What Do You Need to Know About North Carolina Worker’s Compensation?

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North Carolina personal injury lawyers cover all injuries and illnesses that occur in a work-related accident or occupational disease. Typical work-related injuries include back injuries, knee and shoulder injuries, carpal tunnel syndrome, broken bones, etc. North Carolina also covers occupational diseases, illnesses that result due to exposal of environmental hazards in the workplace (such as exposure to dangerous chemicals).

For a worker to get worker’s compensation coverage, they have to have an injury or illness that happened in the course and scope of their employment. Injuries that happened while commuting and during other non-work-related activities are not covered. 

Filing a claim

When a worker gets injured at their workplace, the first thing they ought to do is get immediate medical help. Your health care provider must be informed that you got your injuries at work (tell them about your company and the name of your employer). This way, your health care provider will send the bill to your employer or the company’s insurance company.

Notify your employer as early as possible (no later than thirty days). Provide oral and written notice of your injury to your employer; the written notice is nothing specific, only a written form of what happened to you. 

An injured man signing workers compensation documents.

You will also have to file an official workers’ compensation claim. Your employer should give you a copy of the form. Your employer will complete a separate form and will send it to its workers’ compensation insurance carrier and to the Industrial Commission.

If your employer fails to file the forms properly, you can submit Form 18 directly to the Industrial Commission. This form should be filed within two years of the date of your injury.

Workers’ compensation benefits

Once your claim is allowed, you are qualified to start receiving workers’ compensation benefits. These benefits usually include medical treatment, compensation for lost wages, and compensation for permanent disability.

  • Medical benefits – Your employer or your company’s insurers have the responsibility to cover your medical expenses. Your employer can demand that you get care from a certain physician or clinic. You can petition the Industrial Commission to get treatment from another physician (this may take a little longer, and it may not work for you; the waiting is not the best idea when you need your treatments).
  • Temporary disability  If you are incapable of working because of your injury or occupational disease for more than seven days, you will get temporary total disability benefits. These benefits are 66 2/3% of your lost wages. These benefits will end when you are physically able to return to work or when you have reached maximum medical improvement. If you are able to do modified or alternate work during this time, you will get partial benefits.
  • Permanent disability –  Once your condition has reached maximum medical improvement, your doctor will give you a permanent impairment rating. The Industrial Commission will use this rating to determine the amount of your monetary award for permanent partial disability. If you are permanently and completely disabled and can no longer work, you will keep getting payments for the rest of your life. If you have a partial disability, you will receive an award according to a state schedule, depending on the type and severity of your injury.

Claim denial

There are cases where the employer refuses to give you your deserved worker’s compensation. If that is the case, you will get a notice of the reasons why your claim is denied (within the 14 days of submitting your claim). The most common reason for denied claims is the failure to prove that your injury occurred at the workplace (or while doing your work). 

You may also be denied a claim if you reported your injury too late or if the proper paperwork is not submitted.

You can use mediation if your claim is denied. And about 70% of the cases are resolved in this stage.

You and your employer’s insurance company may select a mediator from an approved list from the NCIC. 

At the mediation conference, you will have to present evidence showing why your workers’ compensation claim should be approved. 

After the mediation, the mediator will make a recommendation whether your claim should be allowed or not. The mediator will also file a report with the NCIC. If somehow, you do not agree with the recommendation, you will move on to a formal hearing with the NCIC.

Call our office if you seek legal help for your worker’s compensation claim. 

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