The Workers’ Compensation Process

Understanding the Workers’ Compensation Process in North Carolina: A Detailed Step-By-Step Guide

Suffering an injury at work can be a stressful and overwhelming experience. Not only do you have to deal with the physical pain and recovery, but you also have to navigate the complex workers' compensation process. Understanding the workers' compensation process is crucial to ensure you receive the benefits you are entitled to.

The Workers’ Compensation Process

In North Carolina, the workers' compensation process is governed by specific laws and regulations that dictate how claims are handled and what benefits are available to injured workers. Our workers' compensation lawyers are experienced with North Carolina's workers' compensation law and how to best help you with your claim.

Step 1: Seek Immediate Medical Attention

If injured, your first step should be to seek medical help. Prioritize your health before anything else.

Step 2: Inform Your Employer

Notify your employer of the injury as soon as possible, ideally within 24 hours. Report even minor injuries as they may cause complications later.

Step 3: Obtain Medical Treatment

See a health care professional provided by your employer or their insurance company. You can request a different doctor, but approval from the North Carolina Industrial Commission (NCIC) is required.

Step 4: File a Written Report

You should file a written report to your employer within 30 days as per NC General Statutes §97-22. Describe the injury and the circumstances that led to it.

Step 5: File a Claim with NCIC

Protect your rights by submitting a Form 18 with NCIC within two years of the injury. This is your formal claim for compensation.

Step 6: Wait for Claim Approval or Denial

The insurance company has 30 days to accept, deny, or extend the investigation period of your claim.

Step 7: If the Claim is Accepted

If your claim is accepted, you will receive benefits including medical expenses and partial wage replacement. Ensure to follow through with all treatments and maintain records of all associated costs.

Step 8: If the Claim is Denied

In case your claim is denied, you have the right to request a hearing before the NCIC. This is a complex process, and it's advisable to have a workers’ compensation attorney guide you.

Step 9: Returning to Work

Once medically cleared, you can return to your former job or a modified one. If your wage is lower due to your injury, you may qualify for partial compensation.

Step 10: Settlements

Upon completing your treatment, you might reach a settlement with your employer's insurance company. This may cover future medical treatment and compensation for permanent disability. All settlements need approval from NCIC.

Step 11: Appeal

If you are dissatisfied with the outcome, you can file an appeal with NCIC. Navigating the appeals process can be challenging, hence professional legal representation is recommended.

How a Workers' Compensation Lawyer Can Help

A workers' compensation lawyer can be an invaluable ally in the process of pursuing your claim. Here's how they can assist:

Understanding and Explaining the Law

Workers' compensation laws can be complex and difficult to understand. A knowledgeable worker's comp lawyer can explain the laws, your rights, and the procedures you need to follow.

Helping with Claim Preparation

A workers' compensation attorney can help you prepare and submit your claim. They know what information is required, how to fill out the forms correctly, and how to gather necessary supporting evidence.

Negotiating with the Insurance Company

Workers' compensation insurers may try to minimize their payouts. Your lawyer can handle negotiations, ensuring you get a fair settlement.

Representing You in Hearings and Appeals

If your claim is denied, your lawyer can represent you in a hearing before the North Carolina Industrial Commission. They can prepare and present evidence, cross-examine witnesses, and make persuasive arguments on your behalf.

Providing Guidance on Other Possible Benefits

If your injury qualifies, you may be entitled to other benefits such as Social Security Disability Insurance or personal injury compensation. Your attorney can advise on these matters too.

Advocating for Your Rights

If you face employer retaliation for filing a claim or need help getting appropriate medical treatment, a workers' compensation attorney can advocate for you and protect your rights.

Who Is Eligable For Workers' Compensation in North Carolina

Eligibility for workers' compensation in North Carolina is guided by several key factors:

Employer Coverage

Not all employers in North Carolina are required to have workers' compensation insurance. Generally, businesses with three or more employees are required to carry it. However, there are some exceptions, such as certain agricultural and domestic workers, and independent contractors.

Employee Status

You must be an employee to be eligible for workers' compensation. Independent contractors and volunteers typically are not covered. However, determining employee status can sometimes be complex and may require legal advice.

Work-Related Injury or Illness

The injury or illness must have occurred in the course of employment. This includes injuries that occur at the workplace or elsewhere, as long as they happened while you were performing a work-related duty.

