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Need Answers To Workers’ Compensation Claims Questions? Talk With A Lawyer

Protect your family’s finances after a work injury. Employers and insurance companies often deny or delay workers’ compensation claims. A delay in your benefits can derail your finances. Don’t let them take advantage of you; get help.

What is Workers’ Compensation Insurance?

Workers’ Compensation insurance is a type of coverage that is designed to compensate employees who suffer an injury, occupational disease or work-related death while on-the-job.

What types of injuries or illnesses are covered by workers’ compensation insurance?

Almost any type of physical injury or disease that was caused by workplace conditions is covered by Workers’ Compensation insurance. In North Carolina, a pre-existing injury or disease does not qualify for compensation unless the condition was aggravated by or made worse on the job.

What is NOT covered by Workers’ Compensation insurance?

In order for an employee to be eligible to receive Workers’ Compensation benefits, the accident must have occurred while the employee was performing job functions. It is not enough to just suffer an injury on a work-site. A North Carolina Workers’ Compensation attorney will be able to determine if you have cause to pursue a Workers’ Compensation claim.

What is a repetitive stress injury?

Repetitive stress injuries occur when the same action is performed repeatedly, putting too much stress on a specific joint. Repetitive stress injuries usually cause pain and swelling in the affected muscles and tendons.

What kinds of benefits are provided by Workers’ Compensation?

Workers’ Compensation benefits provides for the payment of reasonable medical care incurred by treatment. Additionally, under specific circumstances, injured workers may be eligible to receive compensation for lost wages when the employee is unable to work due to their injury or illness. The amount and type of benefits an injured North Carolina worker may receive depends on the circumstances of the accident, so it is important to have the help of an experienced lawyer to determine your best course of legal action.

What if my employer does not have Workers’ Compensation Insurance?

According to the North Carolina Industrial Commission, every North Carolina employer who has three or more employees, they must carry Workers’ Compensation insurance. If your employer does not carry Workers’ Compensation insurance, you should file a Form 18 and a Form 33 with the Commission after suffering an injury.

Can I Choose My Own Doctor or Hospital?

What if someone other than my employer is responsible for my work-related injury or illness?

You may still have the right to receive Workers’ Compensation benefits if your injury was caused by a coworker or another person with no connection to your employer. Additionally, you may be able to file a third-party claim against the individual who caused your injury.

If I am receiving Workers’ Compensation benefits, but return to work, am I able to continue receiving benefits?

Depending on the situation, you may be able to continue receiving benefits after you return to work. If when you return to work, you receive wages greater than or equal to what you were earning prior to the accident, chances are benefits will be stopped. However, if there is still a wage loss as a result to the on-the-job-injury, you may still continue to receive Workers’ Compensation benefits.

Who is required to provide workers’ compensation coverage?

Any employer who regularly employs three or more employees at the same time.

Note: Every executive officer selected or appointed and empowered in accordance with the charter and bylaws of a corporation is considered an employee of such corporation. For example, a corporation with two officers and one employee would be required to provide workers’ compensation coverage. Any employer in which one or more employees are employed in activities which involve the use of or presence of radiation is required to have coverage. Sole proprietors or partners may elect to be included as an employee.

What must an employee do when an injury occurs?

Report the injury to the employer, orally and in writing, immediately and in any event within 30 days.

What should be done if the employer fails or refuses to report an injury?

Employee should file a claim (Form 18 or 18B) within two years of the accident with the Industrial Commission.

Who provides and directs medical treatment for the injured worker?

The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The Commission may permit the employee to change physicians or approved a physician of employee’s selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.

What are the rules for chiropractic treatment?

If the employer grants permission to seek medical treatment from a chiropractor, the employee is entitled to 20 visits if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the employer.

When can reimbursement for sick travel be collected?

If employees travel 20 miles or more round trip for medical treatment in workers’ compensation cases, they are entitled to collect for mileage at the rate of .25 cents a mile for travel prior to June 1, 2000; .31 cents a mile for travel between June 1, 2000 and January 17, 2006; .44.5 cents a mile for travel between January 18 and December 31, 2006; .48.5 cents a mile for travel on or after January 1, 2008. Special consideration will be given to employees who are totally disabled.

Note: The Industrial Commission has given the self- insurers and insurance carriers permission to pay drug and travel expenses directly to the employee without approval from the Commission.

What happens if, in an emergency, the employer fails or refuses to provide medical treatment?

The employee may obtain the necessary treatment from a physician or hospital of his/her own choice, but must promptly request the Commission’s approval.

When does an employee become eligible for lost wage compensation?

No compensation is due for the first 7 days of lost time unless the disability exceeds 21 days. Therefore, the first check (which is due on the 14th day following the injury) will not include payment for days 1-7. Payment for those days will be made should the disability continue beyond 21 days.

How often are compensation payments made and at what rate of pay?

Weekly at 66 2/3 percent of the average weekly wage, not to exceed the yearly maximum weekly benefit rate*. This benefit is not necessarily paid on the same schedule as what the client was being paid wages by the employer before the injury (i.e.: weekly, biweekly, monthly).

*The maximum weekly benefit is adjusted annually.

