What Is Workers’ Compensation in North Carolina?

So, what is workers’ compensation?

In North Carolina, workers compensation law is intended to provide payment of medical expenses and wage loss benefits for persons entitled to workers’ compensation benefits. If you qualify for workers’ compensation benefits you may be entitled to have your medical treatment related to your work injury provided by your employer or their workers’ compensation insurance carrier. You also may be entitled to wage loss benefits while you are unable to work because of your injury.

In a nutshell, that’s how workers’ comp works in North Carolina. It seems simple, but there are a number of ways some employers and insurance companies can delay or deny benefits. If you just want to speak to someone directly, you can always call 1-866-900-7078 for a free case evaluation and conversation.

Where Do I Begin With My Workers’ Compensation Claim?

The ideal place to begin a workers’ compensation claim is from a position of knowledge, both of process and terminology. What follows are answers to common questions, links to helpful resources, and more. We even have information to help you begin filing a claim. It’s important to realize that your employer or insurance company (or both) may not be on your side when you are injured. To protect your interests, or if you have any questions or doubts, it’s wise to contact a North Carolina workers’ compensation attorney for a free case evaluation.

Do I Have a North Carolina Workers’ Compensation Claim?

If you were hurt on the job, the very likely answer is yes.

There is a common misconception that you are not entitled to workers’ compensation if the accident that caused your injury was your fault. This is simply not true, and may be one of the first tactics used by your employer or insurance company to deny your claim.

To be eligible for compensation in North Carolina:

1. Your injury must arise while you are working.
2. Your injury must arise because of the work you are doing.
3. Your injury must be caused by an accident, or, in the case of a back injury a specific incident.
4. Your employer must have three or more employees.

What Are the Most Common Claims, Injuries, and Causes?

There is a misconception that injuries can only happen in occupations and jobs that involve risks, like construction or factory work. The truth is, anyone can be injured on the job. A simple fall could affect an office worker the same as someone on a factory floor. The risk is lower for the office worker, but it still exists. Here are a few types of claims, injuries, and causes we see – some you expect and some that may surprise you.

Common Types of Claims

• Healthcare workers are often injured in the surprisingly hazardous business of caring for others, including exposure to harmful substances, physical injuries, and more.
• Construction workers face the risk of many physical injuries, because construction sites pose many, varied hazards.
• Third party claims are filed when an individual is harmed by a third party while doing their job, in many cases due to a car accident.

Common Injuries

• Back injuries can be truly debilitating, regardless of how they are sustained.
• Knees injuries are common and affect more than mobility.
• Shoulder injuries commonly occur when lifting or pulling.
• Eye injuries are very serious, and their circumstances vary.
• Wrist injuries can affect a worker’s ability to perform even sedentary or light office work.

Common Causes of Workplace Injury

• Falls are one of the most common causes of injuries, especially from heights.
• Injuries requiring surgery are unpredictable and may have unforeseen consequences.
• Occupational diseases can be caused by things such as exposure to toxic hazards or repetitive strain.

For more information, visit our Common Injuries page.

What if My Injury Was My Fault?

In North Carolina, it does not matter if your workplace injury was your fault or not. Workers’ compensation claims do not deal with negligence. Therefore, even if the injury was your fault, you could still be entitled to workers’ compensation benefits. Obviously, an experienced workers’ compensation attorney can help you sort this out.

How Do I Apply for Workers Compensation in North Carolina and Handle Disputes?

There’s a specific process to follow. It can be a long and confusing journey, but an experienced workers’ compensation attorney can handle most of it on your behalf. Here are the basics:

• First of all, notify your supervisor as soon as possible unless your injury is too severe to delay medical attention. The longer you delay in reporting your injury, the more likely it is that your claim will be denied by the insurance company.
• Of course, if you are seriously injured, and delaying treatment could make it worse, take care of yourself first. However, be aware that treatment you seek on your own may not be paid under workers’ compensation.
• Legally, you have 30 days to notify your employer, but immediate notification is best.
• The next step is to file a written claim. By law, you have two years from the date of your injury to file this notice, but again the sooner the better.
• It may benefit you to contact an attorney as soon as possible after your injury to make sure that there are no initial mistakes that complicate your situation.

