Workers' Compensation Frequently Asked Questions - Part Two

Workers’ compensation is a complex area of the law. In Workers’ Compensation Frequently Asked Questions - Part I, the basics of workers’ compensation were discussed, including exactly what it is. This article examines additional questions that often arise in the workers’ compensation arena. 

Can I go to any doctor?

North Carolina law requires that employees see a doctor designated by the employer. If you want to see a different doctor, you will have to contact the NC Industrial Commission and request a change of doctors. It is up to the Commission to approve the change. No medical treatment should be undertaken by a different doctor before getting approval. 

What payments can I get from workers’ compensation?

There are basically two main benefits available through workers’ compensation. Lost wage benefits and medical benefits. Lost wage benefits are referred to as temporary total disability (TTD) benefits. 

• Temporary Total Disability Benefits 

In North Carolina, employees are eligible to receive TTD benefits 7 days after the injury occurs. Therefore, if you suffered a minor injury that requires less than 7 days away from work, you will not receive workers’ compensation payments for lost wages for those 7 days. If you were forced to miss work for 14 days due to your injury, you would not get lost wages for the first 7 days, but would receive them for days 8-14. If the injury is more severe, and lasts longer than 21 day, then workers’ compensation will cover the first 7 days and beyond but you will not receive payment until after you are out of work 21 days or more.

Each year, North Carolina’s Industrial Commission sets forth a minimum and maximum TTD weekly payment. In 2021, the maximum weekly payment is $1,102. 

• Medical Bills

The insurer, or your employer if they are self-insured, has to pay for medical bills that will get you back to work and to heal your injury. It is important to understand that there is a statutory fee schedule applied to all medical payments which sets forth a maximum payment for treatments and services. By using your employer's doctor, it is more likely that that doctor has already agreed to accept the maximum payment. 

In addition to doctors bills, hospital bills, diagnostic imaging, blood work, and prescriptions, medical benefits include: physical therapy, occupational therapy and rehabilitation. 

If you are unable to return to your specific job, workers’ compensation may also cover vocational costs necessary to find a new job like job training, re-education and resume assistance. 

How much are temporary total disability benefits? 

Assuming that you have met the 7 day waiting period, and the insurance company or your employer approves your claim, then you are eligible for TTD payments. Generally, weekly benefits equal two-thirds of your average weekly pay over the prior 52 weeks. 

How long can I receive workers’ compensation payments for?

In North Carolina, employees are generally eligible to receive up to 500 weeks of benefits as long as they remain disabled. An extension can be requested but you will have to prove that you are still either fully or partially disabled. 

What if my injury was caused by a third party, not my employer?

If you were injured at work because of a third party, be it by their actions or defective equipment, you might have a claim against the third party who caused the harm. Claims against third parties arise most frequently under the theories of product liability and negligence. 

In the case of a third party suit, the workers’ compensation provider might have a lien against your claim. Meaning that they might seek to recover the costs of the medical treatment and lost wage payments from the third party. 

What if my loved one was killed in a workplace accident or because of an occupational illness?

North Carolina law does allow for funeral expenses and death benefits if an employee dies because of an occupational illness or a workplace injury. Typically a spouse or children will be entitled to TTD benefits, but the deadlines and determining who actually recovers the benefits are complicated and would best be discussed with a Charlotte, North Carolina attorney. 

Can I be fired if I file a workers’ compensation claim?

While no one can prevent you from being fired, it is illegal to fire someone because they filed a workers’ compensation claim. It is also illegal to demote, punish or discriminate against any employee who filed a workers’ compensation claim. 

If my claim is denied, can I sue my employer in court?

Unlike a typical personal injury case, you cannot go straight to court in a workers’ compensation case. Instead, workers’ compensation claims are handled administratively. The NC Industrial Commission is the administrative agency tasked with overseeing, and administering, workers’ compensation claims under North Carolina’s Workers’ Compensation Act. Claims should be filed with the NC Industrial Commission within 30 days of the injury. 

Similar to a court, the NC Industrial Commission does hold hearings which are similar trials. A Deputy Commissioner hears evidence and listens to witnesses and makes a determination about whether to award the injured party damages. Similar to a court, both the injured employee and the employer can appeal the Deputy Commissioner’s decision to the full NC Industrial Commission, which is generally 3 Commissioner’s acting like judges. Following the full commission's decision, either party can then appeal to the North Carolina Court of Appeals. 

Do I really need to hire an attorney?

You may think that you can navigate the workers’ compensation process on your own and you might be right, particularly if your injury is minor. However, there are a number of issues that can arise with workers’ compensation including having your claim denied, not getting your benefits timely, and an unresponsive insurer. A Charlotte, NC workers’ compensation attorney can help you navigate the process and avoid the pitfalls that commonly occur in workers’ compensation cases. 

Call Our Charlotte, North Carolina Workers’ Compensation Attorneys 

The Charlotte, NC lawyers at Rosensteel Fleishman Car Accident & Injury Lawyers are experienced workers’ compensation lawyers. They are available to discuss your injuries with you and help you navigate the legal process. Please contact our office at 704-714-1450. There is no fee for an initial consultation.