What to Expect During the Workers' Comp Claim Process in North Carolina
If this is the first time you have been injured at work, you probably do not know what to expect from the North Carolina workers’ compensation process or how long a workers’ compensation claim will take. The information on this page will acquaint you with the general pattern of how our firm handles cases of this type. We hope this information will be helpful to you.
If you would like to discuss your case directly with an attorney to get specific answers to your individual questions, contact North Carolina workers’ comp attorneys Younce, Vtipil, & Baznik, P.A., today for a free claim review and advice about your legal options.
North Carolina Workers’ Compensation Basics
History & Regulation
Workers’ compensation was enacted by statute in North Carolina in 1929. As a general rule, each business that has more than three employees must be covered by workers’ compensation insurance. The system is governed by a state agency called the Industrial Commission.
Entitlement to Benefits
An employee may be entitled to workers’ compensation benefits when he or she is injured as the result of an accident or occupational disease. When each and every element of this claim is proven, workers’ compensation benefits become available to the employee.
An employee must give notice to his or her employer of an injury on the job by filing a written notice. This notice of accident should be filed within 30 days of the date of the accident. Your lawyer will discuss this requirement with you if you have not already filed such a form. The absolute limit for filing a written notice is two years.
Sole Remedy & No Fault
Workers’ compensation is generally an injured employee’s sole remedy. This means that, but for some narrow and rare exceptions, an injured employee is entitled only to workers’ compensation benefits and nothing else. A workers’ compensation claim is thus entirely different from a claim for negligence such as in an auto accident. In fact, the negligence of the employer in causing the accident is not even an issue in workers’ compensation claims. As strange as this may sound, this often works to the employee’s benefit because in most cases it is far more difficult to prove the negligence of the employer and the lack of negligence of the employee than it is to prove merely that the employee was injured on the job. Furthermore, many injuries on the job are not caused by anyone’s negligence. In the system that was in place before workers’ compensation was enacted, this would have meant that those employees would have not recovered anything. Under the old system, the employer also had many defenses, such as contributory negligence, that shielded them from liability.
Limited Benefits – Medical Bills & Disability
Under the current system, in exchange for the relative ease of making the employer liable, the legislature limited the benefits the employee could receive. Workers’ compensation provides two main benefits to the injured employee. First, all injury-related medical bills are paid by the insurance company. This includes medical prescriptions. To a great extent, the insurance company directs the medical providers you see. However, you do have the right to request a second opinion and also to request a change of physician. If the insurance carrier refuses, your attorney can then make a motion to the Industrial Commission for approval of your choice of physician.
Secondly, the insurance company will pay disability benefits. Disability payments consist of two thirds (66.66%) of an employee’s gross average weekly wage. This compensation payment is nontaxable. If an injured employee is out of work due to an injury for more than seven days, then the insurance company will begin to pay temporary total disability payments for every day thereafter so long as the doctor keeps the employee out of work on a written excuse. The employee is not entitled to payment for the first seven days unless he or she is subsequently out for more than 21 days.
If an employee has a permanent injury to a particular part of the body, then the employee is entitled to further compensation under the act that is called permanent partial disability. Furthermore, if an employee is determined to be totally and permanently disabled, then he or she is entitled to lifetime benefits which include future medical expenses and disability payments. If either of the last two kinds of disability should be the case in your claim, your attorney will discuss the benefits available in greater detail.
Workers’ compensation does not award a claim for pain and suffering.
The Initial Conference and Investigation
When you first speak to a law firm, general information regarding your workers’ compensation claim will be obtained. Your lawyer will ask you to sign certain authorization forms which will allow your lawyer to obtain necessary information.
Your attorney will notify your employer’s insurance company and the Industrial Commission that you have retained the lawyer to represent you in the matter. Your lawyer will also ask the insurance company for a copy of any statements you may have given them, your medical records, and any Industrial Commission forms executed in your case.
As part of your lawyer’s investigation, any witnesses who may have been involved may be interviewed. Any necessary information from your employer, medical providers, or other persons may be obtained. If necessary, your attorney will ask an investigator to assist.
It is absolutely essential that your attorney has your cooperation in helping to gather facts about your case. The insurance Company has an index system on a nationwide basis that shows all of the people who have made prior claims for other injuries. If you have made a claim in another accident for another injury, your name may be there and they may have this information. You are therefore urged to be absolutely honest with your lawyer in all of your answers throughout the handling of your case.
If you have any questions at any time about your case, do not hesitate to call your attorney and legal assistants. At Younce, Vtipil, & Baznik, P.A., we are always happy to talk to you about your case and keep you updated.
Your Responsibilities in a Workers’ Compensation Claim
It is beneficial to your case if you work together with your lawyer as a team. Some of the things that you can do to help your case are listed below:
Keep track of mileage to your doctor, physical therapist or other accident-related appointments. This mileage may be fully reimbursable as a part of your claim. You can download a free mileage tracking sheet and other helpful workers’ comp forms from our resource library.
Send or bring in your prescription receipts. These are part of incurred medical expenses. These are reimbursable.
Get a written note from your doctor for any missed days from work. This is very important. It is impossible to claim disability payments for days you missed when you do not have a doctor’s excuse.
Be sure to let your lawyer know when you are released from the doctor’s care or if you start treating with another doctor or therapist. This will help avoid delays in your claim.
It is very important that you keep your appointments with your doctor or therapist. Your right to benefits can be cut off if you do not keep your appointments. Please make every effort to keep your appointments.
Keep your lawyer informed of any change in your address or telephone number. It is essential that your attorney be able to contact you on short notice.
Workers’ Compensation Settlement Process
After you have reached maximum medical improvement, your lawyer will discuss the possibility of settlement with you. The value of your claim depends mainly on whether you have any permanent restrictions and whether you can return to your pre-injury job. There are two ways that a workers’ compensation claim can be settled. The first kind is a settlement agreement written on a form provided by the Industrial Commission and the other is what is commonly called a clincher agreement. The main difference between the two involves your right to future benefits because of a change of condition within two years after the last date you received a check. In the IC form, your right to possible future benefits is preserved. In the clincher agreement, this right is waived in exchange for an additional sum of money.
Your claim cannot be settled without your written permission. Furthermore, all settlements must be approved by the Industrial Commission.
Industrial Commission Hearings
If any issue cannot be resolved with the insurance company, your attorney will consider the advisability of filing a request for a hearing. A hearing is then held with a deputy commissioner of the Industrial Commission. There are no jury trials in workers’ compensation claims. The waiting period for the hearing varies, but is always at least a few months.
You have the right to appeal the decision of the deputy commissioner to the full commission, which consists of a panel of commissioners.
Find Out How We Can Help You With the Workers’ Compensation Process
The information contained on this page is necessarily general in its terms. The attorneys at Younce, Vtipil, & Baznik, P.A., handle each and every case on an individual basis. Our legal team includes Chip Younce, David E. Vtipil, and Joseph Baznik. Both Chip and David are Board Certified Specialists in Workers’ Compensation Law. Mr. Vtipil has also been named among the nation’s Top 100 Injured Workers’ Attorneys and he has been selected for inclusion in The Best Lawyers in America in the field of Workers’ Compensation Law.
Contact us today for a free claim review and advice about your legal options for recovering workers’ compensation benefits.