There’s more than meets the eye when filing a claim, so contacting an experienced workers’ compensation attorney for a free evaluation is a good move.

How Exactly Do I File a Workers’ Compensation Claim in NC?

The moment you are injured at work, the clock begins to tick. There are specific time frames during which you have the opportunity to act. Here is a basic breakdown of the timetable:

• When you’re injured, notify your supervisor immediately and take whatever steps your employer’s policy requires. Of course, if you are seriously injured and delaying treatment is not an option, seek medical attention immediately. However, be aware that treatment you seek on your own may not be paid under workers’ compensation.
• By law, you have 30 days to notify your employer of the injury.
• By law, you have two years to file a written claim (North Carolina Industrial Commission Form 18).

This might appear to give you a great deal of time, but why would you delay? That may give an insurance company adjuster a reason to limit or otherwise downplay your injury. In some cases, an injury may not be readily apparent, such as in the case of an occupational disease.

There are also specific forms to fill out and file. Make sure to read our detailed guide on filling out a claim.

How Likely Is It That I Will Be Compensated for My Injury?

This is a complicated answer and depends on numerous factors. In order to be entitled to benefits:

1. Your injury must arise while you are working.
2. Your injury must arise because of the work you are doing.
3. Your injury must be caused by an accident, or, in the case of a back injury a specific incident.
4. Your employer must have three or more employees.

Rather than take chances, consult with an experienced workers’ compensation attorney. Many, including our firm, offer this consultation free of charge.

How Are Workers’ Compensation Disputes Handled in NC?

The North Carolina Industrial Commission in Raleigh handles workers’ compensation claims, including all disputes that arise during those claims. Administrative hearing officers listen to issues and make decisions on what benefits are owed. If a dispute has arisen in your workers’ compensation case, you should consider contacting a North Carolina workers’ compensation lawyer. We have attorneys on our team who have actually worked for the NCIC and understand exactly how the system works. The process for disputes and appeals is complicated.

How Much Does Workers’ Comp Pay?

It depends on what you’re making at the time of the injury. North Carolina law states that an eligible worker is entitled to two thirds of their average weekly wage each week. There are different methods by which an insurance company could calculate average weekly wage.

The law requires that the insurance company look backwards one year from the date of the injury and figure out how much the eligible worker earned during this time period before taxes, also known as gross earnings. That amount is then divided by 52 weeks to determine the average weekly wage. If the worker worked fewer than 52 weeks, then the amount earned is divided by the number of weeks worked.

It is also important to remember that this benefit is generally not taxed by the federal or state government – in general, taxes will not be withheld from the payment and you will not have to pay taxes if you receive it. If you are receiving benefits but believe you are not receiving the correct amount, you should contact an experienced workers’ compensation lawyer.

How Does My Workers’ Comp Claim Affect My Employer?

Another question we hear from injured workers is, “Will claiming workers’ compensation hurt my employer?”

No. North Carolina employers with three or more employees (with few exceptions) are required to have workers’ compensation insurance. A good analogy is car insurance. Just as you are required to have car insurance to drive on the road, employers are required to have workers’ compensation insurance to operate.

Just as your car insurance comes into play if you’re in an accident on the road to help pay for the damages incurred in that accident, workers’ compensation insurance does the same when you’re injured at work. The answer to the question, therefore, is no.

Remember, you are not suing your employer if you file a workers’ compensation claim. You are just seeking your rightful benefits under the law.

Can I Sue My Employer in Court for My Injury?

No. North Carolina workers’ compensation law was created so that employees do not have to sue their employers to get benefits. However, because workers’ compensation law was created, employees do not have the option to sue their employers because of workplace injuries. An exception to this rule exists when a worker is injured by the conduct of an employer when that conduct can be considered an intentional act to cause an injury.

How Does Workers’ Comp Handle My Medical Care and Bills?

The North Carolina workers’ compensation system is set up specifically to ensure that workers receive medical care. Much of how care is performed and by whom is prescribed by law, but as you’ve probably guessed, there’s more to it than that, especially if new injuries develop after your initial injury.

Can I Trust a Doctor That Has Been Provided by My Employer or Their Insurance Company?

