Workers' Compensation Benefits
Have you been hurt on the job? Do you feel you are entitled to benefits as a result of that injury? Have you missed work or been fired after an injury? Do you need medical treatment?
If you have been hurt on the job, you may now be entitled to Workers’ Compensation benefits. You may already have a pending claim and are getting your benefits, or you may need to know your rights and have not yet brought a claim.
Have you have been injured on a job? In addition to your workers’ compensation benefits, do you also have a claim against a third party? »
Hopefully, you are recovering from your injuries and getting the medical care you need, and you are also receiving the workers’ compensation benefits you are entitled to. Here is some general information for you:
An employee is covered if he or she works for an employer who regularly employs three or more people full or part time, or is an employee of a construction subcontractor, or where the employer has workers’ compensation insurance. An individual who works for the State, a County, or City is covered. With some exception, agricultural workers, residential workers, residential domestic workers, independent contractors, and casual workers are not covered by the Act. Federal, maritime, and railroad workers are covered under other State and Federal laws.
It is important for the employer to have notice of this injury or incident. The employee should immediately report to his or her supervisor any on-the-job injury including the time and date of the injury, the manner in which it occurred, and the nature of the injury. If an employee is informed by a doctor, or believes that he or she has a disease or condition which is related to or caused by the job, that should be immediately reported as well.
Most workers’ compensation claims are administered either by the workers’ compensation insurance carrier or, in the case of a self-insured employer, a claims administrator. Remember that payment of medical expenses by an employer, alone, may not bind an employer/insurance carrier to pay other benefits and is not an admission of compensability or acceptance of the claim.
Workers’ compensation insurance carriers often work to find ways to deny or limit legitimate claims. An injured person who is represented by an attorney from the beginning is best able to meet the insurance company’s lawyers and claims adjusters on a level playing field. Further, a prompt evaluation of the circumstances of an injury - on the job or not - by an experienced workers’ compensation lawyer is an important first step toward protecting the rights of the victim and affected family members.
Generally, an injury is fairly obvious as oftentimes an injury needs immediate medical attention from the job-site. However, the initial step for a Plaintiff or Employee in a Workers’ Compensation Case in many cases to provide official notice is to file a Form 18. This must be done within two years from the day of your accident, and it preserves your Workers’ Compensation rights. Despite this, it is important to notify your employer immediately, or at least within 30 days in writing, of your workers’ compensation injury or disease.
Workers’ Compensation developed as an alternative to Personal Injury or tort actions. The benefit of Workers’ Compensation is that it is not fault-based. In other words, you do not have to prove any negligence of the employer in order to recover Workers’ Compensation benefits. You simply need to demonstrate that you sustained an injury by accident arising out of and in the course and scope of your employment with your employer. Basically, this means that you were injured while working for your employer doing your job in an ordinary fashion, when some accident or something out of the ordinary occurred.
For major bodily injuries, this is quite apparent what it could be. For example, a broken bone or other physically visible injury. For your back/neck, the injury must be related to a specific traumatic incident, that you can describe with detail. For example, lifting boxes or twisting in some way when you feel an immediate pain in your back. There are also occupational diseases, repetitive injuries, loss of hearing/vision, and certain mental claims that could also arise and that will be discussed in further detail with you if relevant to your case.
At some point, a hearing may be needed in your case to resolve issues in dispute. These issues can arise from the compensability of the claim, your average weekly wage, the percentage of your maximum medical improvement, or anything else that might be in dispute. If this occurs, a Form 33 needs to be filed on your behalf. This is the form requesting a hearing with the Industrial Commission. The Industrial Commission is the “court system” that handles Workers’ Compensation cases.
When a hearing is filed for, the parties must proceed to a mediation. At the mediation, both sides discuss their position and a settlement is attempted to be reached through what is called a clincher agreement, which would resolve your case permanently, or through some other potential resolution. Part of the considerations for settling are the percentage that the insurance company would pay you for a disability rating that you receive to a certain body part.
For example, pursuant to the North Carolina General Statutes, a back is worth 300 weeks. If your back was completely disabled you would be entitled to receive 300 weeks times your compensation rate as a lump some payment. This is one alternative to resolving a claim and there are many others. If for example your back was only injured 10%, then you would be entitled to receive 30 weeks, which is 10% of 300, times your compensation rate. Your case must be analyzed in detail to be sure you get all of the benefits to which you are entitled.
If the mediation is successful, then the clincher agreement will be drawn up by the insurance company’s attorney and the same would be forward to us and you for review and signatures. Upon approval by us the same will be forwarded to the North Carolina Industrial Commission and they will review the clincher agreement to make sure that it is fair to both parties and will set the attorney’s fee.
They are setting the attorney’s fee based primarily on the contract entered into which you have before you in which we ask you to read and sign acknowledging that you have both read and understood it and that you have watched this video. In general, the fee is done on a contingency fee basis or 25% of the total recovery. Once the Industrial Commission enters their order awarding a fee and approving a clincher agreement, the same is resolved and the checks should come shortly thereafter.
A case does not have to be clinchered, as you maintain medical treatment for up to two years after the date of your last medical treatment relating to this accident. That is always a consideration for some parties. Certain issues arise regarding a disability benefit or social security benefit that can be addressed specifically with you should those situations arise in your case.
Disfigurement from a Compensation Injury
There are some cases where an injury may result in disfigurement for which compensation would be due. The maximum for head or facial disfigurement is $20,000. The maximum compensation for other bodily disfigurement is $10,000. An award for head or facial disfigurement is mandatory. To receive benefits for bodily disfigurement there must be some proof that the disfigurement impairs the employee’s wage earning capacity.
