In the hustle and bustle of daily work, the possibility of injury can often be overshadowed. But if you sustained a workplace injury, you need to make sure you understand the legal framework and what your options are when it comes to workers compensation. This blog examines the intricacies of workers comp in North Carolina, offering a comprehensive guide for employees.
Who Is Covered by Workers Compensation?
Imagine a scenario where a construction worker falls from scaffolding, suffering a broken leg. North Carolina’s Workers Compensation system steps in, ensuring this injured worker receives medical treatment and a portion of their lost wages without needing to prove employer negligence. This “no-fault” system balances the needs of injured employees with the protection of employers from costly lawsuits.
While the general rule mandates coverage for employers with three or more employees, understanding the nuances of who qualifies as an “employee” and the exceptions to the three-employee rule is crucial.
Who Is Definitely Covered?
- Full-time, part-time, and temporary employees: Regardless of their work schedule, these individuals qualify for coverage as long as they perform services for the employer under a contract of hire.
- Seasonal employees: Workers employed for a specific season, like agricultural or tourism workers, are also covered.
- Minors employed under a work permit: Even underage workers, if legally authorized to work, fall under the umbrella of workers’ compensation.
- Corporate officers: In most cases, corporate officers, such as directors and vice presidents, are considered employees and entitled to coverage. However, they can opt out if they own at least 10% of the company’s stock and have written documentation of their opt-out status.
Who Might Be Covered Under Specific Circumstances?
Under certain conditions, independent contractors working for a specific employer with a defined scope of work might be eligible for coverage. Consulting with a North Carolina workers comp attorney or the Industrial Commission is advisable to determine their specific status.
If an employee is leased from a staffing agency to another company, both the staffing agency and the company using the employee’s services may be responsible for workers’ compensation coverage.
Who Is Specifically Excluded?
- Domestic workers: Individuals employed within a private household for domestic purposes, like housekeepers or childcare providers, are typically excluded.
- Volunteer workers: Individuals who offer their services without the expectation of compensation are not considered employees and therefore not covered.
- Federal, state, and local government employees: Public employees in these sectors have separate workers compensation systems or alternative benefits offered by their respective governments.
- Agricultural workers: If an employer has fewer than ten employees and solely engages in agricultural activities, then their workers are generally excluded.
What Benefits Are Typically Provided?
While medical expenses and wage replacement are often the first benefits that come to mind, North Carolina’s Workers Compensation system offers a more comprehensive package of support for injured workers:
Workers compensation covers all reasonable and necessary medical expenses resulting from your on-the-job injury. This includes:
- Doctor visits and consultations
- Hospitalization and surgery
- Diagnostic tests and imaging
- Physical therapy and rehabilitation
- Prescription medications and medical equipment
There are no out-of-pocket costs for eligible medical treatment. Your employer’s insurance carrier will manage and coordinate your care through a designated healthcare provider network. You may have the right to seek second opinions under certain circumstances.
If your work injury prevents you from working, whether temporarily or permanently, you may be eligible for wage replacement benefits. These help compensate you for lost income:
- Temporary Total Disability (TTD): Paid at two-thirds of your average weekly wage when you cannot work at all due to your injury.
- Temporary Partial Disability (TPD): Paid at two-thirds of the difference between your pre-injury and post-injury wages if you can work in a limited capacity.
- Permanent Partial Disability (PPD): A lump sum payment or weekly benefits based on the severity and functional limitations caused by your injury.
- Permanent Total Disability (PTD): Paid at two-thirds of your average weekly wage if your injury renders you unable to return to any gainful employment.
- Vocational Rehabilitation: If an injury impacts the employee’s ability to return to their previous job, vocational rehabilitation services may be provided to help them acquire new skills and secure suitable employment in a different field.
- Death Benefits: In the tragic case of a work-related fatality, eligible dependents, such as spouses and children will receive survivor benefits. This is paid to the spouse and/or minor children of the deceased worker, at a percentage of the deceased’s average weekly wage. These beneficiaries will also receive burial expenses in the form of a one-time payment.
The Claims Process
Here are the key steps you should follow when filing a workers compensation claim:
- Report the Injury: Employees must promptly inform their supervisor or employer of a work-related injury or illness, in writing, making sure to include all the details and circumstances of your injury. Delayed reporting may impact claim eligibility.
- Fill Out and Submit Form 18: The employee then files a Form 18 with the North Carolina Industrial Commission (NCIC). The IC administers the Workers’ Compensation Act and adjudicates claims. The form should be filed within 30 days of the date of injury or the date of your diagnosis.
- Contact a North Carolina Workers Comp Lawyer: An experienced attorney can help make sure all forms are filed correctly and on time and can handle the claim process on your behalf while you focus on healing.
If your workers compensation claim is denied, your employer or their insurance company will provide you with Form 61, within 14 days of our claim. In this case, you can request a hearing with the NCIC to further discuss your claim. You can do so by filing an official request for a hearing, under Form 33.
If your claim is approved, your employer or their insurance company will provide you with either Form 60 (Employer’s Admission of Employee’s Right to Compensation) or Form 63 (Notice to Employee of Payment Without Prejudice).
Important Legalities to Keep in Mind
- Employee Rights: Employees have the right to choose their own healthcare provider within a Commission-approved network. They also have the right to legal representation throughout the claims process.
- Employer Responsibilities: Employers must promptly report workplace injuries to the Commission and cooperate with the investigation. They are responsible for providing coverage through a licensed insurance company or securing self-insured status.
- Dispute Resolution: If disagreements arise regarding benefits or other aspects of the claim, formal hearings or mediation may be necessary.
Contact an NC Workers Compensation Attorney Immediately
No matter if your workers compensation claim has been denied or approved initially, you should still contact an experienced NC workers comp lawyer for help and guidance. Even if you received a Form 63, your benefits may still be denied, in which case a skilled attorney will fight on your behalf to protect your legal rights and get you the compensation you deserve.
Consult with experienced legal counsel at North Carolina Workers Comp Lawyers at 919-328-2336 for detailed guidance and assistance with specific situations.