When you file this claim, the Industrial Commission will conduct an investigation and determine the payment of benefits if they are found to be required. Additionally, the Attorney General’s office and the North Carolina Industrial Commission Fraud Investigation Unit will be involved in the claim because employers who knowingly break laws, in this case the law requiring employers with three or more employees to carry workers’ compensation, are prosecuted accordingly.

There are some limits on the benefits employees can seek using this approach; however, if you’re in Apex, Sanford or anywhere in North Carolina, filing a workers’ compensation claim is a far more successful strategy than filing a civil lawsuit. A workers’ compensation claim is usually the best course of action for the employee.

Q: How do I file a civil lawsuit?

A: If you are an injured employee and seeking compensation for your damages, you do have the option to file a civil lawsuit because of the common-law theory of employer liability, as set out in N.C.G.S. §97-94(b).

In the state of North Carolina, however, if you as the employee are found even the smallest portion responsible for your injuries or losses, you recover no benefits. This is because our state is a “pure contributory negligence state.”

The benefit that some people see with filing a civil lawsuit is that there are no limits on the amount of damages you can be awarded. That means you could be paid in full for your pain and suffering, losses and medical costs.

It is highly unlikely that you would have done nothing to limit risk, and usually your employer would try very hard to prove that you could have limited risk. Because of this, civil lawsuits tend to be expensive and usually unsuccessful.

FAMILY

Q: How can I continue to provide for my family if I’m injured on the job? Can I use my sick time, vacation and Family Medical Leave Act options?

A: If you are providing for your family and suffer a disability injury, you could lose your ability to perform that job and other jobs like it, which would greatly inhibit your ability to support yourself and your family.

One relief option is temporary disability. This is the claim you would file if you are unable to work for a temporary period lasting as long as a few months.

Some states require employers, by law, to carry disability insurance, but North Carolina is not one of them. If your employer does carry disability insurance, it can pay benefits if you are not working because of injuries or illnesses that are not job-related. Workers’ compensation does not cover disabilities caused by injuries or illnesses not related to your job.

Additionally, disability insurance also covers you if you may not be eligible for workers’ compensation, or it can be used to supplement workers’ compensation.

In this case, you are not pursuing a lawsuit against your employer; you are requesting the benefits that are legally provided to you. Filing a claim for disability can be compared to filing an insurance claim.

Many employers offer short- and long-term disability insurance as part of their employees’ benefits package. If your employer has these policies in place, you may be able to receive workers’ compensation benefits and short- or long-term disability benefits at the same time.

Who pays for your disability plan can impact the way the benefits are paid out:

  • If your disability plan is paid 100 percent by your employer, the workers’ compensation insurance is allowed to take a credit on any long- or short-term disability benefits you receive.
  • If you pay for a portion of your disability plan, which is usually done through payroll deduction, then it’s likely the workers’ compensation carrier will not take a credit and that you can receive both benefits.

DENIALS

Q: Is it possible that my workers’ compensation claim will be denied?

A: Yes, it is possible that your workers’ compensation claim may be denied, and in many cases a legitimate claim will be denied. This can happen for a number of reasons, but it does not mean you can no longer pursue workers’ compensation benefits. If you receive a letter saying that your claim was denied, you should talk with an experienced workers’ compensation attorney.

Q: What should I do if my workers’ compensation claim is denied?

A: If your claim is denied by your employer and/or their insurance carrier, they are required by law to send or give you a comprehensive statement within 14 days of the date you submitted your claim. This statement needs to explain why the claim was denied. The North Carolina Industrial Commission’s Executive Secretary’s Office may extend this time period.

If your claim is denied, you will receive a Form 61, also known as a Denial of NC Workers’ Compensation Claims. On this form your employer will detail the reasons for denying your claim. To continue the process of seeking benefits, you will need to file a Form 33. By filing Form 33, you are requesting a hearing by the North Carolina Industrial Commission.

With this request, you are asking the Commission to make a formal ruling on your case. The Commission will review the case and decide if your employer and their insurance company are responsible for providing the benefits.

Wilson & Reives workers’ compensation lawyers know your rights and are ready to help you receive the compensation you deserve. Your health may have already been compromised, and our attorneys are ready and able to help you get back on your feet.