Getting injured on the job is stressful enough. What are the first steps for securing workers’ compensation? Where do you seek treatment and how do you get paid? Below are the answers to all those questions and more. Whatever happens, stay calm, file an injury report, and get treatment. Or call Kelly & West if you have a serious injury and are unlikely to return to work.
Q. Under what circumstances can I file a claim for Workers’ Compensation Benefits?
A. In North Carolina there are three main circumstances under which you are eligible:
The most common is Injury By Accident. This means your regular work routine was disrupted by an unusual circumstance that resulted in your injury. Even if you think the accident was your fault, you may still be able to request benefits.
The second type of circumstance is Specific Traumatic Injury, in this case, you can get compensation if you performed a normal task in which you sustained an injury to your back even if there was no specific accident, so long as you experienced a sudden onset of pain.
Lastly, Occupational Disease. This is when a worker is exposed to a disease or the disease’s development increased because of the workplace.
Q. What should I do first if I am injured at work?
A. First, notify your employer of the details of your accident and your injury. It is best to do so in person and in writing to ensure you do not lose any legal rights you may have for workers’ compensation benefits. You will also want to formally file a claim by completing a Form 18, Notice of Accident to Employer and Claim of Employee, Representative or Dependent for N.C. Workers’ Compensation Benefits, with the North Carolina Industrial Commission, as instructed below.
Second, if you require immediate medical assistance, ask your supervisor for instruction. Your employer may have a health care provider on your work site. If that is not the case, your employer may ask you to visit a designated healthcare office.
If your employer is not onsight and you are unable to ask about a designated off-site health care provider, seek medical care appropriate to your needs. Depending on your injuries, care may be obtained from emergency services or your regular family doctor.
If your injury was an emergency and you were not able to alert your employer, as soon as possible after the accident, and within thirty days, you must give written notice to your employer. This can be a simple written statement giving the date of the accident and a brief description of the injury. If you cannot write the letter, have a family member write it for you and send it to the employer. Keep a copy of the letter for your records.
Q. Why can’t I see my own doctor?
A. Under North Carolina state law, the employer or its insurance company is required to provide and direct medical treatment. You may petition to change physicians however payment by the employer isn’t guaranteed unless written permission to change physicians is obtained from the insurance company or the North Carolina Industrial Commision prior to the change.
Q. How soon after the accident do I have to file a workers’ compensation claim?
A. In North Carolina, you have thirty days to report a workers’ compensation claim to your employer. We recommend you file your claim in writing immediately or as soon as possible. You must also file Form 18, a Notice of Accident to Employer and Claim of Employee, Representative or Dependent for N.C. Workers’ Compensation Benefits, with the North Carolina Industrial Commission and provide a copy to your employer and/or its insurance carrier. Timeliness in these matters is extremely important.
Q. How much will I be paid?
A. This depends on the status of your injury and your ability to work. If you experience Temporary Total Disability (TTD) and you are unable to work in any capacity, but the disability is not expected to be permanent, after a waiting period of seven days you can expect to be paid weekly benefits equal to two-thirds of your average weekly wage. If your disability continues for more than 21 days, you are also entitled to receive two-thirds pay for the first seven days.
If you experience Temporary Partial Disability (TPD) and are earning less than you were previously due to the injury, you are also entitled to compensation equal to two-thirds of the difference between the pre-injury and post-injury weekly wages for a period extending up to 500 weeks.
If you experience Permanent Partial Disability (PPD) and have sustained a permanent disability to a particular body part, the loss will be calculated by the treating physician on a percentage basis. This is referred to as a PPD rating and you will be entitled to compensation equal to two-thirds the average weekly wage for that particular rating and for a period of time that is calculated by the North Carolina Industrial Commission. For example, if a worker loses complete use of an arm, he or she can receive benefits for 200 weeks. If the worker loses 50% use of an arm, he or she can receive benefits for 100 weeks.
If on the job injuries render you unable to work for the rest of your lifetime, Total and Permanent Disability benefits may be entitled to you. In this case, a worker would receive weekly benefits and medical compensation for life.
Q. Can my employer fire me if I am unable to work?
A. In short, yes, your employer may fire you if you cannot work. Legally any employer may fire an employee for any reason at all, as employees are “at will” employees in North Carolina, as a general rule. However, if you are fired solely because you a worker’s compensation claim, this is not legal and you will want to seek legal advice to determine the best way to proceed.
Q. Can I collect monies for my pain and suffering?
A. In North Carolina, no you cannot. The workers’ compensation laws were designed to avoid collecting punitive damages and money for pain and suffering as part of the legislative tradeoff for not having to prove the accident was caused by or the fault of your employer
Q. Do I have to pay taxes on my workers’ compensation benefits?
A. No. In North Carolina, workers’ compensation settlements should be fully tax-exempt if paid under the Workers’ Compensation Act but you will want to verify this with your C.P.A. to be sure.
Q. Will I have to go to trial?
A. That depends. You may have to go to a hearing. Hearings usually take place when there is an area of dispute in the case. The hearing may take place over the phone or in front of the North Carolina Industrial Commission. If a hearing is involved, it’s very important to attend. This shows the insurance company and your employer that you are confident about your case and are invested in the outcome.
Q. Do I have to pay an attorney up front to represent me?
A. At Kelly & West, we do not charge a fee for our first consultation with you. We continuously strive to keep our fees as fair and reasonable as possible and it is our practice to discuss fees with you at the initial interview and to confirm these fee discussions in writing.
If you or a loved one are injured on the job, contact the law offices of Kelly & West for guidance and assistance.
