Is my injury covered by Workers’ Comp?

How do I know if my injury should be covered by Workers’ Comp?  Whether your injury should be covered, or actually is covered, are two different questions. If the system worked the way it was supposed to, I wouldn’t have a job, and the insurance companies would do what they should in every case. But this isn’t fantasy land, it is real life.  Here are the type of injuries that SHOULD be covered by Workers’ Comp in North Carolina:

  1. Injuries by accident, arising out of and in the course of employment. If however, you are engaging in your “normal work routine” when you are injured, the injury may not be compensable.
  2. Back Injuries as a result of a specific traumatic incident are also considered compensable.
  3. Occupational Diseases are considered compensable.  NC Statute 97-53 sets out 27 specific diseases which are compensable.  In order to recover for an occupational disease claim, you must be diagnosed with a covered disease, and the disease must have been attributed to your employment.
There are many instances where a worker is injured in the normal scope of his or her employment, and thus has not suffered an “injury by accident“.  Oftentimes, in these cases the employer/insurance company will deny the claim.  However, it is important to review your medical records and determine whether you have also suffered an occupational disease or back injury as a result of a specific traumatic incident, in which case your claim may very well be compensable.
Any variation from the normal, regular work routine may be sufficient to constitute an “accident” at the workplace.  These cases can become very fact-intensive, and the only way to know for sure whether your claim is compensable is to consult a Workers’ Comp Attorney for an initial consultation.  Please feel free to call our office at 919-460-5422 if you have any questions regarding whether you have suffered a compensable claim.

Injured at Work? Have you applied for Social Security Disability Benefits?

If you are injured at work in North Carolina, you should give some serious thought to applying for Social Security Disability Benefits, in addition to filing for Workers’ Compensation Benefits.  Here are a couple of reasons why:

  1. Filing for Social Security Disability will not adversely affect your Workers’ Compensation.  In some cases, you may be entitled to receive more benefits from Social Security than you would from workers comp.
  2. If your workers comp benefits are stopped or delayed, then you will have your social security disability checks to fall back on while your workers compensation attorney works to restart your checks (which can take 3-4 months, or longer).

The bottom line is that if you are injured at work, you may need to rely on several different sources of income to sustain you until you are able to work again.  For many people, workers’ comp is the main source of income, but Social Security Disability is another income stream, along with long term disability insurance (which you may have purchased through your employer, or privately).

One of the frequent questions I get from clients is:

Will I qualify for Social Security Disability Benefits?

In order to qualify for Social Security Disability Benefits, you must meet the following criteria:

  • You must be age 18 or older;
  • You must have worked and paid social security taxes long enough to qualify;
  • You must have a medical condition that has prevented you from working or is expected to prevent you from working for at least 12 months or end in death, and;
  • You must reside in the United States or one of its territories/commonwealths.

At first glance, these seem like easy and straightforward criteria.  However, there are a number of tricks and hurdles that can trip you up along the way.  Most denied claims are due to a technicality that could be prevented.  It is not necessary for you to hire an attorney to assist you in applying for benefits, but talking to an attorney before you apply can go a long way towards getting your claim approved.

It can take a long time and several applications before you are approved for Social Security Disability – if you feel that you may be out of work for an extended time, call our office to inquire about applying for benefits today.

Workers Compensation Benefits – An Overview

You can also find a copy of this article on Workers Comp Benefits under the “Start Here” heading on the navigation bar…  I thought I would post it here for those that subscribe to my RSS feed.  (If you are not already, you probably should!)

Workers Comp Benefits take several forms in North Carolina.  It is important that you understand the different types of benefits that you might be entitled to, so that you can be informed when it comes time to settle your case.

The major Workers Comp benefits that you are entitled to if you are injured in an accident at work in North Carolina include having the insurance company pay your medical expenses (this is often the biggest benefit), as well as receiving a weekly check that amounts to 2/3 of your “Average Weekly Wage”.  We’ll take these one at a time:

Medical Expenses as a Workers Comp benefit:  When you are injured in a workplace accident, the insurance company is required by law to pay for your medical expenses that are associated with that accident.  These may be expenses for various treatments that are designed to cure the injury or relieve you from pain, or they could be for prescription medications.  You should be aware that there is no deductible, no co-pay, and no requirement that you miss work to receive these medical benefits.

As you will see in other areas of this website, the insurance company, if they accept your claim, has the right to direct your medical care.  This means that they can pick your doctors.  However, if you feel that the doctor is biased, or that they are releasing you to do more work than you feel you can physically do, then you have the right to a second opinion with a doctor of your choice – which the insurance company or employer must pay for.  If the insurance company balks at this, which they frequently do, then you have the right to request a hearing before the NC Industrial Commission to resolve these issues.  You should also know that if you go two years without receiving medical treatment that is paid for by the workers comp insurance carrier than you run the risk of losing your medical benefits forever.

Weekly Disability Payments:  The second type of Workers Comp benefits you could receive after you have been injured in an accident at work involve weekly disability checks.  These checks will traditionally pay out at 2/3 of you Average Weekly Wage.  There are two types of checks you could receive:

  • Temporary Partial or Total Disability Checks.  When your doctors orders you to stay out of work for longer than 7 days, then you are entitled to receive Temporary Total Disability checks at 2/3’s of your Average Weekly Wage amount.  After you have been out for three weeks, then by law you are entitled to the first week as well.  Temporary Partial Disability only comes up where you are able to work, but you have to cut your hours and are unable to earn the same amount as before the accident, in which case you are entitled to 2/3’s of the difference between your average weekly wage and what you are earning now – but only for 300 weeks.
  • Permanent Partial or Total Disability Checks.  Once you have been declared permanently partially disabled by your doctor, they will assign a disability rating.  Your benefits will then be determined using a formula which factors in the average weekly wage, the part of the body that was injured, and the disability rating assigned by the doctor.  As of right now, injured workers are entitled to lifetime benefits if they are permanently and totally disabled.  (The insurance companies want to limit this – click here for more information about what you can do to stop them).

There is one other Workers Comp benefit that you should be aware of – the “Clincher” Agreement.  In some cases, workers are offered a lump sum amount to settle their case.  If you agree to a clincher, do not do sue without carefully weighing all of your options with your attorney.  When you sign a clincher, you are frequently agreeing to not pursue additional benefits or reopen the case should your condition worsen.  This may also mean giving up all of your medical benefits – which is often a huge benefit if you are unable to obtain group health coverage after your case is completed.