Most people employed in North Carolina go their whole careers without ever having to give a thought to seeking workers’ compensation benefits. But in the most recent year accounted for, the North Carolina Industrial Commission accepted more than 63,000 workers’ compensation claims.
The N.C. Industrial Commission handles disputes about workers’ compensation benefits sought by workers dealing with disabling injuries or illnesses. Disputes often arise when employers or insurance companies try to withhold or discontinue benefits.
At Younce, Vtipil, Baznik & Banks, P.A., our Raleigh workers’ compensation attorneys help injured and ill workers seek the workers’ comp benefits available by law. Injured workers may find themselves in an unfamiliar world, dealing with expensive medical care and a workers’ comp system more interested in forms and rules than what the injured person is facing. Our attorneys can handle the workers’ comp claim.
Below are 6 basics to understanding the N.C. workers’ compensation system that everyone employed in North Carolina should know. If you need help with a claim or appeal, contact us online today or at 919-661-9000 in Raleigh for a free claim review and advice about your legal options.
What is Workers’ Comp in North Carolina?
Workers’ compensation is a state-run insurance program that covers most people employed in North Carolina. It provides benefits for full-time and part-time employees who are injured in an accident that occurs while on the job or who become ill because of their job’s working conditions and cannot work for seven days or longer.
Workers’ comp is a no-fault insurance program. That means an injured or ill worker is eligible for payments regardless of why they were injured or became ill. This means the worker does not have to show that his or her employer or anyone else is to blame. An employer cannot deny a workers’ compensation claim by showing that the employee was at fault. Injured workers are eligible for benefits without having to prove an employer was at fault. In exchange for this, North Carolina law prohibits workers from suing an employer whose negligence caused his or her injury or illness.
Workers’ compensation pays for all medical costs and a portion of lost wages while the worker is temporarily disabled and provides payments for permanent disability, stipends for specific disfigurement and payments to survivors of deceased workers who qualify.
What is Covered Under NC Workers’ Comp
Workers’ compensation covers injuries or illnesses that arise out of and in the course of the claimant’s employment. In short, you must have been hurt while on the job.
Back injuries are an example of claims in which decisions about what is covered by workers’ comp can become complicated. A back injury is one of the most common work-related injuries. In many cases, it is simply a byproduct of age.
If your job requires a lot of heavy lifting, a sore back is not outside of what is normal. But, if you have a medically diagnosed back injury that you can show was caused by a specific incident on the job, such as a fall, you should receive workers’ compensation.
Similarly, if you have been diagnosed with a disease, to receive workers’ compensation benefits you would have to prove that it was caused by your work conditions and not your lifestyle. An industrial employee might be able to show that their lung cancer was caused by toxic fumes encountered on the job, but a heavy smoker’s claim could be complicated. Their employer or the insurer would surely argue that smoking caused cancer.
Certain medical conditions acknowledged to be commonly associated with workplace exposures are specifically identified as occupational diseases under North Carolina law.
What Isn’t Covered under NC Workers’ Comp
Under North Carolina’s Workers’ Compensation Act, for an injury to be covered, it must be unexpected and not caused by performing a regular aspect of the job. A sore back, even one bad enough to make a construction worker stay home for a couple of days, is probably not an eligible injury. There needs to be a diagnosed injury related to a single incident or ongoing workplace conditions.
Additionally, workers who are injured while intoxicated or engaging in horseplay at work are generally ineligible for workers’ compensation.
It also should be understood that workers’ compensation benefits do not provide compensation for pain and suffering
Employers’ Requirements for Providing Workers’ Comp
Most employers in North Carolina who have three or more employees are required to purchase workers’ compensation insurance for all their full- and part-time employees. Coverage may be obtained through an insurance company or the employer may be self-insured.
There are exceptions. Most railroad employees and federal government workers employed in the state have other insurance programs they belong to. Domestic servants, casual employment workers (e.g., day laborers), farm laborers where the employer regularly employs fewer than 10 full-time non-seasonal farm laborers, and sellers of agricultural products who work directly for the producer are not covered by workers’ comp law.
It is against the law for an employer to terminate an employee for filing a workers’ compensation claim.
What Happens If Your Employer Doesn’t Have Workers’ Comp Insurance
If you have been injured on the job and find that your employer doesn’t have workers’ compensation insurance, you should complete and submit the N.C. Industrial Commission’s Form 18 to file a claim and notify your employer and Form 33 to request a hearing.
We suggest that you also speak with a North Carolina workers’ compensation attorney. In addition to helping ensure your claim moves forward, a workers’ comp lawyer at Younce, Vtipil, Baznik & Banks can explore your legal options. An employer who fails to maintain workers’ comp insurance gives up their protection against personal injury lawsuits.
You can report a lack of workers’ comp insurance or self-insurance to the NCIC Criminal Investigations & Employee Classification Division at any time. The employer may face fines and criminal charges.
Preparing for Life Under Workers’ Comp
There are numerous rules that regulate a workers’ comp claim in North Carolina. For example, you must be treated by a doctor assigned to you by your employer, and failure to keep appointments and follow the doctor’s order for treatment can jeopardize your claim.
Meanwhile, concentrating on your medical care and recovery should be your primary concern. You could be out of work for a long time. This is why obtaining workers’ comp benefits to pay medical bills and replace income is crucial and why you will be better off if someone is working to ensure you get what you deserve.
The doctors’ bills will start showing up quickly after a serious occupational injury or illness. But workers’ comp should pay them. If you are waiting for a disputed claim to be settled, a statement of representation on a Younce, Vtipil, Baznik & Banks, P.A. letterhead can keep creditors away from your door.
About the Author
Robert C. Younce, JR
Robert C. Younce is an attorney at Younce, Vtipil, Baznik & Banks, P.A. and concentrates his law practice on personal injury and workers’ compensation law. He has tried over 100 workers’ comp cases to Opinion and Award and about a dozen personal injury jury trials to verdict. He has been board-certified by the North Carolina State Bar as a specialist in workers’ compensation law since 2001.
