Answers To Frequently Asked Questions About Workers’ Compensation
In North Carolina, workers’ compensation requires you to have sustained an injury by accident arising out of and in the course and scope of employment. That means:
- An “injury” is an acute injury as compared to a gradual wearing out or gradual pain
- An “accident” Is generally considered to be an unusual occurrence such as a slip, trip or fall. However, an unusual occurrence can also be working faster than normal, lifting a heavier weight than normal, or straining more than normal.
- “arising out of and in the course and scope of employment generally means you are engaged in work duties when the injury occurs, however injuries on the employer’s property or parking lot can also qualify.
Each circumstance of injury is unique so claimants are encouraged to call for a no-cost consultation to let our staff evaluate your claim thoroughly.
What Benefits Am I Entitled To?
- Weekly benefits: If your claim is accepted or found to be compensable you are entitled to weekly benefits equal to 66% of your average weekly wage for up to 500 weeks from the date of injury.
- Average weekly wage is calculated at your total earning for the 52 weekly preceding your date of injury, including all overtime, bonuses and shift differentials.
- Medical coverage: Unlimited 100% medical coverage for all medical needs, including prescriptions, with zero deductibles or co-payments
- The insurance company does have the right to direct your medical care and select the doctors who treat you.
- You do have the right to request an Independent Medical Evaluation and/or a Second Opinion for your disability rating.
- Travel mileage: Reimbursement for mileage to and from the doctor, physical therapy and other medical appointments at the rate of $.575 per mile if your roundtrip travel exceeds 10 miles in each direction.
- Permanent disability rating: Once you reach maximum medical improvement your doctor should give you a permanent impairment rating based on your injury, surgery if any, and loss of function. You will then be entitled to be paid for such disability rating if you have returned to your pre-injury earning rate. If not, you can elected to receive wage loss benefits instead of being paid for your impairment rating.
- Wage loss benefits: If you return to work but are not able to return to your normal job or pre-injury weekly wage then you may be eligible to receive two-thirds of any wage loss for up to 500 weeks.
- Retraining: If you have physical limitations which prohibit you from returning to your regular job or pre-injury earnings rate you may qualify to retrain to the career of your choice to return you to 75% pre-injury earnings.
How Does The Hearing Process Work?
If your claim is denied or you are not receiving all the benefits you are entitled to you may request a hearing before the North Carolina Industrial Commission by filing a Form 33. The insurance company will then have 30 days to file a response. The Commission will then order the parties to participate in a Mediated Settlement Conference with a neutral mediator in an effort to reach a resolution of the issues without the necessity of a full evidentiary hearing.
If the parties cannot reach an agreement, the Commission will place the matter on a hearing calendar to have a full hearing before a Deputy Commissioner. The insurance company will have an attorney present and you or your attorney will be able to call witnesses and present evidence.
The Deputy Commissioner usually does not render a decision at the hearing. Rather he will give the parties an opportunity to take the depositions any necessary doctors. After the conclusion of the depositions, the Deputy Commissioner will give the parties 30 days to submit their final “contentions” or written argument. After this, the Deputy will render and file a formal decision within 90-180 days.
Can I Appeal The Decision?
Either party can then appeal initially to the Full Commission which is a three-judge appellate panel at the Industrial Commission. This will then require submission of formal briefs and appearance at an oral argument after which the Commission will render a formal decision within 90-180 days. Either party can then appeal again to the N.C. Court of Appeals which will require a brief, oral argument after which an appellate decision is rendered.
Do You Still Have Unanswered Questions? Call Us.
At Ganly & Ramer, P.L.L.C., it is our goal to help our clients get the medical attention they need and the compensation they deserve. If you still have unanswered questions about workers’ compensation, give us a call at 828-348-6957 or send us an email. We are proud to serve clients across North Carolina from our office in Asheville.