Workers' compensation is a system of medical and disability benefits provided to workers who are injured on the job or who develop an occupational disease as a result of their employment.
The purpose of the North Carolina Workers’ Compensation Act is "to provide a swift and certain remedy to an injured worker." As such, unlike other areas of personal injury such as auto accidents, the injured worker does not have to prove that the employer was at fault, only that he or she was injured in a work-related accident.
If the worker can establish that he or she was injured in a work-related accident, the claim is "compensable," and the employer and its insurance company have a legal duty to provide necessary medical treatment and weekly disability benefits while the injured worker is out of work under a doctor’s orders.
Workers’ compensation essentially provides injured workers two types of benefits: disability benefits and medical compensation.
Disability benefits are cash payments made to the injured worker as compensation for lost wages or permanent injury. There are several types. If the injured worker is unable to work due to injury, he or she is entitled to weekly temporary total disability or TTD benefits equal to 2/3 of pre-injury wages. An injured worker who returns to work at lower pay is entitled to temporary partial disability or TPD benefits worth 2/3 of the difference between pre-injury and post-injury wages. Finally, an injured worker may be entitled to permanent partial disability or PPD benefits for a permanent injury. PPD benefits are calculated according the permanent impairment rating that the doctor assigns to the worker’s injury.
In addition to disability benefits, an injured worker is also entitled to the medical care, often called "medical compensation," necessary to heal the injury, provide relief from pain and other symptoms, and hasten the return to work. Medical compensation includes payment for doctor visits, medications, hospitalizations, and surgeries. Medical compensation can also include mileage reimbursement for doctor’s visits, vocational rehabilitation services, and in cases of severe injury, attendant and nursing care.
If you are injured on the job, report the injury to your employer immediately, preferably in writing. Employers and insurance companies are much more likely to deny a claim when the injury is not immediately reported.
After you report the injury to your employer, file your claim with the North Carolina Industrial Commission by submitting a Form 18 as soon as possible.
In general, an injury must result from an "accident" to be compensable, or covered by workers’ compensation. In workers' compensation, an accident is an unexpected event – a trip and fall, for example – that interrupts the usual work routine. For back injuries, however, the worker need only experience a "specific traumatic incident," such as a sudden onset of pain while performing routine lifting.
The injury must also "arise out of and in the course of" the employment. Generally, an injury "arises out of" employment when the risk is caused by or inherent to the job and not common to the public. An injury occurs "in the course of" employment when it occurs at a place and time during which the injured worker is furthering the employer's business.
Stated simply, an occupational disease is one that a worker contracts on the job. To establish an occupational disease claim, a worker must prove that he has contracted one of the diseases listed as an occupational disease in § 97-53 of the Workers’ Compensation Act or that (1) he contracted disease, (2) he was exposed to hazardous substances or condition, (3) his job subjected him to a greater risk of developing the disease than members of the public generally, and (4) the hazardous exposure caused or significantly contributed to the development of the disease.
Martin & Jones was founded as a firm concentrating its practice on occupational disease claims. Textile workers exposed to cotton dust contract a condition known as byssinosis, or brown lung. Workers exposed to asbestos many years ago in factories, in shipyards, on ships, at construction sites, and on other jobs can develop asbestos-related diseases, such as asbestosis, mesothelioma, lung cancer, and other cancers.
Some workers have been exposed to chemicals in the workplace – such as nickel and chromium – over long periods of time, which can lead to cancer or other debilitating conditions. Workers who have jobs in factories and in offices where they use their hands in a repetitive manner can contract a condition known as carpal tunnel syndrome.
For more information, please see our Occupational Exposure page.
In many cases, an injured worker does not need an attorney. If the insurance company accepts responsibility for the claim, provides necessary medical treatment, and pays disability benefits, an attorney may not be necessary. This is particularly so when the worker is expected to make a full recovery and return to work.
As a general rule, you should consult an experienced workers’ compensation attorney in any of four circumstances:
- Your claim has been denied by the insurance company.
- The insurance company is not authorizing medical treatment or is not sending your weekly checks on time.
- You are injured so badly that you might not be able to return to the job you worked before your injury.
- You aren’t comfortable with the way the insurance company or your employer is treating you.
In each of these circumstances, you might need an experienced and assertive attorney to help you obtain the benefits you’re entitled to. Of course, any time you have questions about whether you’re receiving the benefits you’re entitled to, it would be wise to consult an experienced workers’ compensation attorney.
There are several ways to settle a workers' compensation claim, depending on whether the injured worker returns to work with his employer.
An employee who returns to work can settle for his or her PPD or "rating" benefits by using an Industrial Commission Form 26A. Under the Form 26A, the employee is paid rating benefits based on the permanent impairment rating assigned by his doctor. When settling on a Form 26A, the injured worker has two years, from the date the last payment of compensation is made, to reopen his claim for disability benefits or medical compensation. If the two-year period lapses with no further action, the claim ends.
An employee who returns to a job that pays lesser wages can still settle his claim by an Industrial Commission form. The worker is entitled to choose the more favorable remedy, or the benefits that pay the most money – PPD benefits or TPD "wage-loss" benefits.
Finally, an injured worker, particularly one who has not returned to work, can enter a final settlement, or "clincher" agreement, for payment of future disability benefits and medical compensation. Insurance companies are motivated to "clincher" a claim, which closes the case forever, and will often pay the injured worker a lump sum of money for a clincher agreement. Once the injured worker and the insurance company enter a clincher agreement and the agreement is approved by the North Carolina Industrial Commission, the claim cannot be reopened.
Importantly, an injured employee who remains out of work and continues to receive disability benefits has no obligation to settle his workers' compensation claim. If an employee is permanently disabled from any type of employment, he or she may be entitled to receive weekly disability benefits for life.