If you or a loved one was injured at work or diagnosed with an occupational illness, you are likely experiencing stress, concern, and worry about the uncertainty of what comes next. Fortunately, North Carolina has a system in place to help you during this difficult time. The system is referred to as workers’ compensation.
Under the North Carolina workers’ compensation laws, an employee may be entitled to workers’ compensation benefits after being injured at work or being diagnosed with an occupational disease. Once all elements of the claim are proven, workers’ compensation benefits become available to the employee, primarily to cover economic losses.
Below, our workers’ compensation lawyers in Charlotte answer some common workers’ compensation questions.
Frequently Asked Questions About North Carolina Workers’ Compensation
Below are answers to some of the frequently asked questions about workers’ compensation in North Carolina provided by an experienced lawyer. You should contact our Charlotte work injury attorneys for your free consultation.
What Is Workers’ Compensation?
Workers’ compensation is a state-required insurance program that’s required for employers with 3 or more employees to compensate employees that are injured or suffer from a work-related illness. It is a system that pays for lost wages and medical costs resulting from work-related injury or illness. For an employee to benefit from workers’ compensation, they aren’t allowed to sue their employer for negligence.
How Does Workers’ Compensation Work?
If an employee is injured at work, they have the option of filing a workers’ compensation claim. In return, they aren’t allowed to sue the employer for negligence that might have been responsible for the injury.
A workers’ compensation policy in North Carolina is just about the only remedy available to employees for accidental workplace injuries. It usually covers about two-thirds of an employee’s wage, but it also covers things such as:
- Retraining costs
- Medical care
- Medical treatment of the injury
- Wage replacement for money lost while injured
- Compensation for any permanent injuries
- Vocational rehabilitation (if needed)
- Death benefits
What Are the Workers’ Compensation Laws in North Carolina?
In North Carolina, businesses with 3 or more employees are required to have workers’ insurance. The businesses here include but aren’t limited to sole proprietorships, corporations, limited liability companies, etc.
Employees can receive benefits in different forms. One of such is medical benefits that cover hospital stays, drugs, doctors’ visits, etc. Employees can also receive disability benefits, which are divided into temporary disability benefits and permanent disability benefits.
Employers that don’t provide workers’ compensation insurance for their employees can be fined, imprisoned, and charged with a felony.
What Are My Rights Under the Workers’ Compensation Laws in North Carolina?
Injured workers throughout North Carolina know that workers’ compensation coverage is aimed at protecting them if they are ever hurt on the job. Still, many people don’t understand their rights under the law and this is hardly their fault.
The workers’ compensation system in North Carolina can be extremely complicated to understand and it can be more difficult to know your rights than it seems. Fortunately, the workers’ compensation lawyers in Charlotte, North Carolina have provided the following list of rights that workers should know about.
Workers in North Carolina have the following rights under the workers’ compensation laws:
- The right to workers’ compensation regardless of immigration status
- The right to benefits even if they are paid in cash
- The right to refuse an employer’s offer to pay outside of workers’ compensation
- The right to a translator, transportation assistance, and travel reimbursement
- The right to choose your physician
- The right to continue medical treatment
- The right to settle your claim
- The right to hire a workers’ compensation lawyer
- The right to dispute a denied claim.
How Do I File a Workers’ Compensation Claim in North Carolina?
To file a claim for workers’ compensation in North Carolina, you should follow the simple steps below:
- Report the injury to your employer in writing.
- Your employer will then fill out Form 19 and hand you a copy along with a blank Form 18.
- You complete Form 18 and file it with the North Carolina Industrial Commission (NCIC), and send your employer a copy.
- You receive a response from your employer within 30 days with a Form 60, Form 61, or Form 63.
- If you receive Form 61 or Form 63, your workers’ compensation benefits could be denied.
- You file Form 33 to request a hearing regarding the denial.
Who Is Not Covered by Workers’ Compensation in North Carolina?
The North Carolina Workers’ Compensation Act states that the vast majority of businesses are required to have workers’ comp insurance. Still, there are some jobs not covered by workers’ compensation. Employees not covered by workers’ compensation in North Carolina include:
- Independent Contractors
- Domestic workers employed directly within a household
- Federal Government employees working in North Carolina
- Business Owners
- Certain Railroad Employees
- Farm Workers at farms employing less than 10 full-time farm laborers
How Can You Know If Your Employer Provides Workers’ Compensation Insurance?
Employees with over 3 regularly employed workers are legally obligated to provide workers’ compensation insurance. Still, it isn’t always possible to know whether your employer actually provides workers’ compensation.
Fortunately, the North Carolina Industrial Commission provides information regarding the workers’ compensation insurance providers in the state. You can search the NCIC’s Insurance Coverage Search System. If your employer appears in the system then they provide workers’ compensation insurance.
What Are the Most Common Reasons for Needing Workers’ Compensation?
The following are some of the most common reasons for needing workers’ compensation in North Carolina:
- Slips, Trips, and Falls
- Machinery Accidents
- Motor Vehicle Accidents
- Repetitive Motion Injuries
- Exposure to Harmful Environments and Substances
- Cuts and Punctures
- Strains and Sprains
- Fires or Explosions
What Are the 4 Types of Workers’ Compensation Benefits?
