The North Carolina Workers’ Compensation Act was developed to help people who were injured at work. Workers’ compensation helps injured workers and families who might otherwise struggle to cover the costs of daily living and medical expenses, while trying to recover from an injury.
Unfortunately, sometimes legitimate claims are denied. There are a number of reasons a workers’ compensation claim could be denied, but all workers are entitled to an appeal should he or she feel the decision is wrong.
If you’ve been injured at or through your work, you may be entitled to wage-loss benefits and medical expenses for the work-related injury. Contact our NC Workers’ compensation attorneys to learn more.
At the DeMayo Law Offices, our greatest reward is helping injured people and their families. We would be proud to represent you and your workers’ compensation claim.
Call us toll-free at (877) 333-1000 to schedule a free case consultation or tell us about the accident online to get started now.
What’s Covered by Workers’ Compensation?
Workers’ compensation reimburses medical expenses (past, present, and future) as well as any related lost wages. It doesn’t cover non-economic damages like pain and suffering, mental anguish, etc.
When injured workers collect workers’ compensation, they are no longer entitled to seek compensation from their employer through a personal injury claim.
However, it’s possible that an injured worker or surviving family member may be able to sue a third party whose negligence contributed directly to the injury or death. A third party, for example, is not the immediate employer but could be an equipment manufacturer or other business associated with the employment.
You may find that the workers’ compensation you receive for your injury or illness is much less than you were expecting or doesn’t cover your expenses. It’s important to contact an experienced injury lawyer should this circumstance arise. A workers’ compensation attorney will work with the employer and their insurance company to ensure benefits for the worker.
Have you been injured on the job? Call (877) 333-1000 to schedule a free consultation or tell us about the accident online.
Occupational Diseases Covered by Workers’ Compensation
Certain medical conditions are specifically identified as workplace exposure diseases, and are listed in North Carolina General Statute 97-53. These include:
- Mercury poisoning
- Radium poisoning due to radiation exposure
- Hearing loss caused by workplace noise
- Miner’s nystagmus
- Sulfuric, Hydrochloric, or Hydrofluoric acid poisoning
- Carbon monoxide poisoning
- Certain cases of lead poisoning
- Manganese poisoning
- Zinc poisoning
- Brass poisoning
- Phosphorus poisoning
- Blisters caused by pressure or use of tools during employment
- Synovitis and tenosynovitis
- Bone felon caused by pressure
- Smallpox infection from vaccinations
- Diseases caused by exposure to chemicals
- Undulant fever
- Compressed air illness
- Epitheliomatous cancer
- Benzol poisoning
If an employee has developed one of these conditions, it is presumed that the workplace increased their risk of developing the disease.
Steps to Report A Work-Related Injury
There are several steps you must take to report your injury in order to apply for workers’ compensation benefits:
- Report the injury or condition to your employer and get medical treatment. Your employer may have a health care provider on-site, or they may direct you to a doctor. Either way, you must have a medical diagnosis to present a claim.
- Inform your doctor that the injury is related to your employment, and name your employer, so that the health care provider can bill your treatment under workers’ compensation.
- Inform an appropriate manager that you’ve suffered a workplace accident as soon as possible.
- Give written notice to the employer of your accident within 30 days. A letter describing the injury and including the date of the accident is sufficient. Keep a copy of this letter for your own records.
- Follow all of your doctor’s treatment instructions, including any physical therapy or medication requirements.
It’s very important to keep detailed medical records, as well as other evidence such as photographs and receipts for medical care.
What Happens If a Claim Is Denied?
There are several reasons a legitimate claim could be denied or limited. The most common reason is that injured workers fail to meet the state deadlines for filing or forms aren’t properly completed.
Other reasons a claim could be denied include:
- Missing forms or documentation
- Lack of credible evidence (i.e., medical records, witness testimony, etc.)
- Disputes with the employer or insurance company
- The injury isn’t severe enough to qualify
In North Carolina, any injury or illness must be reported orally and in writing to the employer within 30 days of the accident. Workers will also need to formally file the claim (Form 18) with the North Carolina Industrial Commission. This form establishes a legal claim of injury on the victim’s behalf and must be filed within two years of the injury.
Decision letters are mailed approximately two weeks after the claim is filed. If you receive a letter from the Commission denying the claim, note the appeal deadline, and contact a workers’ compensation lawyer immediately.
