Workers Comp NC Questions
Here are some questions I am often asked. The answers are frank. Not everything is easy or comforting. It is, however, the truth. The truth gives you knowledge; knowledge gives you power.
Please note: The information contained on this web site may provide general legal information but is not intended to give legal advice on any specific legal matter. It does not create an attorney-client relationship and should not be relied upon in lieu of legal counsel. All FAQ material is specific to North Carolina Workers Compensation Law. If you are viewing this page from another state, please see your local state law statutes, as they may differ from North Carolina's. I only practice in NORTH CAROLINA.
1. What do I do if I am injured on the job?
If you are injured on the job, do not dismiss it as just a pulled muscle or some minor injury that will get better overnight. While your injury may not turn out to be serious or permanent, you will regret not reporting it if it does not dissipate
You should make sure someone else knows about it. Report the accident to your supervisor right away. If anyone witnessed your injury, take him or her with you. Tell the first medical center you go to exactly what happened.
Your claim will be stronger if you can identify specifically when, where, and how your injury occurred. Explain to your supervisor in great detail about how the incident occurred. Demonstrate how it happened, if possible.
You must file a report, called a Form 18, with the North Carolina Industrial Commission within two years of your injury. You can get this form by calling the Commission at (919)807-2500.
2. When will my weekly checks start to come?
Your checks should begin to come within weeks of your injury. The insurance company may first want to take your recorded statement and get initial medical records.
3. What if my checks are late?
If an occasional check is late, do not fret. If they are constantly late, the insurance company could be setting itself up to pay you a 10% penalty. They may also have to pay your attorney if you have to hire one to get the checks on time.
4. What if my checks stop?
Well, they shouldn’t. By law, the insurance company must keep sending the checks until you return to work making about what you used to make, or the case is settled. There are a least two complicated procedures the insurance company can use to stop your checks. These procedures are rarely used; they are too much trouble for the insurance company. You shouldn’t have to worry about checks not coming.
5. What if my case is denied?
This is serious. You should contact a lawyer right away.
What has happened is that the insurance company has determined that, for some reason, it is not responsible for paying you or your medical bills for the injury you claim. You have the right to have the Industrial Commission hear the issues in your case to decide if your case is “compensable” or not. There is a process and time limit for making the request and is best handled by an attorney.
6. What if my check is the wrong amount?
You’ll need documentation to prove it, but a lawyer can have that corrected, plus any back pay due you because the weekly checks have been short.
7. Can I be fired because I am hurt and cannot do my job?
Your employer has an obligation to hold your job open for twelve weeks. This requirement is part of the Family Medical Leave Act. After twelve weeks, your employer has no duty to hold your job.
If you go back to work with restrictions and are fired, it is presumed that you have been fired because of your injury, which is illegal. The employer has to prove that they did not fire you because of your injury, and this is hard for them to do. When these issues are contested, the company almost always loses.
8. Will the insurance company treat me fairly?
The insurance company has many laws and regulations they must follow in handling your workers compensation claim. Keep in mind that the insurance company is likely to have thousands of claims, in addition to yours, open at any given time. Also, remember that the insurance company is in business to make a profit, and that profits are not made by paying claims. Generally, the insurance company will pay out a little as possible.
9. What medical treatment is covered?
Any medical treatment or medication is covered if the need for it is caused by your injury. The cost of special medications like anti-depressants, sleeping pills, or Viagra are covered when they are necessary because of your injury.
10. Do I have to see the Company Doctor?
Discuss with the insurance adjustor about seeing the proper medical care provider. Many insurance companies send you to primary or urgent care facilities. These medical professionals are usually not trained to deal with orthopedic or other serious injuries. If you are not confident with the medical care provider, you can usually get a different physician, but you may have to petition the Industrial Commission to do so. Insist on seeing a specialist when necessary.
11. What about insurance adjusters?
Within a few days of reporting your injury an insurance adjustor should call. Insurance adjustors work for the insurance company, not for you. Their job is to settle insurance claims. You may be asked to give a recorded statement about the accident. You must do this, but, if you’ve been truthful and consistent on the when, where and how of your injury, you need not fear. Just tell the truth again.
12. Who is that guy with the video camera?
The insurance company wants to keep claims paid to a minimum. If they can videotape you doing something that indicates your injury is not as serious as you claim, like playing softball or water skiing, for example, they may try to use this in a proceeding to stop paying you. If they are successful, they are likely to “save” some money. The guy with the camera is a private investigator, hired by the insurance company. Use common sense. If you know you are being spied on, call a lawyer.
13. What is a Vocational Rehabilitation Counselor?
This is someone the insurance company has hired to get you back to work, as quickly as possible. This person may seem harmless enough, even helpful. But, remember who has hired them, and remember that the insurance company and your interest are in opposite corners. Be wary, even nervous about this person. Do not let them come to your home. They will be looking for things around your home that indicate you are able to work. When you hear the words “vocational rehabilitation counselor”, you should call a lawyer right away.
14. What is MMI?
When, in a doctor’s opinion, you have healed as much as you are going to, you have reached Maximum Medical Improvement, or MMI. The doctor releases you from his care, often with restrictions on what you are able to do. The doctor will give you a rating, indicating, in his opinion, the degree of your disability. MMI is often a pivotal point in a workers comp case. You may start to feel pressure from the adjustor to settle, or you may have to endure vocational rehabilitation.
15. What about my health insurance?
Unfortunately, workers comp law does not require your employer to continue paying your health insurance. Another law (COBRA), however, says that you can pay for your insurance if you choose. While workers comp will pay for the medical costs related to your accident, the burden to provide health insurance is on you.
