What You Deserve: Understanding Workers’ Compensation In North Carolina

In this article you will find essential information about workers’ compensation and how the system for helping workers who have been injured works in North Carolina. This includes:

• The expected duration of the workers’ compensation process and payments,
• How weekly benefits for disabled workers in North Carolina work, and
• What factors contribute to the calculation of weekly workers’ compensation benefits.

What Is Workers’ Compensation? How Do I Apply For It?

In North Carolina, when a worker has been injured because of their work, they are entitled to workers’ compensation. A series of reimbursements and benefits that help take care of the expenses related to the injury, as well as provide payments to help support them and their family when the worker cannot continue to do their job.

If you are injured on the job, you must report the accident to your employer. If they fail to report it to their insurance, you can take/report it to the industrial commission. After an injury is reported to the employer, their insurance kicks in to cover both weekly payments, if needed, and medical coverage. Unfortunately, things rarely go quite so smoothly.

How Can I Determine Whether My Workers’ Compensation Claim Has Been Accepted Or Denied?

The only time a workers’ compensation claim in North Carolina is 100% fully accepted and official is when the insurance company has filed what’s called a Form 60, or when the Industrial Commission has entered an opinion and award concerning someone’s claim.

In either situation, you can then be assured that the body parts that were injured will be covered, that the insurance company has to pay, and that if you are missing work or earning less, the insurance company will pay disability compensation.

Sometimes, however, insurance companies may be paying medical benefits but, technically, the insurance company has still not officially accepted or denied the claim. Fortunately or unfortunately, the Industrial Commission allows defendants to pay for months and months of medical compensation even when the decision has not been finalized.

Insurance companies are allowed to tell injured workers which doctors they should see, what treatments they are going to pay for, and what treatments they are not going to pay for. Whenever they feel like it, they can also suddenly deny a claim and argue they should not have to pay one more cent.

When that happens, your only recourse is to file a request for a hearing and litigate the case in court and have the industrial commission decide if the claim should have been accepted or not. Workers get lulled into a false sense of security because of North Carolina’s infamous Form 63, which allows the insurance providers to pay and then change their minds.

You might be getting weekly checks and the doctor’s recommendations may be being paid by the insurance company, but unless that Form 60 has been filed, or unless the Industrial Commission has ruled otherwise, the acceptance of your claim or the ongoing acceptance of that claim, is entirely based on the whims of the insurance company. They can and do sometimes take them away at a moment’s notice.

How Long Does It Typically Take For A Workers’ Compensation Claim To Be Accepted Or Denied?

After you submit a claim regarding an injury, the law says that the defendants are responsible for filing some kind of response within 30 days. In theory, once you have informed the Industrial Commission and your employer of the injury, the insurance company of your employer should take those 30 days and do an investigation to try to determine if the claim is false under the Workers’ Comp Act or should be found compensable.

Unfortunately, the insurance companies have found ways to not do that. They will often now file a Form 63, where they will pay for medical but not disability. They will use that to decide which doctors you see and, in the meantime, you are left in a lurch because, although medical benefits are being paid, the insurance company can deny your claim at any moment and you will not be entitled to anything.

While it should be 30 days, the Industrial Commission has not really put its foot down on that deadline. As a result, it could be years or longer before the insurance company has to finally be told to either accept or deny the claim. In one case, after 18 months of directing medical treatment, the defendants just decided they were not going to pay for anything else. They did not file Form 61 to deny the claim. They just said they were not going to pay for the surgery being recommended and the Industrial Commission didn’t dispute it.

Can I Receive Weekly Checks Forever If My Workplace Injury Renders Me Disabled?

Unfortunately, disability checks are not life-long anymore. Starting in 2011, injuries now have a 500-week cap. So, after 500 weeks, there are no ongoing disability payments required. There are some exceptions to this rule, though.

Some current case law suggests that if someone is truly, truly incapable of any kind of work or any kind of work activity, they might be entitled to an extension of that. Even then, those benefits are reduced by the amount of social security that they have received. Therefore you should expect that the longest duration of benefits that you are going to receive is about nine and a half years.

What Types Of Disability Qualifies An Injured Employee For Ongoing Weekly Benefits Under Workers’ Compensation?

You are entitled to weekly disability benefits when you are no longer able to earn the same kind of money that you did before your workplace injury. This can include…

• Total disability when you are not capable of any kind of work, which gives two-thirds of your previous average weekly wage, or
• Partial disability, which is when you return to work, but at a job that pays less. You are entitled to two-thirds of the difference between your current and previous average weekly wages.

You can roughly expect that you will be receiving in total, no more than two-thirds of your previous year’s average salary.

What Factors Determine The Amount Of Weekly Compensation An Injured Employee May Receive?

In North Carolina, it is always up to the plaintiff to prove that they are disabled. That burden always falls on you if you are an injured worker.

The best proof you can show is that the treating doctor, chosen by the defendants, has officially told you that you cannot work. The second type of medical information would be work restrictions by the doctor. If the doctor’s work restrictions are extremely limiting, such as don’t lift over two pounds or that you must lie down for 30 minutes every three hours, they will exclude you from most work.

In such a situation, if you can show that there are no jobs that you are capable of doing within a 50-mile radius, that should be enough to allow them to get you weekly workers’ compensation benefits.

Can I Continue To Receive Lifetime Weekly Benefits If I Can Work In Some Capacity But Not At My Previous Job?

In such a case, you are only eligible for at most two-thirds of the difference between your previous wage and your new one. Even then, the compensation will not last indefinitely and will run out after 500 weeks.

Remember, the burden of proof is on you, if you are injured, to show that you deserve and need compensation. In doing so you are up against your employer and big-name insurance companies. That is why it is vitally important that after a workplace injury, you get a top-notch workers’ compensation lawyer on your side.

For more information on the Acceptance & Denial Of Workers’ Compensation Claims, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (833)444-4127 today.