In order to appeal the decision, you must first notify the Industrial Commission of your intent to appeal within 14 days of the denial. You will attend a mediation conference with your attorney, and the mediator will make a recommendation based on the evidence in your claim. The appeal process will start with a hearing with a judge, and it will require organization and evidence gathering to ensure a fair outcome. Presenting detailed medical records and other evidence can be key to your success at this step. It’s very important to have an attorney who is experienced with workers’ compensation appeals, as the process can be complex.
Workers’ compensation laws are complex, but you don’t have to fight for the benefits you deserve alone. With four convenient locations throughout North Carolina, the DeMayo Law Offices are dedicated to helping injured workers maximize their benefits.
Call us toll-free at (877) 333-1000 to schedule a free case consultation or tell us about the accident online to get started today.
Frequently Asked Questions About Workers’ Compensation
Your workers’ comp attorney is the best source for information about your claim, but here are some answers that may help you with the questions you may have.
Is there a waiting period to receive benefits?
In North Carolina, you must wait seven days after your injury before you start receiving benefits, unless your disability lasts for at least 21 days. If you miss 8 to 21 days of work, you will receive benefits for those days. If you miss more than 21 days of work, you will receive benefits for the entire time, including the first week of your injury. The compensation rate for wage benefits is two-thirds of your average weekly wage (AWW). Medical benefits are paid immediately following the injury, with no waiting period.
How long will my benefits last?
For injuries that occurred before June 24, 2011, there is no time limit. For later cases, benefits can continue for up to 500 weeks, with a possible extension in certain circumstances. Benefits stop when you return to work or when your employer files an Application to Terminate Benefits with the Industrial Commission.
Who chooses my doctor in a workers’ compensation case?
Your employer has the first opportunity to choose the doctor who treats you. You may request a change in doctors from the Industrial Commission if you can show that a change is necessary to cure your condition or help you return to work. You may also ask another doctor for a second opinion on your injury.
Does workers’ compensation cover mental health conditions?
Certain mental health conditions may be eligible for workers’ compensation benefits if they arise from your employment. North Carolina workers’ comp laws are relatively restrictive in this respect. You must be able to prove that you developed a mental condition, such as anxiety or depression, as a result of a specific workplace accident. The general stress you experience in your everyday job would not count, even if it caused you to develop a mental condition.
If a family member dies on the job, can I collect workers’ compensation for them?
If the death is related to a workplace injury or a disease acquired in the course of employment, you may be able to collect if it is within six years of the date of injury or onset of disability, or within two years from a final determination of disability. You should discuss this situation with an experienced workers’ compensation attorney.
What employees are exempt from the North Carolina Workers’ Compensation Act?
Certain employees are not eligible for workers’ compensation under North Carolina law. These include casual employees who don’t work regular hours, domestic or household employees, farmworkers on farms with fewer than ten employees, certain railroad employees, and employees of the federal government. Federal employees are covered under the Federal Employees’ Compensation Act.
Can I receive workers’ comp if I contracted COVID-19 on the job?
It is possible to receive benefits if your employment exposed you to COVID-19. You must prove that your work exposed you to a greater risk than that of the general public, and that your job exposed you to the disease. To establish an injury by accident claim, you must show that you contracted COVID-19 as the result of an accident arising out of your employment.
What North Carolina Workers Need to Know
Workers’ compensation functions like insurance. However, collecting these benefits prohibits a worker from suing his or her employer for injuries.
To receive workers’ compensation, you have to be employed at the time of the injury, and the injury must be a result of the employment. In other words: injuries must be caused by whatever tasks are required by the job.
This rule also extends to illnesses sustained while working (e.g., lung cancer or mesothelioma) and cumulative trauma such as carpal tunnel syndrome. Benefits can be provided temporarily while the injury heals or provided in perpetuity, depending on the circumstances.
Workers’ compensation claims are awarded based on strict liability: this means fault or negligence doesn’t have to be proven or assigned to a particular party in order to collect benefits.
All North Carolina employers who employ three or more workers must obtain workers’ compensation insurance or qualify as self-insured employers. If an employer fails to provide this coverage, they could face stiff financial penalties or be charged with a misdemeanor or felony and possibly imprisoned. All injured workers who qualify are entitled to workers’ compensation, and neglecting to provide these benefits is a criminal offense.
Contact A Workers’ Compensation Attorney
Do you have questions about a denied workers’ compensation claim? The workers’ compensation attorneys at DeMayo Law Offices are here to help. We can guide you through the process from start to finish, so that no detail is missed. The success of workers’ compensation claims often depends on providing accurate and complete information, according to strict deadlines. Our firm has decades of experience helping clients obtain the compensation and benefits they deserve for their injuries. We take pride in our ability to serve all our clients with personalized care and top-quality legal advice.
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