Permanent loss of an important bodily organ as the result of an occupational injury or disease may entitle the employee to compensation up to $20,000. If caused by an occupational disease or accident, the loss of hearing or a portion of hearing in one or both ears or loss of vision or a portion of vision in one or both eyes is compensable.
Workers' Compensation Hearing
The first step in a Workers’ Compensation hearing is to go before a Deputy Commissioner. When the case goes before the Deputy Commissioner medical providers are usually not present, as their testimony is taken afterward through depositions. The testimony is from you and other lay witnesses. Arguments are then made by filing written briefs with the Deputy Commissioner and are not made orally at the hearing. The Commissioner will then issue a written decision.
If either side loses, they have the right to appeal the same to the full North Carolina Industrial Commission in Raleigh, which has a hearing scheduled at some time in front of three commissioners that hear the legal arguments of the case and read through the transcript. No further evidence is presented and your attendance is therefore not mandatory at the full Industrial Commission hearing but we recommend that you attend if you are able to, as it is important to try to personalize your case to the three commissioners. Settlement discussions can go on throughout the entire process. There are also some additional considerations with attorneys fees in cases of hearings which we will discuss. They are still based on a contingency fee basis, but may extend to things other than a final award.
Temporary Total Disability Benefits Explained
When you are hurt, and a doctor keeps you out of work for over seven days, you are entitled to receive your Temporary Total Disability benefits or TTD. Your first check is generally for two weeks, the first week you are out, and then the second week as well. These benefits are 2/3 of your average weekly wage. Your average weekly wage is calculated based on your income, but can also include things such as a per diem, travel pay, lodging monies, or other bonuses you might receive. If you have a second job, that may also come into play. It is therefore very important that you provide us with specific details of all of your wages as everything that arises in a Workers’ Compensation case is based upon your average weekly wage.
Therefore, the higher your average weekly wage, the more financial benefits you would be entitled to. Each year, a minimum and maximum compensation rate is set by the North Carolina Industrial Commission. Once a proper compensation rate is set, this amount is the same throughout the case…there is not an increase for inflation or cost of living.
You are entitled to have medical treatment paid for by the insurance company. If it is an accepted claim, the insurance company can direct your medical treatment within reason. If it is a denied claim, you would have to see your own doctors and pay for them yourself and we would pursue obtaining their reimbursement from your claim. You are entitled to reimbursement for your travel mileage over 20 miles for a medical visit, and we will give you the respective form required for you to submit in order for you to get reimbursed for your mileage.
You are also entitled to have your prescriptions paid for. Basically, anything that is medically necessary to effectuate a cure, lessen your period of disability, or provide relief to you should be covered. If the claim is denied, you will not get any benefits from the employer and we will proceed with a Form 33 Hearing request.
Generally, Workers’ Compensation cases proceed with you getting the treatment you need and receiving your TTD benefits until you reach maximum medical improvement or MMI. At this point, several things can occur. You can possibly go back to work with your employer if they have a position available for you that is within your medical restrictions. If this is not an option, you may have to get a job elsewhere if your employer cannot accommodate your medical restrictions. Finding you a job with another employer is the responsibility of the insurance company, as long as you take steps to assist with the job search.
In most cases, they must provide you with suitable employment somewhere before they can stop their TTD benefits to you. They could put you through vocational rehabilitation in order to attempt to return you to work. It is important that you attend all doctors’ appointments, particularly those set up by the insurance company so that they do not claim that you are failing to comply with medical treatment. Most likely a nurse case manager will be assigned to your case to oversee your treatment and make recommendations to the insurance company. This nurse case manager is ethically obligated to look out for your best medical interests.
If your case goes through vocational rehabilitation, there are specific rules and guidelines that the vocational rehabilitation counselor must follow or they can be removed from your case. It is important that you keep up with the details of every dealing you have with a nurse case manager or vocational rehabilitation counselor so that your attorney is aware of the same.
Compensation for Your Medical Expenses
You may need medical treatment. If you need treatment, we suggest that you go immediately to your family doctor or a doctor that has been recommended to you by friends or family, or at the very least to a hospital or urgent care. Immediate treatment is often necessary to make sure that there are no other severe problems that could develop.
It is also important that you keep track of all of the doctors you see, that you obtain copies of all bills and records from the medical providers, and that you get copies of any prescriptions you might fill.
You are entitled to be compensated for the amount of your reasonable medical expenses, the pain and suffering suffered by you, lost wages or other income, and permanent disabilities if any. These amounts can vary and it is difficult to place a quantitative value on some aspects such as pain and suffering. We will work with you during your case to keep you informed of settlement negotiations.
Pain and Suffering from a Compensation Injury
One last thing to think about is that Workers’ Compensation does not cover some things. What is commonly known as “pain and suffering” is not compensable. Ongoing pain may contribute to a disability which may be compensable, but the pain itself is not. Some opinions from other doctors are not automatically covered by the carrier/employer, unless the same is ordered by the Industrial Commission or pre-approved by the carrier or employer, except that the employee is allowed a second opinion from another physician as to the question of an impairment rating only on the question of permanent partial disability.
The North Carolina Industrial Commission’s can be reached at 1-919-807-2500 or by visiting their website. The Industrial Commission also has an office that is designed in particular to attempt to answer telephone questions and resolve some problems, 1-800-688-8349 and 1-919-807-2501. Any call to the Commission should also include a request to be sent a copy of the Commission’s latest bulletins.
Here is a link from the North Carolina Bar Association that will provide some additional information on Workers' Compensation:
In a nutshell, by reading this information above, you have gotten some basic information on workers’ compensation cases. The specifics of your case will be discussed with you in more detail with your attorney. We thank you very much for visiting our website and considering us as your local legal team!