What is workers' compensation?
     Workers' compensation is a system of benefit payments for those persons injured by accident arising out of and in the course of their employment. It also provides compensation for workers who develop an occupational disease as a result of their employment. Injured workers can receive temporary total disability checks while they are out under a doctor's care, medical treatments which are reasonable or necessary to effect a cure, give relief, or lessen the period of disability, and payments for permanent injury based on their impairment rating, impaired wage earning capacity or permanent total disability.

Do I need an attorney to represent me in my workers compensation claim?
     A lawyer should be retained to represent the injured worker in a serious injury claim. Upon being injured, you should call an attorney and discuss the circumstances of your injury with him or her. There is no charge for an initial consultation and the lawyer will be glad to give you an honest determination of whether an attorney will be helpful to you. A good rule of thumb is that an attorney should be retained in any serious injury claim.

How do I pay the attorney?
     No attorney’s fee is paid until you are compensated. If you do not receive workers’ compensation, you will not have to pay an attorney’s fee. All attorneys’ fees have to be approved by the North Carolina Industrial Commission.

What is the North Carolina Industrial Commission?
     The North Carolina Industrial Commission is the state agency that regulates and oversees workers' compensation claims filed in North Carolina. The Industrial Commission is located at 430 N. Salisbury Street, Raleigh, North Carolina 27611. The main phone number is (919) 733-5020.

Are all employers in North Carolina required to carry workers' compensation insurance?
     All employers who regularly employ 3 or more workers must carry workers' compensation insurance in North Carolina. A subcontractor who is employed by a general contractor must carry workers' compensation insurance if it has one or more employees.

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. Failure to do so may forever bar the employee from filing a claim for workers’ compensation.

How long do I have to file a workers' compensation claim?
     The employee must file a Form 18 with the North Carolina Industrial Commission within two years of the date of injury. Otherwise, the claim may be forever barred unless the employer intentionally engaged in actions to deliberately mislead the employee about his right to pursue workers' compensation. If the injury is classified as an occupational disease cases, the employee must file a Form 18 or Form 18B with the Industrial Commission within two years of being advised by a doctor that he/she has a work-related disease.

What types of injuries are covered by workers’ compensation?
     In general, injuries must be accidental to be compensable under the North Carolina Workers' Compensation Act. For the injury to be deemed accidental, there must be a slip, trip or fall, or some other unexpected event that disrupts the ordinary work routine. The rule is more flexible for hernias and back injuries, which are compensable even if not accidental if they were the result of a specific traumatic incident at work.
     In addition, the injury must arise out of and in the course of the employment. The injury must result from a risk created by the work required in the job and not common to the public, and also must occur at a place and time during which the employer's business is being conducted. If the injury occurs off the employer's premises while the employee is engaging in activities that do not benefit the employer, the injury is generally deemed not compensable under workers’ compensation.

What is an occupational disease?
     Diseases or conditions which arise slowly or over a period of time can be paid as workers’ compensation, if the employee was placed at an increased risk of contracting the disease compared to the general public not equally exposed and if the hazards of employment significantly contributed to the occupational disease.

What if the accident was my fault?
     Workers compensation is a fault free system; the negligence or actions of the employee or the employer in causing the accident are not relevant in determining whether the worker is entitled to compensation benefits. The only exception to this general rule is if the employee is under the influence of alcohol or drugs at the time of injury and the intoxication causes the accident to occur. If the employee willfully disobeys a safety rule which causes the injury to occur, the compensation the employee is entitled to receive can be reduced by ten percent. The failure of the employer to obey a safety rule can result in a ten percent increase of the workers’ compensation benefits.

