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Workers’ compensation is a system of benefit payments for people who contract an occupational disease or who are injured by an accident arising out of and in the course of their employment.
Injured workers can receive:
To learn more, read our workers comp FAQ below, and then contact our North Carolina workers compensation law firm for a free consultation.
All employers who regularly employ three or more workers must carry workers’ compensation insurance in North Carolina. Some companies self-insure their businesses for workers’ compensation, so you may have to deal directly with the employer rather than an insurance company.
Deteriorating health conditions which arise slowly and over a period of time can be grounds for workers’ compensation under certain conditions:
For example, textile workers exposed to cotton dust can contract a condition known as “brown lung,” or byssinosis.
Other workers have been exposed to a hazardous mineral known as asbestos, which can lead to asbestosis, mesothelioma, and other cancers. These diseases strike workers who were exposed to asbestos many years ago in factories, shipbuilding sites, construction, insulation, brake production and transportation.
Some workers have been exposed over long periods of time to chemicals in the workplace. This can lead to cancer or a myriad of other ailments.
Workers who have jobs in factories and in offices where they continually use their hands in a repetitive manner can get a condition known as carpal tunnel syndrome.
You must have missed at least seven days before the entitlement to weekly benefit checks begins. This does not have to be seven consecutive days. The entitlement to receive medical treatment, however, is not contingent upon missing any time from work. You may receive medical treatment immediately after being injured.
While you are out of work under a doctor’s care, you are entitled to temporary total disability payments, called TTD payments, and reasonable authorized medical treatment.
Your employer does not have to provide light-duty work merely because you have been hurt on the job. The federal Americans with Disabilities Act requires that your employer make reasonable accommodation for you to perform work, but this is the extent of its obligation.
If an employee returns to work unable to earn the same wages or work the same hours as before the injury, then he or she is entitled to temporary partial disability, also known as the wage differential. This wage differential is paid at two-thirds (66-2/3 percent) of the difference between the previous average weekly wage and the new rate of pay. The calculation is done on a week-by-week basis. There is a maximum of 300 weeks from the date of the accident that a worker can draw a wage differential.
Medical bills are paid by the workers’ compensation insurance company. These bills must be forwarded to the insurance company by the doctor’s office. The insurance company then sends the bills to the Industrial Commission to make sure they are reasonable charges. When the Industrial Commission clears the bills, the insurance company pays the doctor’s office.
If the insurance company refuses to pay medical charges, the injured worker can file a request with the Industrial Commission for a hearing to order that the medical bills be paid.
An injured worker can receive medical treatment which is reasonable and necessary while under the doctor’s care. After you get your final payment, you have two years to petition the Industrial Commission to receive additional medical treatment. Workers injured before July 5, 1994, are entitled to receive lifetime medical treatment.
You must be able to show that treatment sought is related to the on-the-job injury. Only those consequences which would reasonably and naturally flow from the on-the-job injury will be paid by the insurance company. The employee must be able to show that the medical treatment is reasonably necessary to effect a cure, provide relief, or lessen the period of the disability.
The injured worker must first ask permission of the insurance company to change doctors. If the insurance company refuses or does not respond to the request, a petition can be filed with the Industrial Commission requesting an order to allow a change of physician. Failure to comply with these steps in the proper order can result in the employee having to pay the new doctor.
You should contact an attorney to determine whether there are grounds to pursue a claim for workers’ compensation. A Form 18 must be filed with the Industrial Commission within two years of the date of the accident in order for a claim to be properly registered. Then, the injured worker can file Form 33 Request for Hearing to contest the denial of workers’ compensation benefits.
Normally, it takes several months for a case to be placed on a hearing docket for a deputy commissioner to hear the matter and decide whether or not the injury meets the requirements for workers’ compensation benefits. The entire hearing process can take an additional six months to a year after the initial hearing occurs.
The insurance company or your employer will have an attorney representing it at the hearing. While the injured worker can represent his own interests at the hearing, it usually makes sense to have an attorney at this stage.
Workers’ compensation cases are handled on a contingency-fee basis. This means that unless there is a recovery or settlement, no fee is paid. The attorney is paid a percentage of the recovery. All fees are regulated by the North Carolina Industrial Commission.
Although there are several ways a workers’ compensation case can be settled, an attorney’s advice and involvement can add value to a claim in a variety of ways.
Some cases are settled based on the impairment rating ordered by the physician. The body is evaluated by separate parts: fingers, hands, arms, back, legs, feet, etc. A maximum number of weeks of benefits can be paid based on whichever part of the body is injured. The impairment rating allows the worker to get whatever percentage of the maximum number of weeks is payable for that part of the body. An attorney’s knowledge of whether the rating may be too low is important.
Another type of settlement is based on the wage differential between pre and post-injury wages. These payments are limited to 500 weekly installments. Insurance companies typically resist paying these claims even when the worker is entitled to it.
A third form of settlement is for permanent and total disability when the injured worker is unable to return to any work. Injured workers are only entitled to payment for total disability for a period of 500 weeks from the date of first disability, and must re-prove disability after that initial period. Insurance companies strongly resist these claims. Attorney involvement is usually needed to receive benefits for permanent and total disability.
Normally, an injured worker would have a period of time to claim future medical care or to reopen his case. However, some insurance companies wish to “clincher,” which closes the case forever. They will usually pay a lump sum in order to close the case. A clincher of a case stops your right to receive payments for additional medical care, to reopen the case for change of condition, or to have another hearing before the Industrial Commission. Great caution should be exercised when a clincher agreement is proposed. An attorney can take steps which will add value to the claim, for example, by estimating the costs of future medical care or the potential for a change of condition.
Lastly, when there is third-party liability, as discussed elsewhere in this pamphlet, an attorney can add value to the claim by negotiating to reduce the lien against the third-party recovery. This results in more net returns for the injured worker.
If you settle your case on any agreement other than the clincher, you have two years from final payment of compensation to reopen the case to receive additional lost wages if your condition materially worsens.
Martin & Jones has made every effort to insure that the information is correct and up-to-date. However, laws change and specific fact situations may require the application of a different rule of law. For this reason, you should consult an attorney or one of the organizations listed below if you have further questions about workers’ compensation.
Martin & Jones provides the information in this brochure for informational purposes only. It is not intended as and should not be considered legal advice. Contacting Martin & Jones in any manner does not imply any form of attorney-client relationship with Martin & Jones. If you have any questions, please contact us.