A Guide to Your Rights Under the North Carolina Workers Compensation Act

1. Are you protected? The North Carolina Workers’ Compensation Act was created to protect workers who have been injured on the job. However, only certain employers are required to maintain workers’ compensation insurance. To determine if you are covered, ask yourself the following questions:

1. does your employer regularly employ three or more employees in the same business or establishment?
2. b. If you are an agricultural worker, does your employer regularly employ 10 or more full-time nonseasonal workers?

Those who are not covered:

1. Residential domestic workers
2. Independent contractors
3. Workers employed only on a casual basis to do work unconnected with an employer’s business
4. Railroad workers, maritime workers, and Federal employees. All of these groups are covered by separate State or Federal laws.

2. If I was hurt while at work, does that mean I am automatically covered? Not necessarily. The Workers’ Compensation Act covers the following types of injuries:

1. injuries that occur due to accident;
2. back injuries that occur as the result of a specific traumatic incident
3. occupational diseases. It does not cover situations where you may be experiencing pain due to performing your job duties for an extended period of time. For example, an insurance carrier may deny a back claim if the problem was caused by prolonged heavy lifting over an extended period of time.

3. What should I do if I have been injured on the job? If you have been injured on the job, you should immediately, if physically able, report the injury to your supervisor. You should mention the time and date of the injury, the manner in which it occurred, and the nature of the injury. In regard to occupational diseases, if you have been informed by a doctor that you have a disease or condition which is related to or caused by the job, you should report this information to the employer as well.

After reporting the injury to the employer, you should request a North Carolina Industrial Commission Form 18 from either the employer or the Industrial Commission. Once completed, keep a copy for yourself, then give one copy to your employer and return one to the Industrial Commission.

4. If I did not report the injury immediately, how long do I have to report it? In this situation, you must give written notice of a claim as soon as possible after the occurrence of the injury (preferably within 30 days). The best way to do so is via the Form 18 previously mentioned. This Form can be filed up to within two years past the date of the injury or within two years of the time the employee is told by a physician that they may have a job related condition or disease. If a Form 18 is not filed within the specified time frame, you run the risk of having your claim time barred.

5. If the insurance company accepts my claim, what happens now? There are several benefits that are available under the Workers’ Compensation Act. These include the following:

1. Medical expenses during your healing period. These services may include medical, surgical, hospital, and nursing services; medical and surgical supplies; rehabilitation services; artifical limbs and other prosthesis; some chiropractic services; prescription medication; and travel of more than ten miles one way for medical appointments.
2. If you are injured seriously enough that you are unable to work, you may be entitled to temporary total disability benefits for time missed from work. You will not receive anything for the first seven days out of work, but will begin receiving out-of-work benefits on the eighth day. If your time out of work exceeds twenty-one days, however, the insurance carrier must go back and pay you for these first seven days. You should also remember that to be eligible for these benefits, you must be written out of work by the doctor you were sent to by the insurance carrier. If you are written out of work by some other doctor (such as your family physician), the insurance carrier is not required to pay benefits based on their opinion.
3. Once healed, you may have work restrictions that prohibit you from returning to your previous employment. If so, the insurance carrier may elect to provide vocational rehabilitation services which are designed to find new employment that pays reasonably close to your prior wage and accommodates any permanent work restrictions caused by your injury. During this job hunting period, the insurance carrier continues to pay temporary total disability benefits.
4. Future medical treatment. If your injury occurred after July 5, 1994, your right to payment for future medical treatment ends two years after the date of last payment of any compensation including medical compensation. This time can be extended by filing an Industrial Commission Form 18M before the end of the two year time period, and the form is approved by the Commission.
5. Permanent partial impairment rating. Once the treating doctor feels your condition is not expected to improve or worsen significantly in the future, then he or she has reached a point of “maximum medical improvement” which is considered the end of the healing period. At this point, the doctor may assign a percentage rating to the body part that was injured. There is a statutory schedule of benefits which can be used to calculate the dollar amount of that rating.

6. What happens if the insurance carrier denies my claim? If the insurance carrier has denied your claim (and you have filled a Form 18 within two years after your date of injury), you may file a Request for Hearing through the use of an Industrial Commission Form 33. The parties are then ordered into a process known as mediation where the parties attempt to work out a voluntary settlement. If the claim is not settled though mediation, it is then referred to a Deputy Commissioner, a judge with the Industrial Commission, for a hearing. Evidence is presented in open court through live testimony of witnesses. Medical records are usually stipulated into evidence and any medical testimony that needs to be taken from any doctor is usually done through deposition after the hearing. After depositions have been completed, the Deputy Commissioner makes a decision by issuing a written Opinion and Award. Both sides have the right to appeal this decision to the Full Commission (a panel of three Commissioners) if they are unhappy with the outcome.

7. Can I sue my employer for negligence? Generally, an injured worker’s rights are limited to his or her workers’ compensation rights and there is no right for the injured worker to sue his or her employer. However, an injured worker may have the right to sue an employer who acted intentionally and knew that the action was substantially certain to cause serious injury or death, but this is a very rare situation and has been extremely limited by the Appellate Courts.

8. Can I collect for pain and suffering caused by my injury? Generally speaking, the pain and suffering you have endured due to a work related injury is not compensable under the Workers’ Compensation Act.

9. Should I hire a lawyer? Whether or not you hire an attorney is a personal decision that may be influenced by several factors. If your injury causes you to miss a few days of work and results in no long lasting problems, you may very well decide to handle your claim yourself. However, if your injury is more serious or if you feel uncomfortable dealing with insurance companies, you may be inclined to seek legal representation. Regardless, by understanding the information provided in these materials, you are on your way to making sure you receive everything to which you are entitled.

BACK WORKERS FAQs