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Understanding The Workers’ Compensation Process In North Carolina

Although your financial standing may be frustrating after a workplace injury, it is very important to obtain treatment for the injury and work toward recovery. At Jay Gervasi, P.A., we assist clients through the process of obtaining workers’ compensation benefits so that they can focus on their recovery. With more than 35 years of legal experience and a board certification in workers’ compensation, we work to efficiently and effectively resolve your claim for benefits. Contact Greensboro workers’ comp attorney Jay Gervasi to ask about a free initial consultation.

First Steps After An Injury

IMPORTANT!!! You are required to do two things as soon as possible after an injury: 1) notify your employer and 2) file your claim with the Industrial Commission.

The deadline for filing with the commission is generally two years from the date of your injury, but determining the deadline can be complicated, and there are some exceptions, so you should not necessarily assume that your filing is late without checking with a qualified attorney. However, the best and safest policy is to file your claim as early as possible.

Note that papers your employer may file with the Industrial Commission are not the same as the ones you must file and will not satisfy your filing requirement.

How Accepted Cases Typically Progress

Most workers’ compensation claims are accepted as compensable by employers and their insurance carriers, and things go fairly smoothly — the worker receives medical treatment and, if unable to work, compensation for wages. In North Carolina, employers are given broad — but not unlimited — power to control which doctor provides treatment. When the injured worker is able to return to work, even if treatment is still ongoing, he is generally required to do so, if there is suitable employment available. While return to work is usually at the original job, sometimes it can be to a different, suitable job with the original employer or even with another employer. In the small percentage of accepted cases that do not go smoothly, return to work issues are often the reason. For more on this, please click here to go to the page on issues and injuries . If an injured worker remains unable to return to work, compensation is due for the duration of total disability. (The maximum duration of compensation for total disability has become complicated, with revisions to the Workers’ Compensation Act in 2011. Injuries before the effective date of those revisions allow for compensation for an indefinite time period. Injuries occurring after that date may be limited to 500 weeks of compensation, though some injured workers will qualify for longer periods. If your claim involves such long periods of time out of work, you should consult a qualified workers’ compensation lawyer.)

If an injury leaves the worker with permanent damage to a body part, the doctor will usually assign a rating of permanent impairment or disability, which allows calculation of an amount of additional compensation to which the worker may be entitled, without regard to wage loss. In most cases, compensation based on ratings is only meaningful if the worker is able to return to work. If an injured worker is able to return to work, but only at a reduced wage, he or she may have the choice of continuing to receive compensation based on the wage loss. The decision as to whether to return to a low-paying job has been complicated by the 2011 changes to the Workers’ Compensation Act, which extended the time that compensation based on wage loss can be paid, but also may have affected when injured workers will be required to accept low-paying jobs. If that situation comes up in your case, you should contact a qualified workers’ compensation attorney. For more, please click here to go to the page on issues and injuries .

Medical benefits are paid on a separate “track” and can go on indefinitely, even if the injured worker has returned to work. The benefit usually terminates if there is a gap of two years in treatment paid for by the employer or carrier, but there are exceptions to that, including the ability to ask the Industrial Commission for an order of future treatment. This is yet another issue about which a qualified workers’ compensation lawyer should be asked, if there are concerns. As a general rule, make sure you go to the doctor as scheduled and be sure that the employer or insurance company pays for treatment.

While most accepted cases do not require a lawyer, there are some that do, because there can be complicated issues that can affect an injured worker’s ability to receive the benefits to which he or she is entitled. If you have concerns, you should contact a qualified workers’ compensation attorney. Please click here for more information on when you might need a lawyer .

What Happens When A Case Is Denied

Workers’ compensation claims can be denied for a variety of reasons, ranging from simple credibility questions to complicated issues of whether the employment relationship existed, an accident “arose out of” the employment, or a condition constitutes an occupational disease. Regardless of the reason for the denial, it is still important to obtain medical treatment and work toward recovery and return to work. If there is a dispute you wish to litigate, you must file a separate hearing request with the Industrial Commission. If you expect to hire a lawyer to represent you, you should probably speak to him or her before you file for the hearing.

If you are planning on litigating your claim, you will probably need a lawyer. As an experienced North Carolina workers’ compensation law firm, we can guide you through the hearing and appeals process, including:

  • Filing your claim and requesting a hearing
  • Advocating for your rights through a mandatory mediation
  • Representing you at all stages of litigation that might be necessary, including your hearing before the Deputy Commissioner of the Industrial Commission, review before the Full Commission, and appeal to the North Carolina Court of Appeals and Supreme Court

Workers’ Compensation Settlements

Although a settlement can be reached during any phase of a claim, do not hasten to settle without consulting an experienced attorney. It is important that you and your doctor are certain that your condition has stabilized so that you can ensure that you receive accurate compensation. It is also important that the issues in your case have stabilized, or that your settlement takes into account continued instability.

There are two different types of workers’ compensation settlements. One type, generally referred to as a “clincher” agreement, ends the case completely. Clinchers are several typed pages, prepared by a lawyer hired by the employer or insurance company. The other type is called a “form” agreement, because it is made on a single-page form generated by the Industrial Commission. After a “form” agreement, it is sometimes possible to reopen a case when the injured worker’s condition changes and medical treatment is usually not affected so that it can continue after the settlement. The ability to reopen a “form” agreement does not mean that you can simply get more benefits if you need them. You must prove that your condition has changed, or the settlement remains final. Therefore, you should not fall into the trap of taking settlement on a “form” less seriously. It can end your case.

Both types of settlements are only valid after they are reviewed and approved by the Industrial Commission. However, the commission’s review is limited to evaluating for a minimum level of fairness. If you are thinking about settling your case and have any questions or concerns, you should consult a qualified workers’ compensation lawyer. You should be particularly careful before settling a case when you remain out of work.

Additional Questions About The Workers’ Comp Process?

To consult with an experienced workers’ compensation lawyer about your claim, contact our Greensboro workers’ compensation law firm.