Workers’ compensation benefits in North Carolina may fall into these 4 categories:
- Temporary Total Disability
- Temporary Partial Disability
- Permanent Total Disability
- Permanent Partial Disability
Additionally, if someone died as a result of their injuries incurred during an on-the-job accident, death benefits may be paid to the surviving family.
How Long Can You Receive Workers’ Compensation in North Carolina?
Unfortunately, this is a question without a simple answer. Complex formulas are used to determine the amount and length of workers’ compensation benefits. Depending on the extent of your injuries, you may be entitled to receive benefits for several weeks, months, years, or perhaps even the rest of your life.
Why Is Time Important When Dealing with the Claims Process?
If claims are reported in a timely manner, the injured employee will receive faster treatment, their injuries won’t become worse, and perhaps even future accidents will be avoided. Furthermore, if you are an employee filing a claim, you will be permanently barred from ever doing so if you fail to file your claim within the set deadline.
What Should I Do Immediately After a Workplace Injury?
You should do the following immediately after a workplace injury:
- Report the injury to your employer in writing without delay.
- Seek medical treatment promptly.
- File your claim with the NCIC.
- Cooperate with the claim investigation.
- Cooperate with medical treatment providers.
- Call an experienced North Carolina injury attorney to help you file a claim.
If I Work from Home, Can I File for Workers’ Compensation?
You are entitled to workers’ compensation if you were injured on the job or were diagnosed with a work-related illness. This means that you are eligible to file for workers’ compensation whether you are working at the office or working from home.
To help you establish if you had a work-related injury, the following questions will help:
- Does my employer approve of my remote work?
- Did my employer require me to engage in the activity that caused me to get injured or fall ill?
- Did my employer benefit from the actions I was carrying out when the accident or injury occurred?
You are typically entitled to workers’ compensation if you answer the questions above in the affirmative.
What Mistakes Could Mess Up My Workers’ Compensation Claim?
The process of filing a workers’ compensation claim in North Carolina can be complex and a number of mistakes could make it challenging to obtain the benefits you need, such as:
- Not seeking medical attention promptly
- Not reporting the workplace accident
- Not following the doctor’s advice
- Not hiring a North Carolina workers’ compensation lawyer
- Exaggerating your injuries and symptoms
- Giving a recorded statement without your lawyer present
- Not returning to work on light duty if permitted by the doctor.
What Is Considered a Compensable Work Injury in North Carolina?
Not all injuries that happen on the job in North Carolina are actually compensable under the state’s workers’ compensation laws. Compensable work injuries are those that result from an accident that happens while the employee is in the course and scope of their employment. “Course and Scope” of employment refers to an activity that’s related to work that benefits the employer.
Can You Get Pain and Suffering Benefits Through Workers’ Compensation?
Physical pain, mental suffering, strains on your personal relationships and finances, as well as a general sense that life is spinning out of control are usually part of the recovery process following a work injury.
When it comes to settling your worker’s compensation claim, you might assume that you will be compensated for the pain and suffering you have endured. Unfortunately, that isn’t the case. The workers’ compensation laws in North Carolina don’t provide pain and suffering benefits for injured workers.
Why Should I Hire an Attorney for My Workers’ Compensation Claim in Charlotte?
You should consider hiring a lawyer for your workers’ compensation claim in Charlotte, NC for the following reasons:
- The application process is complicated
- Your disability or impairment rating may be disputed
- You may have issues returning to work
- You risk settling your claim for significantly less than its actually worth
- Your application may be denied.
Your lawyer can help you address all of these issues the right way and ensure that you receive the maximum compensation possible.
Who Pays for Workers’ Compensation?
Your employer is generally responsible for paying for your workers’ compensation insurance under the North Carolina Workers’ Compensation Act. If your employer is unable to get coverage through private insurance, they may be eligible to get coverage through the assigned risk pool that’s administered through the North Carolina Rate Bureau.
What’s the Difference Between a Workers’ Compensation Claim and a Personal Injury Lawsuit?
There are two primary differences between a workers’ compensation claim and a personal injury lawsuit:
- Workers’ compensation claims are only between employees and employers.
- Personal injury lawsuits are based on fault while proving fault isn’t required for workers’ compensation claims.
Is Workers’ Compensation the Same as Disability? What’s the Difference?
Workers’ compensation is not the same as disability. The key difference is that workers’ compensation covers workers for injuries that the employer would be liable for, while disability benefits aren’t paid via your employer, but still help make up for lost income.
Can I Collect Workers’ Compensation and Disability Benefits at the Same Time?
If you are injured at work in North Carolina, you may qualify for workers’ compensation benefits as well as social security disability benefits, but only if you meet the eligibility requirements of both programs.
Can I Receive Unemployment Benefits While Receiving Workers’ Compensation?
Simply put, no. You are still technically employed even if you aren’t working while on workers’ compensation. However, there are exceptions. In North Carolina, you may collect unemployment benefits while your workers’ compensation claim is being filed or disputed. Once you start receiving workers’ compensation benefits, however, you will be required to repay your unemployment benefits.