In North Carolina, the employer and insurance carrier have the right to select the physician who provides you medical treatment for your workers’ compensation injury. Although doctors have an ethical responsibility to act in the best interest of their patients, some insurance companies may try to pressure doctors to release patients from treatment before the patients feel ready. Insurance companies often hire their own nurses to attend appointments between the injured worker and the workers’ compensation doctor, and may try to influence the doctor’s decisions. If you have concerns about the provided medical treatment, consider contacting a North Carolina workers compensation lawyer.

Can I Be Treated by My Own Doctor for My Injury?

The law allows the employer or insurance company to select the physician who provides medical treatment to those injured at work. However, if you are not satisfied with the treatment you’re being provided, you can request that treatment be provided by a different physician. The North Carolina Industrial Commission has the authority to allow a switch if it’s deemed necessary or appropriate. This is something a qualified workers’ compensation attorney can assist you with.

Can I Get a Second Medical Opinion on My Injury?

If you’re injured and become frustrated with treatment, there are several options. An injured worker can request that their employer and insurance company allow them to be evaluated by an independent physician. If the employer and insurance will not agree, then an injured worker can apply to the North Carolina Industrial Commission to be evaluated by an independent physician.

If medical treatment reaches a conclusion with the physician chosen by the employer and insurance company, and that physician assigns a permanent impairment rating, then an injured worker is entitled to a second opinion on the rating with a physician of their choosing.

What if the Insurance Company Is Stalling on Providing Treatment?

Contact an experienced workers’ compensation lawyer. A lawyer can assist by communicating with the insurance company and providing documentation that they may need to speed up the treatment process. In fact, it may be best if you said as little as possible to the insurance company. If the insurance company continues to drag its feet an attorney can file requests with the North Carolina Industrial Commission seeking to require the insurance company to provide the treatment in a more timely fashion.

What if the Insurance Company Is Not Approving the Treatment Recommended by My Doctor?

If your doctor has recommended treatment and the insurance company has not authorized the treatment, you should consider contacting an experienced workers’ compensation lawyer. A lawyer may be able to help you obtain the necessary medical treatment by filing a motion with the North Carolina Industrial Commission that seeks to force the insurance company to provide you the medical treatment.

Do I Need a North Carolina Workers’ Comp Lawyer?

Should I get a lawyer for workers’ comp? If so, when? How does my attorney get paid? If you’re asking yourself those questions, our answers would be “yes,” “now,” and “like this.” We’re familiar with how the system works. An experienced workers’ compensation attorney can be an asset to an injured worker from the date the worker is injured throughout the entire life of the workers’ compensation claim.

Sometimes, an injured worker needs an attorney at the beginning of the claim to make sure the insurance company begins paying benefits promptly. In other situations, an injured worker may need an attorney to help them understand the return to work process involved in workers’ compensation claims. And in other situations, an injured worker may need an experienced workers’ compensation attorney to help them understand why the insurance company is trying to settle their claim, as well as the settlement value of their claim. Insurance companies will likely try to get you to settle for as small an amount as possible. Chances are, you should not accept their first offer.

What if My Adjuster Told Me I Did Not Need an Attorney?

An insurance adjuster’s primary responsibility is to the insurance company. They are employed to “adjust” claims and limit the amount that an insurance company has to pay. Therefore, when an adjuster tells you that you don’t need an attorney, they are thinking more about the insurance company than what’s best for you.

What Do I Do if My Adjuster and My Employer Are Ignoring My Calls?

It likely makes sense to reach out to a lawyer who focuses on workers’ compensation. They can provide guidance on how to obtain the attention of the adjuster and employer. Sometimes, adjusters have a lot of files on their desk and it takes the right steps to have that adjuster pay attention to an injured worker’s claim. That could be something as straightforward as a letter, or it might require filing a request for a hearing at the North Carolina Industrial Commission. Once an experienced lawyer has the facts of your case, they can determine the correct next step to help move your claim forward and try to obtain the benefits you may deserve.

What if I Have Multiple Injuries and the Insurance Company Is Only Approving Treatment for One?

