Tag: workers’ compensation

Returning to work after an on-the-job injury is difficult, not only physically, but mentally. You may still be recovering, and your employer might be making things difficult for you. Quitting your job is tempting — but don’t quit.

If you are still receiving workers’ compensation for your injury, be sure to speak to an attorney before quitting. Taking the right steps during this confusing process will help make sure your benefits continue.

Workers’ Compensation Benefits
There are three basic benefits you are entitled to under workers’ compensation: wage replacement benefits, medical treatment, and permanent disability compensation. These benefits vary based on the state you reside in. (This is why it is extremely important to have an attorney by your side.)

If you decide to resign or quit, you will continue to receive medical benefits according to your doctor’s note, but will give up your right to wage replacement benefits. If you are left partially disabled, your payments may be in jeopardy depending on your state’s law. In extreme cases, where you are permanently disabled, payments will continue to benefit you.

A Better Job
If you have found a job that suits you better, by all means, it’s worth considering. Just be sure to speak to your attorney first to discuss what will happen to your benefits.

Employer Refusal
If your employer denies to pay your benefits after you quit your job or after you file a workers’ compensation case, call an attorney. A qualified practitioner can help you avoid mistakes that could forfeit your benefits.

Taking Action
Talk with your lawyer before taking any actions. Laws and regulations for workers’ compensation are different in North Carolina. Insurance company claim adjusters are not there to notify you of all your benefits. Unfortunately, from their perspective they are trying to finish your case as quickly as they can.

Put yourself in good hands that can handle your case with precision and care. Contact Kelly and West for consultation today at 910-893-8183.

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.

Workers’ compensation is a form of insurance for employees. This coverage provides wage replacement and medical benefits to employees injured in the course of employment in exchange for the employee’s right to sue their employer for negligence. When involved in a case dealing with workers’ compensation, there are many confusing terms. Here are just a few to know if you are dealing with a workers’ compensation claim.

A

Arising out of and in the course of employment (AOE/COE): Two necessary conditions that must be met to establish a work-connected accidental injury; an injury that “arises out of” is one that results from a hazard of the employment, while an injury “in the course of employment” is one that occurred at a time, place and under circumstances related to the employment.

Average Weekly Wage:  The average wage of an employee, according to the worker’s compensation laws.

B

Beneficiary: An injured worker’s spouse, domestic partner, child, or dependent entitled to receive payments, in the event of death of the injured worker.

C

Claim: A written request by the worker, or on the worker’s behalf, for compensation.
Cumulative injury: An injury caused by repeated events or repeated exposures at work.

D

Deferred claim: A claim not yet accepted or denied by the insurance company or self-insured employer.

Deputy Commissioner: An employee of the Industrial Commission who makes decisions about workers’ compensation disputes and approves settlements.

E

Ergonomics: The study of how to improve the fit between the physical demands of the workplace and the employees who perform the work.

F

Family and Medical Leave Act (FMLA): A federal law that provides certain employees with serious health problems or who need to care for a child or other family member with up to 12 weeks of unpaid, job-protected leave per year.

H

HIPAA (Health Insurance Portability and Accountability Act): A federal law that ensures the privacy and security of protected health information and patients’ access to their health-care records.

N

Non-disabling claim: A worker’s compensation claim that does not result in time-loss or permanent disability, but requires only medical treatment.

O

Occupational disease: A disease or infection, arising out of and occurring in the course and scope of employment.

Occupational Safety and Health Administration (OSHA): The federal agency that oversees workplace safety and health in federal offices and in states without state OSHA programs.

R

Regular work: The job the worker held at the time of injury or a substantially similar job.

S

Settlement: An agreement between a worker and the insurance company about workers’ compensation payments and future medical care.

Suspension of benefits: An interruption of payment of benefits to an injured worker.

T

Temporary Total Disability: The amount of weekly compensation payments paid to a worker who cannot work because of a work-related injury.

W

Worksite modification: The changes made to an injured worker’s job, tools, tasks, or worksite to accommodate the worker’s injury-caused limitations.

Contact us today if you have any questions about workers’ compensation.

1. What is workers’ compensation?
Workers’ compensation is a form of insurance required by law to cover accidents, injuries, or illnesses that occurs among employees while at work, provided that certain conditions are met.

2. How do I know if I am covered?
There are certain elements that must be met before you will receive workers’ compensation benefits. However, despite having to prove certain things, you are not required to prove that the accident was not your fault. Workers’ compensation provides coverage to an employee no matter who is at fault. It is also provides coverage for certain work-related illnesses. However, there are a few restrictions to be aware of. If you are found to have been under the influence of any type of drug during the time of the accident, you will likely not receive workers’ compensation. In addition, if you received an injury as a result of doing your job in the normal and customary way, you may not be covered. Regarding illnesses, only certain work-related illnesses, called occupational diseases, are covered, so if you have suffered an illness related to work it is important that you check with an experienced attorney to see if you may be entitled to benefits.

3. What types of bills does workers’ compensation cover?
In most cases, workers’ compensation covers any bills such as prescriptions, hospital stays and doctor visits that are directly related to the injury sustained or work-related sickness developed. Workers’ compensation may also reimburse you for travel expenses, should you have to travel longer distances away from your home for treatment. In addition workers’ compensation pays you if you are out of work, at a rate of two-thirds (2/3) of your average weekly wage. In more serious cases, workers’ compensation may provide compensation for employees who have become permanently disabled as a result of an accident while on the job as well as compensation to families who have lost a loved one due to a work-related accident.

4. Do I need a workers’ compensation attorney? Why?
If you have been injured at work, chances are your relationships with your bosses and employers are in flux. In the midst of attempting to recover, communicating with your employer and your employer’s insurance company can be overwhelming and complex. Without the help of an attorney, you are at great risk for not receiving the full compensation you may be entitled to. In many cases employers and their representatives lead you into putting comments on the record and answering questions that leave you with less support and less monetary compensation without you realizing it. Hire an attorney to protect your rights. In order to focus on your recovery and receive that to which you are entitled, you need a seasoned attorney on your side.