Can I be Fired for Filing a Workers’ Compensation Claim in North Carolina?
Your employer cannot fire you, demote you, or take any adverse employment action against you for filing a workers’ compensation claim in North Carolina. It is a violation of the Retaliatory Employment Discrimination Act and you should report any attempts to do this to the North Carolina Department of Labor.
Is Workers’ Compensation Taxable?
Workers’ compensation benefits are usually not taxable. Still, there’s an exception for persons that also receive disability benefits via either Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI).
If your workers’ compensation benefits and disability payments are above a certain threshold, the Social Security Administration (SSA) could reduce the benefits so that the combined total remains below that threshold.
What Is Maximum Medical Improvement?
Maximum Medical Improvement is a legal term defined as the point at which an injured person’s condition has improved as much as it possibly can. It is used for determining the value of personal injury claims.
Notably, maximum medical improvement does not mean that the person has recovered from their injuries. Rather, it only means that they have reached a condition that’s considered to be the healthiest they can be.
How Do You Calculate Workers’ Compensation Wages?
Compensation is typically based on the Average Weekly Wage (AWW). In North Carolina, you are entitled to 66 2/3% of your average weekly wage. Once calculated, the value, which is your compensation rate, is payable on a weekly basis.
The AWW is calculated in several ways:
- If you have worked every week for an employer for at least 52 weeks before the injury, your total earnings will be divided by 52.
- If you have missed 7 or more consecutive non-calendar days during the 52-week period before the injury, 1 week may be deducted from the 52-week period for each 7-day period.
- If you have worked less than 52 weeks prior to the injury, your AWW is typically calculated by dividing your earnings during that period by the number of weeks worked.
- If it isn’t practical to calculate the AWW since you worked just a short period prior to the accident, you can make a claim for an AW of a person of the same pay grade and similar job duties or position as you did during the 52 weeks prior to the injury.
- If it is not possible to calculate the AWW using the methods above, you may request an approximate amount that you would have earned were it not for the injury.
Is There Always a Settlement in Workers’ Compensation Cases in North Carolina?
No. There’s actually no legal obligation for you to settle your case, and in some instances, you may be better off leaving the case open. The laws in North Carolina allow you to forego a permanent disability award in favor of receiving ongoing wage loss benefits. A workers’ compensation lawyer can advise you whether this option is suitable for your situation.
If I Had a Pre-Existing Condition, Can I Still Get Workers’ Compensation?
In spite of common efforts by both employers and insurance providers to deny coverage, North Carolina allows workers with pre-existing conditions to file for workers’ compensation.
Do I Have to Go Back to Work When My Workers’ Compensation Ends?
You must only go back to work after a medical professional has evaluated you and confirmed that you have recovered from the injury. Your employer and their insurance provider both have a financial interest in seeing you go back to work sooner. However, you must only return to work after fully recovering from a work-related injury or after reaching maximum medical improvement.
What Should I Do If My Workers’ Compensation Claim Is Denied?
If your workers’ compensation claim is denied, you should consult a competent workers’ compensation lawyer in Charlotte, North Carolina. Workers’ compensation law may be too complicated for you to handle on your own. If you attempt to go it alone, you may end up making irreversible mistakes.
It is important to have a knowledgeable North Carolina workers’ compensation lawyer who will help you navigate the process. Your employer and their insurance provider will obviously have lawyers representing them, which puts you at a disadvantage unless you have your own legal representation.
What Is the Retro Workers’ Compensation Policy in North Carolina?
Workers’ compensation Retrospective Rating Plans are insurance policies with a built-in mechanism for allowing employers to share in the financial risk and reward when it comes to their workers’ compensation insurance coverage. Retro workers’ compensation policies are typically designed for companies that pay $250,000 or more for a standard workers’ compensation policy.
With a Retro Plan, the insurance company issues a policy with both a maximum and minimum premium for the policy along with a rating formula. The final premium is determined at the end of the policy period using the formula based on various rating factors and actual losses. Essentially, the plan is loss sensitive and the employer participates in the cost of actual losses and the potential savings for losses that are lower than expected.
What Is the Administrative Review Process and How Will It Affect My Claim?
Workers’ compensation claims in North Carolina are first processed through an administrative agency known as the workers’ compensation administration, not a court. In North Carolina, this administrative agency is the North Carolina Industrial Commission (NCIC).
In North Carolina, once you have reported a job-related illness or injury to your employer and a claim is submitted, you will be notified within 14 days whether the claim has been accepted or denied. If the claim is denied or disputed, it will undergo the administrative review process.
The administrative review process involves presenting the case before a judge who will hear evidence and decide on the disputed issues. The process generally takes a matter of months, unlike the courts, where litigation can go on for several years.
Contact Waple & Houk, PLLC Today for a Free Case Review!
If you have been injured as a result of a work-related accident or illness in Charlotte, North Carolina, you should contact an experienced lawyer to schedule your free initial consultation.
You are also encouraged to learn as much as possible about workers’ compensation claims in North Carolina, which is where the FAQs featured here come in. The more information you have, the better your chances of having a successful claim.