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North Carolina Workers' Compensation Claims

Worker’s compensation was enacted by statute in North Carolina in 1929. As a general rule, each business that has more than three employees must be covered by worker’s compensation insurance. The system is governed by a state agency called the Industrial Commission.

An employee may be entitled to workers’ compensation benefits when he or she is injured in the course and scope of his or her employment. When each and every element of this claim is proven, workers’ compensation benefits become available to the employee.

An employee must give notice to his employer of an injury on the job by filing a written notice. This notice of an accident should be filed within 30 days of the date of the accident. The absolute limit for filing a written notice is two years.

Workers’ compensation is generally an injured employee’s sole remedy. This means that, but for some narrow and rare exceptions, an injured employee is entitled only to workers’ compensation benefits and nothing else. A workers’ compensation claim is thus entirely different from a claim for negligence such as in an auto accident. In fact, the negligence of the employer in causing the accident is not even an issue in workers’ compensation claims. As strange as this may sound, this often works to the employee’s benefit because in most cases it is far more difficult to prove the negligence of the employer and the lack of negligence of the employee than it is to prove merely that the employee was injured on the job. Furthermore, many injuries on the job are not caused by anyone’s negligence. In the system that was in place before workers’ compensation was enacted, this would have meant that those employees would have not recovered anything. Under the old system, the employer also had many defenses, such as contributory negligence, that shielded them from liability.

Under the current system, in exchange for the relative ease of making the employer liable, the legislature limited the benefits the employee could receive. Workers’ compensation provides two main benefits to the injured employee. First, all injury-related medical bills are paid by the insurance company. This includes medical prescriptions. To a great extent, the insurance company directs the medical providers you see. However, you do have the right to request a second opinion and also to request a change of a physician. If the insurance carrier refuses, you can then make a motion to the Industrial Commission for approval of your choice of a physician.

Secondly, the insurance company will pay disability benefits. Disability payments consist of two thirds (66.66%) of an employee’s gross average weekly wage. This compensation payment is nontaxable. If an injured employee is out of work due to an injury for more than seven days, then the insurance company will begin to pay temporary total disability payments for every day thereafter so long as the doctor keeps the employee out of work on a written excuse. The employee is not entitled to payment for the first seven days unless he is subsequently out for more than 21 days. If an employee has a permanent injury to a particular part of the body, then the employee is entitled to further compensation under the act that is called permanent partial disability. Furthermore, if an employee is determined to be totally and permanently disabled, then he is entitled to lifetime benefits which include future medical expenses and disability payments.

Workers’ compensation does not award a claim for pain and suffering.

Some of the things that you can do to help your case are listed below:

Keep track of the mileage to your doctor, physical therapist or other accident-related appointments. This mileage may be fully reimbursable as a part of your claim.
Keep a copy of your prescription receipts. These are part of incurred medical expenses. These are reimbursable.
Get a written note from your doctor for any missed days from work. This is very important. It is impossible to claim disability payments for days you missed when you do not have a doctor’s excuse.
IIt is very important that you keep your appointments with you doctor or therapist. Your right to benefits can be cut off if you do not keep your appointments.

Settlement

The value of your claim is determined by statute and depends mainly on the kind of injury and the extent of any permanency. There are two ways that a workers’ compensation claim can be settled. The first kind is a settlement agreement written on a form provided by the Industrial Commission and the other is what is commonly called a clincher agreement. The main difference between the two involves your right to future benefits because of a change of condition within two years after the last date you received a check. In the IC form, your right to possible future benefits is preserved. In the clincher agreement, this right is waived in exchange for an additional sum of money.

Settlement of a worker’s compensation case can be complex especially if there are return to work issues. Before you sign anything, you should consult an attorney.

Finally, your claim cannot be settled without your written permission. Furthermore, all settlements must be approved by the Industrial Commission.

Industrial Commission Hearings

If any issue cannot be resolved with the insurance company, you can consider the advisability of filing a request for a hearing. A hearing is then held with a deputy commissioner of the Industrial Commission. There are no jury trials in workers’ compensation claims. The waiting period for the hearing varies, but is always at least a few months.

You have the right to appeal the decision of the deputy commissioner to the full commission, which consists of a panel of commissioners.

For more information please refer to the Industrial Commission website.