Notification and Reporting

You must report your injury to your employer as soon as possible, ideally within 24 hours, and file a written report of the injury with your employer within 30 days, according to North Carolina law.

Filing a Claim

You must file a Form 18 (Claim by Employee, Representative, or Dependent) with the North Carolina Industrial Commission (NCIC) within two years of the date of injury or diagnosis of a work-related illness.

What Injuries Are Covered In a Workers' Compensation Claim?

Workers' compensation is designed to cover injuries that occur in the workplace or as a result of a worker's job duties. The types of injuries that are typically covered by workers' compensation insurance in North Carolina include, but are not limited to:

Physical Injuries

Physical injuries include:

• falls
• burns
• fractures
• cuts
• and so forth.

It also covers injuries caused by repetitive strain, such as carpal tunnel syndrome or back problems due to heavy lifting over a prolonged period.

Occupational Diseases

Occupational diseases include:

• lung diseases caused by exposure to harmful substances
• certain types of cancers linked to specific work environments
• or hearing loss due to exposure to loud noises at work.

Traumatic Injuries

These are injuries caused by a specific event or series of events, such as injuries caused by machinery, falling objects, or physical violence at the workplace.

Mental and Emotional Injuries

Some states allow for workers' compensation claims based on mental stress or emotional trauma related to work. These could be a result of a traumatic event or sustained workplace stress. However, these types of claims can be more difficult to prove and may not always be covered.

Death

If a worker's death is caused by a work-related injury or illness, the worker's dependents (like a spouse or children) can receive death benefits through workers' compensation.

NC Workers' Compensation Deadlines and Statute of Limitations

In North Carolina, specific deadlines and statutes of limitations exist within the Workers’ Compensation Process. They are:

Report to Employer

If you're injured at work, you must inform your employer immediately, ideally within 24 hours, and no later than 30 days after the incident. This notification should ideally be in writing, including information on the nature of the injury and when and where it happened.

Employer's Reporting to the Insurance Company and NCIC

After your employer learns about your injury, they are required to file a Form 19 "Employer's Report of Employee's Injury to the Industrial Commission" with their insurance carrier and the NCIC within five days.

Filing a Claim with the NCIC

As an employee, you should file a Form 18 "Notice of Accident to Employer and Claim of Employee" with the NCIC to establish your legal claim for benefits. This form should be filed within two years of the date of your injury or diagnosis of an occupational disease.

Claims against Third Parties

If someone other than your employer or a co-worker caused your work-related injury (a third party), you generally have three years from the date of the injury to file a lawsuit against them.

Claims for Additional Compensation or Changes in Condition

If your employer's insurance carrier has paid compensation to you for an injury under a final award of the NCIC and your condition changes, you generally have two years from the date of the last payment of compensation to ask the NCIC to change or re-open the award.

Claims for Medical Expenses

Generally, the employer (or its insurance company) is required to pay for all medical treatment related to the injury for as long as such treatment is needed, as long as the treatment is authorized by the employer or its insurance company or ordered by the NCIC.

How Long Do You Get Workers' Compensation Benefits in North Carolina?

The duration of workers' compensation benefits can vary depending on the nature and severity of the injury, as well as state-specific laws. In North Carolina, here are some general rules:

Medical Benefits

As long as the workers' compensation claim is approved, the employer (or its insurance company) is required to pay for all necessary medical treatment related to the injury. This coverage can last as long as the treatment is required, which could potentially be for the remainder of the worker's life, depending on the severity of the injury or illness.

Temporary Total Disability Benefits (TTD)

If an injured worker cannot work at all while recovering, they are usually eligible for TTD benefits, which is typically two-thirds of their average weekly wage, up to a maximum set by state law. These benefits can generally continue until the worker is able to return to work or until it's determined that the worker will not likely make further significant medical improvements (often referred to as reaching "maximum medical improvement" or MMI).

Temporary Partial Disability Benefits (TPD)

If an injured worker can return to work but not earn the same wages as before (due to working fewer hours or a lower-paying job), they may be eligible for TPD benefits. These are typically two-thirds of the difference between the worker's pre-injury and post-injury weekly wages.

Permanent Partial Disability Benefits (PPD) and Permanent Total Disability Benefits (PTD)

If a worker has permanent impairments due to a work-related injury, they may be eligible for PPD or PTD benefits. The duration and amount of these benefits can vary widely and are typically based on a disability rating assigned by a doctor, the worker's wage before the injury, and specific state laws.

