After filing a workers’ compensation claim for an on-the-job injury in North Carolina, what happens if workers’ comp doesn’t pay? Are injured workers out of luck? Or are there other options available to cover your medical bills and lost wages?
If you’re experiencing this situation right now, a North Carolina workers’ comp lawyer can help you pursue an appeal if your injury should be denied. If not, they can help you find alternative methods of paying for your injury-related expenses without having to reach into your own pocket.
Contacting a Workers’ Compensation Lawyer in North Carolina
Your first step should be to contact an experienced workers’ compensation attorney in North Carolina. A lawyer can help you with all aspects of your workers’ compensation case, from filing the initial claim to seeking the compensation you deserve.
If the workers’ comp insurance company won’t pay, a lawyer can help. Some of the ways workers’ comp lawyers assist clients include:
- Filing appeals with the Industrial Commission and representing injured workers in their appeal hearings
- Collecting and presenting evidence that shows a worker’s injury is related to their job
- Representing an injured worker in settlement negotiations with the insurance provider
Health Insurance for Medical Bills
The next option injured workers have is to rely on their health insurance to cover their medical costs. Under normal circumstances, health insurance typically won’t pay for work-related injuries. This is because workers’ compensation insurance is supposed to handle those cases.
However, if workers’ compensation disputes your claim by saying that your injury isn’t related to your work, then there should be no conflict with your health insurance provider. Workers’ compensation insurers must provide a detailed reason when they deny your claim. If your health insurance provider doesn’t want to pay because it believes your injury is work-related, you may be able to use the workers’ comp insurer’s denial as evidence to get the health insurance to pay for your treatment even while you fight for workers’ compensation benefits.
Another situation in which you may be able to use your health insurance is if there’s a dispute with the workers’ comp insurer about the necessity of certain medical treatments. Sometimes, workers’ comp will deny part of your claim by saying the treatment isn’t reasonable or necessary. In these cases, you may be able to get your health insurance to cover the cost of the treatment.
It’s important to keep in mind that if your health insurance covers medical expenses related to a work injury and you later receive a settlement from workers’ compensation insurance for those expenses, you may have to repay your insurance provider.
Unemployment Benefits
In some cases, injured workers can still work in a lessened capacity. However, employers don’t always have available positions for these workers, leading to them getting laid off.
If your employer lays you off because they don’t have any available roles that meet your work restrictions, you may be able to cover your lost wages with unemployment benefits. While these benefits won’t cover your medical expenses, they can provide stable income while you recover and get back on your feet after a work injury.
The eligibility criteria for unemployment benefits are:
- Your loss of employment must not be your fault.
- You must have reached a minimum income level in the past 15 months.
- You must be able and available to work.
- You must actively look for a new job.
Even if you have work restrictions to accommodate your injury, you should usually be able to meet these criteria. However, the maximum payment you can receive through unemployment is $350 per week, and you can only receive benefits for up to 12 weeks.
Short-Term & Long-Term Disability
If your work injury left you with a disability that prevents you from working, you can also seek compensation through short-term and long-term disability (LTD) benefits if you qualify. These benefits pay a portion of your wages. The payment is specified in your STD/LTD policy document. These benefits aren’t tied to whether your disability was work-related. Even if the workers’ comp insurer said your injuries didn’t result from your job, that has no impact on disability benefits.
However, if you receive a workers’ compensation settlement that includes wage compensation after receiving long-term disability benefits, you will likely have to repay that money.
Social Security Disability Insurance (SSDI)
An alternative to short-term and long-term disability benefits is to receive Social Security disability benefits. You can check the Social Security Administration’s (SSA’s) website to determine your eligibility. If you’re eligible, you can receive wage replacement benefits for your lost income.
The basic criteria are that you must have previously worked in jobs covered by Social Security, and your medical condition must meet the Social Security Administration’s definition of a disability. Typically, if your disability impacts your ability to work for at least 12 months and appears on the SSA’s list of qualifying impairments, you can obtain these benefits.
Injured workers can receive both Social Security disability and workers’ compensation benefits simultaneously. However, the combined compensation you receive from both systems cannot exceed a certain threshold. If you are going to receive too much money from Social Security and workers’ compensation, the amount you receive will be reduced to the maximum allowed.
Call Our Workers’ Compensation Lawyers for Help
If you filed a workers’ compensation claim and the insurance company is refusing to pay, call Younce, Vtipil, Baznik & Banks, P.A. at 919-661-9000 for a free consultation with our knowledgeable workers’ compensation lawyers.
Our team will do everything we can to help you seek the workers’ comp benefits you deserve for your injuries. We give every case the attention and care it deserves, and our staff is fluent in both Spanish and English. Past clients say we “articulate things in a way you’ll understand, and show empathy and compassion for your situation.” Reach out today to see how we can help you.
About the Author
Joseph R. Baznik
Joseph Baznik is an attorney at Younce, Vtipil, Baznik & Banks P.A. who specializes in workers' compensation and personal injury. Joseph speaks both English and Spanish fluently. He is licensed to practice law in the State of North Carolina and the U.S. District Court for the Western District of North Carolina.