How long is the employee eligible to receive lost-time weekly benefits?

Until the employee is able to return to work.

What is permanent partial disability?

Total loss or partial loss of use of a member of the body or inability to earn the same wages in any employment at the time of injury.

Who determines permanent partial disability?

The Commission, based on the impairment ratings of physicians or evidence of consideration of wage earning capacity.

What happens when the employer refuses to acknowledge the claim?

When liability for payment of compensation is denied, the Commission, claimant, his or her attorney, if any, and all known providers of health care shall be promptly notified pf the reason for such denial. The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the denial of liability.

A. If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.

B. Medical providers may bill the employee only after it finally been determined that it is not a compensable workers’ compensation claim.

Do I have to let the Medical Rehabilitation Nurse go to my doctor visits when I go?

Yes, you do. However, you do not have to allow them in the room while you are being examined. If you want to talk to the doctor alone about your condition, you may request to speak to him/her privately.

Can I still call and talk to the adjuster about my case once I sign up with Lewis & Keller?

No. When you hire an Attorney, we will be responsible for your case daily, and if you have any problems regarding the adjuster, you need to let your Paralegal know as soon as possible. The Paralegal and/or Attorney will handle the problem with the adjuster for you.

Why do I have to do a recorded statement when the employer knows that I was injured at work?

A recorded statement is a way for the adjuster to get all the facts about the accident/injury to investigate your claim, and decide whether or not to accept liability and pay for medical treatment and other benefits that you are entitled to.

Can I get compensated for my pain and suffering?

No. In North Carolina, our laws do not allow payments for pain and suffering to workers’ compensation claimants. There are other ways to get compensation (i.e. permanent disability rating, ttd/back benefits, etc.) and the attorney will discuss this with you when the time becomes appropriate.

What is a permanent disability rating?

A permanent disability rating is a percentage rating that the treating doctor may assign to the injured body part when you have reached maximum medical improvement. This can be a total loss or partial loss of the use of a member of the body. It is assessed at the very end of all necessary treatment.

If the doctor releases me back to work, do I have to go?

Yes, you do have to TRY to go back to work at his request and under the restrictions given. The doctor should review a job description first. If you go and cannot do the job as he request, follow-up with the doctor regarding your pain and see what he will do for you
(i.e. change your restrictions, take you back out of work, etc.).

Can I get a second opinion on my diagnosis?

Yes, you can. In North Carolina, you are allowed to get a second opinion from another doctor. If you case in an accepted one, you have to go to the doctor with the carrier’s approval. If your case is denied, you can go to whom you wish, but will have to find a way of paying for the visit. Also see answer to question 12.

What happens if I go back to work making less money than before I got hurt?

The law in North Carolina allows you to receive 2/3 of the difference between the two wages for a maximum of 300 weeks, which begins to accrue at the date of injury. The best option will be discussed with the Attorney.

When can I settle my case and get compensated?

It depends on where you are in terms of treatment. Settlement will not begin until you are released at MMI, all treatment remedies have been exhausted, and you are ready to go back to work and have received a PPD or are due TTD or back benefits. After this information is gathered, we can set up an appointment with your Attorney to discuss possible settlement.

What are Defendant’s Interrogatories?

These are written questions drawn by the Defendants for the purpose of discovery. We have 30 days to answer these questions and provide the requested documentation to the opposing Attorney.

How much money is my claim worth?

You will have to discuss this question with your Attorney after we have received all permanent partial disability rating. Without that information, we do not know the extent of your disability and therefore cannot assign value to your claim. We can tell you the equation used to calculate the worth of the rating, but this does not mean that your claim is not worth more than this amount. Many factors are involved, such as your time out of work and the need for any future treatment, etc.

I do not like the doctor I’m seeing. Why can I not choose my own doctor?

In an accepted claim where the WC insurance carrier is paying the medical bills and compensating you for time out of work, they have the right under NC law to choose your treating physician. They do not have to pay for treatment performed by any doctor other than the one they provide for you. After this doctor releases you, you are allowed to be seen by a doctor of your choice at their expense for a one time second opinion evaluation. If this doctor offers treatment options that your previous doctor did not, we can request a change of treating physician. If you do not feel that you can wait to be released by their doctor, then we can file motion for a change of treating physician with the North Carolina Industrial Commission, requesting that this be approved.

Can my employer terminate me for hiring an attorney?

If you are terminated while written completely out of work by your doctor or if you have returned to work under restrictions, then you are entitled to receive compensation of two-thirds of your regular pay each week until such time that you find new employment. They may appoint a vocational rehabilitation counselor to assist you with finding new employment. If you are not under restrictions and you feel that you have been terminated as a result of your injury, then you should file a retaliatory discrimination complaint with the Department of Labor. We may refer you to an attorney who handles these types of cases if necessary.


North Carolina Workers’ Compensation Law Firm

When you don’t know where to turn, call our workers’ compensation lawyers for answers to all of your questions. Call 866-299-1769 or fill out the FREE Case Evaluation form.

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Winston-Salem, North Carolina 27103

Phone: 336-765-7777
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Greensboro, North Carolina 27410

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