Death Benefits

If a worker dies as a result of a work-related injury or illness, the worker's dependents may be eligible for death benefits, which can include payment for burial expenses and compensation payments to the deceased worker's dependents.

Contact The Law Offices of John M. McCabe

Navigating the complex world of workers' compensation can be overwhelming, especially while you're focused on recovery. Remember, the key steps involve timely reporting, meticulous documentation, and keeping track of all deadlines. However, understanding your rights and the intricate laws can be challenging without professional help.

At The Law Offices of John M. McCabe, we're committed to supporting you through this process. With years of experience in North Carolina's workers' compensation claims, we can provide the necessary guidance and legal representation to ensure that you receive the benefits you're entitled to.

NC Workers' Compensation Process FAQs

1. What should I do if I'm injured at work?

First, seek immediate medical attention. Then, notify your employer of the injury as soon as possible, ideally within 24 hours. Ensure to follow up with the recommended medical treatment and keep all relevant records.

2. Do I need to file a claim if my employer already knows about the injury?

Yes, you should still file a Form 18 with the North Carolina Industrial Commission (NCIC) within two years of the injury to protect your rights and initiate your claim.

3. Can I see my own doctor for a work-related injury?

In North Carolina, your employer or their insurance company typically has the right to direct your medical treatment. If you want to see your own doctor, you generally need to request permission from the NCIC.

4. What if my claim is denied?

If your claim is denied, you can request a hearing before the NCIC, where you will have the opportunity to present evidence to support your claim. This can be a complex process, and it's generally recommended to have a workers' compensation attorney assist you.

5. Can I return to work while receiving benefits?

Yes, but it depends on your medical condition and the nature of your job. If your doctor clears you for work, whether for your regular duties or for lighter duties, you should generally follow their advice. If you're not earning as much due to your injury, you may be eligible for partial compensation.

6. Can my employer fire me for filing a workers' compensation claim?

It's illegal for an employer to retaliate against an employee for filing a workers' compensation claim. If you believe you have been retaliated against, you should contact a workers' compensation attorney or the NCIC.

7. What happens if I disagree with the amount of benefits I'm receiving?

If you disagree with the amount of your benefits, you can request a hearing before the NCIC to review your case. It's advisable to have a workers' compensation attorney guide you through this process.

8. What if my injury gets worse after my claim is settled?

If your condition worsens after a settlement, you might be able to reopen your claim or seek additional compensation, but this can depend on the specifics of your settlement agreement and state laws. Legal advice is strongly recommended in these cases.

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Important Workers' Compensation Terms and Acronyms

Navigating workers' compensation can often feel like learning a new language due to the numerous acronyms and legal terminology used. Here are some important ones that you may come across in the process:

• TTD (Temporary Total Disability): Benefits paid to workers who are unable to work temporarily due to their work-related injury or illness.
• TPD (Temporary Partial Disability): Benefits paid to workers who can return to work with limitations and are earning less than they did before their injury.
• PPD (Permanent Partial Disability): Benefits paid to workers who have a permanent impairment but can still work in some capacity.
• PTD (Permanent Total Disability): Benefits paid to workers who are permanently and totally disabled due to their work-related injury or illness.
• MMI (Maximum Medical Improvement): A term used to indicate that a worker's medical condition has stabilized and no significant improvement is expected.
• NCIC (North Carolina Industrial Commission): The state agency that administers the Workers’ Compensation Act and handles workers' compensation claims and disputes in North Carolina.
• Form 18: This is the form an injured worker must file with the NCIC to initiate a workers' compensation claim.
• Form 19: This is the form an employer must file with the NCIC after being notified of a workplace injury.
• Occupational Disease: A condition or illness caused by exposure to harmful substances or conditions at work.
• Compensation Rate: Generally, this is two-thirds of your average weekly wage before the injury, subject to a maximum amount set by law. This rate is used to calculate your workers' compensation benefits.
• Retaliation: This is an illegal action taken by an employer against an employee for exercising their right to file a workers' compensation claim.
• Statute of Limitations: The legal time limit within which a workers' compensation claim must be filed. In North Carolina, this is typically two years from the date of injury or diagnosis of an occupational disease.