16. When will my case end?
You can never be forced to settle your case. Some cases end only with the death of the injured worker, but most cases can eventually be settled. Generally, many factors influence the decision to settle and as such, any settlement offer should be carefully considered, advisedly, with the counsel of an experienced workers comp attorney. Some factors that may be considered in evaluating whether to accept a settlement offer include:
17. How long is all this going to take?
It may be a long time, but, time is on your side. The insurance company wants to get your case off its books, and so they are in a hurry. This fact alone should make you go very slowly. This is your life, your health. It shouldn’t be rushed. You need time to decide whether you can ever go back to work, whether you need more education, or whether you can find suitable employment.
18. Should I apply for Social Security Disability?
If your injury is serious enough to keep you out for six months, yes, you should apply. Your application, like most, may be denied, regardless of your medical condition. Many disability claims are successful on appeal. Please contact our office as we also handle Social Security Disability cases and may be able to advise you on your case.
19. What if the insurance adjuster is pressuring me to settle my case, and I don’t think it is enough money?
First of all, if your Doctor has just released you (you have reached MMI), it is way too early to settle your case. There are too many unknowns for you to risk your future on whatever the money offer is. A rule of thumb is: if you think the offer is too low, it probably is. At this point, you’d better get a lawyer.
20. When should I settle?
If you are permanently disabled, you must not settle your case until there’s enough money offered to help you live with dignity for the rest of your life. If you can go back to work, but at something else, you must not settle your case until you feel like there is enough money on the table to help you live until you are able to find another job.
21. What if the only way I can match what I was earning is to get more education?
Either the insurance company or the North Carolina Department of Vocational Rehabilitation may pay for you to go back to school if the only way you can match your pre-injury earnings is to get more education.
This may be best explained with an example using one of Janet’s former cases: There was an airline attendant who suffered a back injury while working. Her injury was such that her doctor believed she could not return to work as an airline attendant. Because airline attendants make pretty good money but do not require a college degree, the injured attendant could not find suitable employment that paid her what she earned in her old job. Janet was able to convince the Industrial Commission that additional education for the airline employee was a reasonable means of allowing her to get employment that would be suitable. Sure, the insurance company fought hard to prevent this, but, ultimately, the North Carolina Court of Appeals agreed with Janet. Now, it is the law.
22. I’m mad at my company for not keeping me safe. Can I sue them?
Workers compensation law works for both the employee and the employer. Generally, you have a bar against legal claims against your company for negligence. Conversely, you are covered by workers comp insurance, even if your negligence caused the injury. Workers comp laws are designed to insure the replacement of your income, not to punish your employer, or to pay you for pain and suffering.
23. What makes Worker’s Compensation law different?
Legal claims arising from bodily injury are civil (as opposed to criminal) law. Injuries that are not workers compensation claims are adjudicated through the courts and, as such, are done in accordance with “Rules of Civil Procedure”. Workers Compensation claims are filed with and heard by a quasi-judicial branch of government, established by the State. In North Carolina, the North Carolina Industrial Commission is the body through which workers compensation claims are heard. The Commission establishes its own unique set of rules and procedures, which have the force and effect of law. For this reason, an attorney who may be quite capable of handling any other personal injury claim may find the rules and procedures of workers compensation matters to be strange and confusing.
24. What is mediation?
At some point, you and/or the insurance company may wish to end your case by paying a lump sum settlement to you. Often, these settlements are reached with the help of a mediator. The mediator is a person with special training in helping opposing parties reach a mutually acceptable settlement.
The mediation is held in an office that the parties agree on in advance. During the mediation, the mediator will discuss the issues with all of the parties, both as a group and individually. He or she will then act as a go-between, auguring both sides with the goal of reaching a settlement. You do not have to accept the recommendation of the mediator, but, with the assistance of a good, experienced, workers comp lawyer, and a good mediator, many cases are settled this way.
25. What is a FCE?
FCE stands for Functional Capacity Evaluation. It is an examination, conducted by a physical therapist, to determine the extent of disability that has been caused by your injury.
After you have reached Maximum Medical Improvement, your doctor will be asked to give your injury a “rating” and to list restrictions on what you are physically able to do. He will use the results of the FCE to help him make this determination.
26. What is the importance of Restrictions?
Restrictions are determined by your doctor after you have reached Maximum Medical Improvement and your physical limitations have been measured by a FCE. The doctor specifies what you are physically capable of doing. For instance, the doctor may specify that you can not lift more than twenty pounds. He has therefore, “restricted” you to work that would not require you to lift more than twenty pounds.
Restrictions become very important. Their purpose is to prevent you from incurring further injury. Once they are known, only the jobs that you can do within the restrictions may be considered suitable employment. Often, suitable employment within the restrictions is difficult or impossible to find. The nature and number of restrictions given by the doctor should be considered in settlement negotiations.
27. What if I am not in the US legally?
If you are injured on the job, your legal status is not an issue for workers comp. You are entitled to the same workers compensation benefits and protections as anyone else. Of course, by filing a workers comp claim, you will most likely be discovered and your deportation may be the result. However, if you are injured so badly that you will not be able to work like you did before, your earnings capacity is already diminished, whether you live in the USA or Mexico. If you must go home injured, why not go home with a good workers comp settlement?
28. How does the lawyer get paid?
The attorney will likely get 25% of the money they get for you. Their fee is paid out of the settlement money the insurance company pays.
29. Can you tell me anything else that helps?
Yes. Do not be scared. Although the insurance company has been playing this game a lot longer than you, handling your case properly can put you back on even footing with them, maybe even in a place of advantage you never knew you had.
30. Did you get the answer to your question?
We hope so. If not, please see the “Contact Us” section of this web site. We would like to help you.