Aside from fatal injuries, one particularly devastating type of workers’ compensation claim is for injuries that result in the loss of function of body parts. Sustaining such severe injuries not only affects a person physically, but in many cases, mentally, emotionally, and often, financially. Losing a function of a body part may prevent a person from going back to the same job that they were working prior to the injuries, and may require numerous accommodations in order to pursue a decent livelihood. Some accommodations can include retraining in order to work, prosthesis, wound care, home modifications, and vehicle modifications. What is most frustrating is these issues all require time and money. In particular, an individual may be struggling with lost wages from the inability to work and an increase in medical bills.
Fair compensation for the loss of use of a body part is governed by N.C.G.S. §97-31. This is a schedule of injuries, rate and period of compensation, for permanent injuries to certain body parts a person is entitled to, whether there is actual wage loss or not. In this context, permanent disability applies to permanent damage or to loss of some part of the body after the stage of maximum improvement from medical treatment has been reached and the condition is stationary. Therefore, an employee with a permanent injury to one or more of these body parts is entitled to Permanent Partial Disability benefits even if they return to work at their pre-injury wage.
Under North Carolina Workers’ Compensation laws, there are two types of permanent partial disability—scheduled losses and nonscheduled losses. As mentioned in N.C.G.S. §97-31, scheduled losses are specific losses listed in the workers’ compensation statute such as loss of an eye, a finger, a hand, an arm, a toe, a foot, or a leg. §97-31 lists the specific loss, the number of weeks of compensation payable for that particular loss, with a percentage of the average weekly wage to be paid during the period specified.
When a worker faces an injury that is specified on the scheduled list, the authorized treating physician will assign the disability a “rating” to the body part at the end of the healing period, known as Maximum Medical Improvement. Physicians rate injuries according to percentage of impairment of the affected part. Under North Carolina Workers’ Compensation laws, a “Rate Guide” is provided as a reference point for physicians making impairment evaluations. However, in making rating examinations of individuals who have had industrial injuries to their spine or extremities, there are many intangible factors that cannot be stereotyped, such as pain, weakness, and dexterity. As such, it is often re-emphasized that the Rate Guide is intended to be used only as a guide by physicians, and the final rating of impairment should be entirely the examining doctor’s independent opinion based on his/her knowledge, experience and clinical examination.
In sum, the amount of the Permanent Partial Disability rating payment considers three main factors: (1) the rating assigned by the doctor, (2) the number of weeks assigned in §97-31 for the injured body part, and (3) the injured workers’ compensation rate. This means that a worker who injures there back may be rated as follows: 10% as rated by the physician x 300 (which is the number of weeks assigned in §97-31 for a back) x $400 for the employee’s compensation rate = $12,000.
For nonscheduled losses, or loss of or permanent injury to any important external or internal organ or part of the body for which no compensation is payable under any other subdivision of the North Carolina Workers’ Compensation Act, the Industrial Commission may award proper and equitable compensation up to a certain limit. N.C.G.S. §97-31(24). As stated in the Workers’ Compensation Act, an injury could include damage to eyeglasses, hearing aids, dentures, or other prosthetic devices which function as part of the body. However, as the Act employs the word “may,” the decision regarding compensation for loss of, or permanent injury to, an organ, is within the discretion of the Industrial Commission. The amount of compensation also rests in the sound discretion of the Industrial Commission, and its decision will not be overturned on appeal absent an abuse of discretion on its part. An abuse of discretion is shown where the decision is proven to be manifestly unsupported by reason.
For nonscheduled losses, to support an award under the North Carolina Workers’ Compensation Act catchall provision, the record must contain evidence as to the value of the organ or body part in question to the body of the individual bringing the claim. This could result in more or less an amount of compensation for an individual with existing physical conditions that make them more susceptible to injury.
For example, in a 2000 case in North Carolina, Aderholt v. A.M. Castle Co., the Plaintiff was involved in an accident with a logging truck while working as a salesman for defendant-employer. While traveling pass the truck on a two-lane road, a dangling chain from the truck struck the Plaintiff’s car, and with such force, mangled his arm, penetrated his chest, punctured his diaphragm, and ruptured his stomach. After several surgeries, the Plaintiff, nevertheless, lost virtually all use of his left arm and hand. Further evaluations reported damages to the Plaintiff’s spleen, to which the Industrial Commission awarded the Plaintiff $20,000. The Defendant argued that the award for the loss of Plaintiff’s spleen was excessive because the spleen does not serve as an important organ and its function to the human body is somewhat illusive. However, the physician testified that the spleen filters the blood and protects the body from bacterial infection. Therefore, because of the Plaintiff’s already vulnerable physical condition and increased risk of infection, the Commission’s determination for the Plaintiff that the spleen was an important internal organ required proper and equitable compensation.
For both scheduled and nonscheduled losses, payment must be approved by the North Carolina Industrial Commission, pursuant to Industrial Commission Form 26A. Payments are typically made in lump sum, however, they are occasionally paid weekly for the appropriate number of weeks. The payment immediately stops any other ongoing disability payments, but does not terminate related medical benefits. Under N.C.G.S. §97-47, receipt of payment of a disability rating starts the clock on a two-year deadline for a change in condition. Meaning, if an injured worker experiences changes in their condition, they will have two years from the day they receive payment to file a notice to the Industrial Commission, or face forfeiting their right to additional wage replacement benefits.
Because an injured worker is allowed to elect the best disability “remedy” for his or her particular situation, it is best to consult an experience attorney to discuss the most appropriate disability option.
If you or a loved one have been injured on the job and are considering accepting payment of a disability rating in your North Carolina Workers’ Compensation claim, please contact our us at (704) 714-1450 to discuss your claim. There is no fee for an initial consultation.