FAQs: Workers’ Compensation
What must an employee do when an injury occurs?
Who provides and directs medical treatment?
What should I do if my employer doesn't acknowledge my injury or doesn't send me to a doctor for treatment?
What are the rules for chiropractic treatment?
Do I have to go to the doctor where the insurance company sends me?
When do I become eligible for lost wage compensation?
At what rate of pay are wage compensations made?
Two-thirds (or 66.6 percent) of the average weekly wage, not to exceed a maximum, calculated based on the year you were injured. This number is known as the maximum comp rate. It is $904 for 2014 and $920 for 2015.
How long is the employee eligible to receive lost-time weekly benefits?
Are travel costs, such as mileage, to doctor's appointment reimbursed?
Do I get compensation for pain and suffering?
What is partial disability?
Who determines partial disability?
Who is required to provide workers' compensation coverage?
What happens when the employer refuses to acknowledge a workers' compensation claim?
Who is my employers workers' compensation insurance carrier?
Do I need an attorney?
Workers’ compensation is a complex and ever-changing legal system. An attorney who regularly practices in this area can help you navigate this complex system and ensure that you’re getting the full range of benefits and treatment available to you under the law. You should especially consider hiring an attorney if:
- Any part of your case has been denied.
- You are not receiving medical treatment.
- You are out of work without any income.
- You have an accepted claim but are unable to return to your previous work position.
- You are dissatisfied with your current medical treatment.
- You have been terminated.
- You have been released to return to work but do not feel capable of doing so.
- You have a significant injury claim that will result in a permanent disability.
What kind of attorney do I need? How do I choose an attorney?
Many attorneys say they handle workers’ compensation cases when, in fact, they do not have the experience, or the knowledge, to help you navigate through this complicated process. Look for an attorney whose primary focus is workers’ compensation and who regularly handles these kinds of cases, as we do at the Deuterman Law Group.
We suggest you choose an attorney who is a board certified specialist in workers’ compensation law by the N.C. Board of Legal Specialization.
A good attorney will:
- Monitor medical treatment.
- Make sure you receive the best medical treatment possible.
- Make sure your weekly checks are on time and that you are receiving the correct amount of money every week.
- Ensure you are receiving all benefits to which you are entitled.
- Advise you on options regarding returning to work, and/or dealing with restrictions and your employer.
How is my workers' compensation claim settled?
There are different ways to “settle” workers’ compensation claims:
- Clincher Agreement: A clincher is a compromise settlement agreement. Once you’ve signed this agreement, you give up all rights to future workers’ compensation benefits for the particular injury in exchange for a sum of money.
- Forms 21 and 26: If you sign one of these forms, your workers’ compensation case may remain open but you will be giving up certain rights and the rights you retain will be limited in time. An experienced attorney can help you decide whether you are making a decision that is best for you.
- Mediation: Mediation is often an effective tool to reduce the costs, risks and delay of litigation. A mediation is a conference between some, or all, of the parties involved in the case, including:
- injured employee
- workers’ compensation insurance carrier
- attorneys for both parties
- a third party, a mediator, selected by agreement of the plaintiff (employee) and defendant (employer and insurance company), who comes to the conference to hear both parties’ versions of the case, and then tries to help the parties reach a compromise on the matter.
In mediation, the mediator then goes back and forth between the parties carrying offers and demands, as well as facilitating discussion on the issues in the case, discussing the applicable case law, etc. If the parties are able to reach an agreement, then a Memorandum of Settlement is signed and the case is officially settled. If the parties do not reach an agreement then, assuming there remain contested issues, the case moves on to a hearing in front of a deputy commissioner of the North Carolina Industrial Commission.
How does workers' compensation affect my Social Security benefits?
What happens at a workers' compensation hearing?
In the workers’ compensation practice, a hearing is a formal presentation of the case by all interested parties in front of a deputy commissioner of the N.C. Industrial Commission. This person may also be referred to as a judge. The Deputy Commissioner presides over a trial of the issues, and renders a decision on the claim. An order is typically issued as follows:
- Parties have 60 additional days to take any medical doctor (expert) depositions, followed by another 30 days to draft contentions and submit a proposed opinion and award.
- Contentions drafted by the parties are written closing arguments on the case, which discuss case facts, case law and present arguments on behalf of their client.
- A proposed opinion and award that each party drafts, discloses what the party feels the deputy commissioner should find as Findings of Fact in the case, legal conclusions and what the award should be in the matter.
- The deputy commissioner reviews both parties’ submissions, and then enters an Order of the Court, ruling on the matter.
The biggest difference between mediations and hearings lies in who has control over the result of the case. At mediation, the parties each have input and a degree of control over the result in the case whereas at a hearing, the judge makes the sole determination of the outcome.