What are my rights if I am hurt by someone other than my employer or a co-employee?
     Whenever an employee is hurt by a third-party (i.e., someone other than an employer or a co-employee), in addition to the worker’s compensation claim the worker can file, he or she also has the right to file a claim against the person who caused the injury. This is a civil action for which the employee must be able to show that the third party was negligent and that the employee did not contribute to the accident. It is very important to pursue these claims, because there may be additional recoveries obtained above and beyond what the Workers’ Compensation Act allows the injured worker to receive.
      An example of a third-party claim would be a delivery driver who is involved in an automobile accident while on the job and the person who causes the accident is not the employer or a co-employee. In this instance, the injured worker can file both a workers’ compensation claim and a third party negligence claim against the driver who ran into the vehicle.
     The Law Offices of Holly S. Cutler handles both workers’ compensation and third-party claims.

How long must I wait before my weekly benefits start?
     The worker must have missed at least seven days before the entitlement to weekly benefit checks begins. This does not have to be seven consecutive days. No compensation is due for the first seven (7) days of lost time unless the disability exceeds 21 days. Therefore, the first check will not include payment for days 1-7. Payment for those days will be made should the disability continue beyond 21 days.
     The entitlement to receive medical treatment, however, is not contingent upon missing any time from work. You may receive medical treatment immediately upon being injured.

What payments do I get while I am being treated and out of work?
     While the employee is out of work under a doctor’s care, he or she is entitled to receive temporary total disability benefits for lost wages and reasonable or authorized medical treatment.

How are my weekly benefits figured?
     Compensation is paid based on 66 2/3% of the average weekly wage, not to exceed the maximum weekly benefit, which is determined annually. The employee’s gross wage, including overtime and payments in lieu of wages are calculated for the 52-week period prior to the accident to determine the average of the weekly wage of the employee. If the period employed prior to the accident is less than 52 weeks, whatever time period the employee worked is used. However, if the time period is so short so that using the gross pay for that time would be unfair to either the employee or the employer, the parties can use the wages of a similar or comparable employee.

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 own choice, but must promptly request the Commission's approval.

How do my medical bills get paid?
     Medical bills are paid by the workers compensation insurance company. These bills must be forwarded to the insurance company by the doctor’s office. The insurance company then forwards the bills to the North Carolina Industrial Commission for it to review the bills and approve them, if the charges are within the Industrial Commission’s guidelines. The Industrial Commission then notifies the insurance company of this authorization to pay the medical bills and then the insurance company makes direct payment to the medical provider’s office. If the insurance company refuses to pay medical charges, the injured worker can file a request with the North Carolina Industrial Commission for a hearing to seek an order that the medical bills be paid.

How long can I receive medical treatment?
     The injured worker can receive medical treatment which is reasonable and necessary while under a doctor’s care. Upon being released, the worker has two years to petition the Industrial Commission to receive additional medical treatment. (Workers injured before July 5, 1994 are entitled to receive lifetime medical treatment.) The worker must be able to show that treatment sought is related to the on the job injury. Only those consequences which would reasonably result from the on the job injury will be paid by the insurance company. The employee must be able to show that the medical treatment is reasonable or necessary to effect a cure, give relief, or lessen the extent of the disability.

Can I change doctors?
     The proper procedure for switching doctors is to first seek the permission of the insurance company to change doctors. If the insurance company refuses or does not respond to the request, a Motion for Change of Treating Physician or a Form 33 can be filed with the Industrial Commission requesting an Order that a change of physician be allowed.

How do workers compensation claims get settled?
     There are several ways in which a workers’ compensation case can be settled. Depending on your particular situation, you may want to choose a settlement method that leaves your case open for future medical treatment, or you may want to accept additional money in exchange for releasing your employer and the insurance company from any future liability in your case. There are many factors that go into determining the best way to settle your claim and you should consult an attorney before signing any type of agreement in your case.

Can my employer fire me because I have filed a workers compensation claim?
     It is a violation of the North Carolina REDA statute for an employer to fire an employee because they have pursued a workers’ compensation claim. If your employer has retaliated against you for pursing a workers’ compensation claim, the North Carolina Department of Labor should be contacted immediately at (800) 522-6762. You must take action within 180 days of the retaliatory act.