Workers' Compensation (WC) is an administrative system set up by the North Carolina General Assembly to compensate workers who get injured by an accident on the job, or develop a disease caused by their job. The system generally provides the worker with compensation even if the worker was partially at fault. The N.C. Industrial Commission (IC) is the court that handles WC cases.
What injuries are covered?
WC law covers most accidental injuries as well as back injuries if they are caused by your work. While pre-existing injuries are generally not the responsibility of the employer, aggravation of these same injuries may be compensable under WC law. The critical determination is whether your new injury was caused by your medical condition or by an accident on the job. An injury by itself does not mean an accident occurred.
What benefits can I receive under WC?
The employer is normally responsible for any medical expense your doctor feels will make you better. This normally includes prescriptions, medical supplies, TENS units, crutches, braces, physical therapy and any other expenses you would not have incurred but for your injury. These expenses are payable by the employer until the case is settled. While you have a general right to choose your own doctor for treatment, the insurance company retains certain rights to pre-authorize medical treatment. You should never go to a doctor without obtaining insurance pre-authorization. You should also never let an insurance company force their doctors on you without your approval. A rehabilitation nurse assigned by the insurance company does NOT have the right to be in your exam room with the doctor.
Lost Wages
In N.C., the employer is responsible for paying you only 66 2/3% of your gross average wages, up to a maximum that changes each year. This "temporary total" payment (TTD) continues until: 1. Your doctor releases you and/or assigns you a permanent partial or permanent total disability rating, OR 2. You are able to return to work, OR 3. The IC approves a "cut-off" of benefits.
These payments do not start until you have missed at least one (1) continuous week of work. Once you have missed a full month, that first week is paid.
Permanent Partial Disability
When a doctor releases you from his/her care, a permanent disability rating will often be assigned to your injured body part. A rating means that you will never be 100% healthy in that body part. Whether you can return to work depends on the severity of your injury and how that injury affects your ability to handle the physical demands of your work. The IC uses your rating and the N.C. law to determine how much money you are entitled to receive for you injury. The law requires that the rating and TTD compensation amount be used to determine this benefit. If you are only partially disabled but your employer won't take you back, you may have a claim under the Americans with Disabilities Act. Call the EEOC at 1-800-872-3362 to report a claim.
Permanent Total Disability
If you will never return to any type of work because of your injury, the IC can award lifetime benefits. These benefits can include payment of 66 2/3% of lost wages (PTD) for the rest of your life plus future medical bills. You may want to consult a vocational rehabilitation expert on whether you have any other job options based on your physical/mental condition. You may also want to apply for Social Security Disability or other retirement benefits that may be available to you. Since some benefits are offset or deducted because you receive WC benefits, you should consult your lawyer to minimize these deductions.
Each WC case is different. Other benefits for unusual injuries, scarring, disfigurement may be available depending on the facts of your claim.
What time limit do I have to file WC?
As soon as possible, you should file a Form 18, Notice of Accident, with the IC and employer, informing them that you wish to make a claim. While N.C. law requires this Form 18 to be filed within 30 days, an absolute time limit of 2 years may be applicable to your claim depending on the facts. After your claim is settled, time limits also exist for reopening the case. This form can be obtained by e-mailing our office or calling the IC at (919) 733-6721.
Can my employer fire me while I am on WC?
Beginning October 1, 1992, the N.C. General Assembly passed The Retaliatory Employment Discrimination Act (REDA) to protect employees who file WC claims. This law allows employees to sue the employer for monetary damages if the employer fires, demotes, punishes or takes any retaliatory action against the employee just because the employee files or testifies in a workers' compensation case. An attorney can give you the correct form to file a REDA complaint with the Department of Labor or you may call the Department of Labor at 1-800-522-6762.
What if I have problems after I settle my claim?
Most insurance companies will try to clinch or close out the claim when they offer a settlement. This means you can never reopen your claim and cannot get any more medical treatment paid by the carrier. Other settlements can be reached that allow you to reopen the claim for at least a two (2) year period after settlement if your condition changes. Whether you should "clinch" or leave the case open for the two (2) year period is an important decision that should not be made without consulting a lawyer.
Do I need a lawyer?
In order to make sure you have all the necessary facts and N.C. laws to make an intelligent decision on your WC case, it is important to consult an attorney who is both experienced and knowledgeable in WC law.
How do I pay my lawyer?
All charges for legal services must be approved by the IC. Generally, lawyers charge a 25% flat fee for their services on WC cases. This fee is payable only if:
- Your claim is successful; and
- The IC approves the fee.
Most lawyers also charge for copies, medical records received from medical providers, long distance calls and other expenses of handling your claim. These costs are usually owed whether or not your claim is successful.
