How A No-Fault System Works In Workers’ Compensation Law
North Carolina’s workers’ compensation law is a no-fault system. Whether the injury suffered was the employee’s fault or the employer’s fault doesn’t factor into one’s ability to receive workers’ compensation benefits for their work-place injury.
An individual is not entitled to any more benefits because it was the employer’s fault or entitled to any less benefits because it was the employee’s fault. The only real issue, for purposes of a North Carolina Workers’ Compensation case, is whether or not there was an accident. If so, what medical treatment is needed and what disability benefits are due as a result of that accident?
Let’s assume, for example, that you work in a factory and you’ve complained about a particular machine having a safety mechanism that isn’t operating properly. The employer tells you that they’ve fixed the safety mechanism and, on that day, you end up losing several fingers when something is stuck in the machine and the safety mechanism is faulty. Even though that was clearly the employer’s fault, you would be entitled to the same set of benefits that you would have received even if the injury were a result of your own negligence in ignoring safety procedures.
While some individuals obviously benefit from the system being set up this way because they’ve been injured due to their own failure to comply with safety protocols, others are understandably frustrated when they were injured through no fault of their own and don’t receive anything additional as a result.
The Maximum Amount Of Benefits That You Can Receive For A Work-Related Injury
The North Carolina Industrial Commission will set out a maximum compensation rate. This maximum amount of disability compensation is dictated on an annual basis. They will determine how much an individual is entitled to receive in temporary total disability checks for the year. This amount is based on the year of your injury, not when the benefits begin.
For example, if you’re injured in December of 2021 but the checks don’t begin until you’re pulled out of work in February of 2022, that maximum compensation rate is going to be set by 2021. It’s important to know exactly what that maximum amount is, especially for high wage earners, to ensure that you’re receiving the most you can.
An Employer’s Part In Handling Workers’ Compensation Cases
Many people are under the impression that their employer will handle their workers’ compensation case for them to ensure they receive their benefits. Unfortunately, when it comes to paperwork for your injury, that is often not true. Paperwork that needs to be filed or saved for your work-related injury is something that you, as the employee, need to be responsible for.
Whether it be completing an accident report and keeping a copy of it, sending an email, providing notice to the employer of the injury and keeping a copy of that, an injured employee needs to ensure that they are on top of their paperwork for their case. In reality, the only party that has a vested interest in ensuring that these things are taken care of is going to be the injured employee.
The employee is also going to be the individual filing for workers’ compensation benefits via a Form 18. This form is filed with the North Carolina Industrial Commission by the employee. An employee should never assume that their employer is going to take on the responsibility of setting their workers’ compensation claim in motion.
Do You Have To Sue Your Employer To Obtain Workers’ Compensation Benefits?
Filing your claim for workers’ compensation doesn’t amount to suing your employer. Filing the claim is simply what sets in motion the process by which you obtain your benefits for your work-related injury. In some instances, your employer and their insurance company will either admit liability for your injury at work or agree to pay medical-only benefits.
However, when an employer and their insurance company deny a workers’ compensation claim, the employee can choose to pursue benefits by arguing for their entitlement. That would require a hearing before a deputy commissioner at the North Carolina Industrial Commission.
For purposes of that hearing, the employer and the workers’ compensation insurance company would have to be listed to identify those parties responsible for those benefits that are owed. It is less of an issue about suing the employer and more of an issue about identifying those parties who are responsible for benefits to address those issues via a formal hearing.
Workers’ Compensation Benefits Available To You
One of the main differences between workers’ compensation and a personal injury claim is that you cannot collect compensation for pain and suffering via your workers’ compensation claim. The only benefits available to you through workers’ compensation are medical and disability compensation.
Medical compensation requires payment to the treating physicians based on the treatment rendered. This compensation is either provided as the treatment occurs or it’s something that the parties are arguing about at a formal hearing. If the case is denied, the employee would have to then pay for the medical treatment pending a decision at the formal hearing.
Disability compensation is either a total disability check when the injury prevents the individual from working or a partial disability check when the injury results in work restrictions and a reduction in wages. There is also something known as a disability rating where an individual can receive a certain amount of benefits based on a percentage of disability assigned to the injured body part.
Disability benefits are either paid as they are incurred based on the acceptance of liability by the employer’s insurance company or potentially something that the parties will take to a formal hearing to determine entitlement.
Unfortunately, the Industrial Commission cannot order or award any benefits for pain and suffering, or how this injury impacts someone outside of work. That is why it’s so critical for the purposes of these workers’ compensation benefits, to make sure that you are receiving every bit of the medical and disability compensation. Given that limited or restricted set of benefits, making sure you obtain all of those is critical to the work-related injury.
For more information on Fault In A NC Workers’ Compensation Claim, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (833)444-4127 today.