Call Us 919-240-4054If you were injured on the job, you may be eligible to file a workers’ compensation claim. An experienced Charlotte workers’ compensation attorney can protect your rights if your claim is denied or argue on your behalf at a claim appeal.
Call Johnson & Groninger PLLC today at (704) 200-2009 for a free consultation.
Purpose of workers’ compensation
The purpose of workers’ compensation is twofold:
- Provide medical care and compensation for employees injured on the job
- Protect employers from litigation filed by injured employees
North Carolina employers with more than three employees must carry a workers’ compensation policy. The policy covers payment of related medical treatment for injured workers, including surgery and physical therapy.
In exchange for carrying workers’ compensation insurance for their employees, employers have a certain level of immunity from negligence suits filed by their employees. This prohibits “double recovery,” meaning that in most circumstances you can’t recover through both types of claims and are limited to recovery under the North Carolina Workers’ Compensation Act.
Eligibility for workers’ compensation benefits
The North Carolina Workers’ Compensation Act, administered by the North Carolina Industrial Commission, governs workers’ compensation claims in the state.
Most employees are covered by their employer’s workers’ compensation insurance unless they are independent contractors. Coverage extends to workers driving a company vehicle or completing their job duties at a remote location, such as a delivery driver doing their rounds.
It also extends to people working from home, as long as they’re performing their assigned job duties and are considered “on the clock” by their employer while doing so.
Federal government employees are covered by the Federal Employees’ Compensation Act (FECA) and not the North Carolina Workers Compensation Act.
Employees may be ineligible for coverage if they’re found to be under the influence of drugs or alcohol at the time of their injury. Workers may also be excluded from coverage if they violate company safety procedures and protocols or otherwise engage in reckless behavior.
Claims process
You don’t need a Charlotte workers’ compensation lawyer to file an initial claim for benefits. However, if you don’t follow applicable timelines for filing a claim, you may be rendered ineligible for coverage, so it’s highly recommended that you hire an attorney to help you to increase your chances of a successful claim.
Steps for filing a workers’ compensation claim in North Carolina
1. Report the injury to your employer and seek immediate medical treatment
These go hand-in-hand. If you’re seriously injured, 911 should be called right away, and your supervisor or employer should be notified of the accident, however, your health should be your first concern.
If you can personally report your injury, do so. However, if your medical condition precludes this, have a trusted family member, friend, co-worker, or a doctor inform your employer.
Your company likely has an internal procedure for documenting workplace accidents and the details of the incident. You may be asked to give a written statement or answer questions. Per North Carolina law, your verbal or written report (ideally both) should contain the date of the accident and a brief description of your injury. If possible, be sure to keep copies of all written incident reports for your injury.
2. Seek medical attention from your employer’s designated medical treatment provider
If your injury isn’t life-threatening or doesn’t require emergency care, you must go to the provider indicated by your employer, even if you have a preferred physician. This is to ensure that your employer’s workers’ compensation policy covers you. When you arrive at the doctor, inform them that your injury occurred in your workplace.
3. Follow your treating physician’s directives
The doctor that treats your injuries is referred to as the “treating physician” on workers’ compensation paperwork. Make sure that you follow all directions for your care, including wearing any medical device or support, and adhere to their recommendations for activities you can engage in, such as light duty at work or not lifting heavy items.
You must also attend all follow-up appointments as scheduled unless you have a documented reason for not attending. An insurance company may deny your claim if you don’t complete the doctor-recommended aftercare requirements.
Time limits for filing a claim
You’re required to report any workplace injury to your employer within 30 days of the incident. This isn’t the same as filing a workers’ compensation claim with the North Carolina Industrial Commission; that deadline is two years from the date of your accident.
Necessary documentation
It’s your responsibility to file your claim with the North Carolina Industrial Commission (NCIC). You may do so by filling out a Form 18 and emailing it at the address printed on the bottom right of the form, or printing it and mailing it to the North Carolina Industrial Commission.
You must also provide a copy to your employer. You should keep a copy for your records. You do not need to submit any medical records or other documentation with your Form 18.
Types of benefits available
The available benefits available to you under the North Carolina Workers Compensation Act include:
- All medical expenses related to the injury, including surgery, medication, physical therapy, transportation to appointments, and durable medical devices;
- 66 ⅔% of of your average weekly wage after you miss more than seven days of work–what is known as temporary total disability;
- 66 ⅔% of the difference between your average weekly wage preinjury and your average weekly wage post-injury (assuming you are earning less)–what is known as temporary partial disability;
- Permanent partial impairment ratings for permanent impairment to the specific body part injured.
Workers’ compensation may also cover the funeral and burial costs of an employee who didn’t survive a work-related accident. In some cases, the employee’s beneficiaries may receive limited death benefits related to the workers’ compensation claim and may also be eligible to file a wrongful death lawsuit against a third-party.
Insurance company’s role in the process
Your employer’s workers’ compensation insurance carrier is the party that administers workplace injury claims and pays the medical bills and disability payments for a covered claim.
The insurance company will assign an adjuster to your case to investigate your accident or the development of your medical condition. Expect to be contacted fairly soon after filing a claim. You will likely be asked questions such as:
- What were the circumstances leading up to the accident?
- Were you following company safety protocols?
- Do you have underlying medical conditions that could have contributed to your condition?
For example, suppose you developed a respiratory disease like mesothelioma due to toxic exposure on the job. In that case, the insurance company may investigate your smoking habits and consider whether this contributed to the development of the disease.
The insurance adjuster represents the insurance company, and their interests may not necessarily align with yours. Their goal is to settle the claim for as little as possible, as fast as possible.
You have the right to appeal a denied claim
Your employer has 30 days (G.S. 97-18(j)) from the date you submitted the claim to issue a denial. If they do, you have the right to appeal the denial. Although you have up to two years from the date of your injury to do so, it’s best to begin the process sooner rather than later.
At this point, the services of a Charlotte workers’ compensation attorney can be very helpful. Your lawyer knows workers’ compensation law and the elements of a successful claim appeal. Your lawyer will communicate with your employer and their workers’ compensation insurance company on your behalf and file all the necessary forms to notify the North Carolina Industrial Commission (NCIC) of your intent to appeal.
After your lawyer files a Form 33, Request for Hearing, to appeal your claim with the NCIC, the process will likely resemble the following:
- Request that your claim be assigned for hearing before a Deputy Commissioner at the NCIC;
- Participate in mandatory mediation with your employer– your lawyer can represent you in this process;
- If your claim impasses at mediation, your case proceeds to the hearing.
At the hearing, your lawyer presents evidence and conducts questioning and cross-examination of witnesses. Post-hearing your lawyer takes the sworn testimony of your doctors. The hearings are adjudicated by a Deputy Commissioner who will decide the matter. If you don’t agree with their decision, then you may request a second appeal before the Full Commission, a three-judge panel.
Resources for assistance and further information
The NCIC has an extensive list of resources regarding the workers’ compensation process, eligibility, and options for appeal.
A North Carolina attorney with Johnson & Groninger PLLC can also help you by answering your questions and advocating for you throughout the process.
Why work with Johnson & Groninger PLLC?
The legal team at Johnson & Groninger PLLC has a deep knowledge of North Carolina workers’ compensation laws with decades of collective experience arguing appeals and negotiating with insurance companies on behalf of our clients.
We provide timely communication at every step of your case, insightful legal advice tailored to your particular situation, and fierce representation of your interests. If you have trouble receiving the workers’ compensation coverage you’re entitled to, or if your employer created hazardous conditions through oversight or negligence, we can help.
Call (704) 200-2009 today to schedule your free consultation.