If the insurance company is ignoring some of your injuries, it is important to explain to them and your doctor the problems you are having with all of your injuries. Oftentimes, the most serious or obvious injury, like a broken bone, gets the immediate attention and other injuries, which eventually may turn out to be even more serious, like what starts out as a back strain, are ignored.

It is important at every doctor’s visit, especially the first one, to tell the doctor about every part of your body that is hurt. If you have notified the doctor and the insurance company and you are still being ignored, you should consider consulting a workers’ compensation lawyer. If you sustained multiple injuries as a result of a work accident, a lawyer can pursue your claim at the North Carolina Industrial Commission and seek to require the insurance company to provide you treatment for all of your injuries.

It is also very important to document the injuries with the insurance company and the doctor so that the Industrial Commission will be able to clearly understand the problems that you have had since your accident.

What if My Employer and the Adjuster Are Minimizing My Injury?

In our experience, it is in the employer and adjuster’s benefit to minimize the severity of an injury. The less severe the injury, the less they will owe in workers’ compensation benefits in the future. A workers’ compensation attorney can help try to make sure your injury is not minimized and is taken seriously by the insurance company and your employer.

Consult an Experienced Workers’ Compensation Attorney IF…

The choice to involve an attorney may not come easy for some people. Hopefully, you now have a better understanding of how the system works, and what motivates the people involved in your process. Your employer may not be on your side. Your insurance adjuster works for the insurance company – not for you. Physicians should be objective, but sometimes are not. The state’s rules for filing claims and getting compensation can be confusing.

Even when you make a claim properly and follow the rules, questions, problems and obstacles may come up. If you’re facing any of these issues, it may be time to make the call to an experienced workers’ compensation attorney.

• Your employer does not report your injury to its workers’ compensation insurance company.
• Your employer’s workers’ compensation company denies responsibility for your injury.
• Your NC workers’ compensation benefits have been terminated and you don’t understand why.
• Your NC workers’ compensation checks are not arriving consistently or on time.
• You are being forced to return to work before you are ready to do so.
• You are being forced to go back to a ‘made-up’ “light-duty” position that offers no dignity, job security or enjoyment.
• Your employer promised to accommodate your medical needs if you returned to work, but has failed to do so.
• You briefly returned to work, but couldn’t handle it, and went back out of work. The insurance company hasn’t restarted your weekly workers’ compensation checks.
• You are unhappy with the medical provider the insurance company selected and you don’t know how to ask for a new medical team or second opinion.
• Your doctor says you can’t lift heavy objects due to a knee injury, back injury or shoulder injury, but your employer expects you to push/pull heavy carts, which is just as difficult.
• You worry about paying for potential future needs, such as medicine, physical therapy, or another surgery.

Can I Be Fired for Making a Worker’s Comp Claim in North Carolina?

Another question people often ask is, “Will I lose my job if I file a workers’ compensation claim?” Maybe. However:

If your employer terminates you for filing a workers’ compensation claim then your employer may have violated North Carolina Law. Chapter 95, Article 21 of the North Carolina General Statutes, otherwise known as the Retaliatory Employment Discrimination Act or REDA for short, protects workers that file workers’ compensation claims. It states who a worker can file a claim, with the Commissioner of Labor if the worker has been discharged or fired for filing a workers’ compensation claim.

The Department of Labor has the power to pursue the claim on behalf of the worker or allow the worker the right to sue in civil court. A worker that wins the claim may be entitled to back pay, reinstatement to their job, and other potential damages. Therefore, if you were to lose your job just because you filed a workers’ compensation claim you would likely have a REDA claim to pursue.

Do I Have to Return to Any Job My Employer Offers Me After My Accident?

This question is complex and the right answer is usually different for every injured worker. To find the answer, it’s first important to determine if the job offered by the employer is physically suitable to you. That will usually be determined by the doctor. The employer will likely present a job description to the doctor. It’s important to let the doctor know if you have any concerns about that job description.

If the job is physically suitable, then it is important to determine where you are in the treatment process for your injury. If the doctor is providing ongoing treatment, a specific part of the law applies. If the doctor has released you, a different part of the law applies. If you are confused and your employer is asking you to return to work, you should likely contact an experienced workers’ compensation lawyer.