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Going to work should be a safe, normal part of life. Unfortunately, the workplace can be dangerous, and thousands of people are hurt on the job every year. Whether you work at a desk or on a construction site, it is important to understand your rights if you get hurt at work.
Workers’ compensation helps protect employees and employers in the case of an accident or injury. Although this program is meant to help, it can often be confusing and make things more difficult for those who are injured. In response, we have assembled some frequently asked questions to help you as you consider your workers’ compensation claim.
A: Workers’ compensation is a type of insurance that North Carolina requires most employers to have. This insurance works similarly to other types of insurance, such as auto and home insurance. Every month, an employer pays a premium for insurance coverage. If a worker gets hurt while on the job, the insurance company will review the incident and pay for the damage. With this arrangement, both the employer and employee are protected from having to pay for expensive medical bills.
A: No. Workers’ compensation insurance only requires that you were doing something within the scope of your job when the injury occurred. This means that if you were doing something like walking to the bathroom, making copies, getting a cup of coffee, etc. when you were injured, you should still get workers’ compensation insurance.
You will not be eligible for workers’ compensation if you were doing something dangerous, illegal, or foolish and caused the injury. For example, you cannot play roughhouse with your coworkers and receive workers’ compensation for the injury that results. Similarly, if you are under the influence of drugs or alcohol while at work, or if you cause the accident on purpose to avoid work or collect payments, you will not be eligible for workers’ compensation.
A: Most injuries are covered by workers’ compensation. Injuries can be put into three categories: traumatic, gradual, or occupational.
Ultimately, a workplace injury occurs anytime a job causes, aggravates, or accelerates an injury or illness.
A: No. Part of the purpose of workers’ compensation insurance is that it protects employees and employers in the event of an accident. Because your employer has provided you with insurance coverage to help pay for any injuries, you cannot file a claim against your employer after a workplace injury in most cases. However, if your employer illegally prevents you from filing for workers’ compensation or does not have workers’ compensation when they should, you may be able to take some form of legal action.
These laws do not mean that you cannot hold anyone responsible for your injury. If a third party is involved in your injury, you can file a personal injury claim against them if they were acting negligently. For example, if your coworker fails to run their mandatory safety check and equipment malfunctions and breaks your arm, you can file a personal injury claim against your coworker. They were acting negligently by failing to perform their safety check responsibilities, and your injury was a direct result of their negligence.
You can file a personal injury claim against anyone involved except for your employer. This includes:
A: When you report a workplace injury, your employer should immediately file a report. They will likely ask you for details about what happened to help them complete the necessary paperwork. Then, they should supply you with the necessary information to file a workers’ compensation claim and walk you through the process. This can be done by your employer, a human resources representative, or someone in a similar position.
A: In North Carolina, you have two years from the time of your injury to file a workers’ compensation claim. This timeline accounts for injuries that appear slowly because of an accident. You may suffer an injury that gradually appears or compounds after the initial date, which means that you have sufficient time to report your injury before the window of opportunity closes.
If possible, it is always better to file a workers’ compensation claim as soon as possible. Although you technically have two years to do so, waiting to file only gives the insurance companies more opportunities to deny that your injury happened at work. If you report the accident right away, it is difficult for them to question the cause-and-effect nature of the accident and the injury, and they are obligated to take financial responsibility. If you wait, they could try to shirk responsibility by blaming someone else.
A: No, not legally. North Carolina law prevents employers from retaliating against employees who make a workers’ compensation claim, even if their claim is denied or they do not ultimately receive compensation. If you believe that your employer has broken this law, you should seek legal counsel right away.
You will have to prove that they fired you for that reason when they will likely use a different excuse to avoid legal ramifications. An experienced attorney can help you build your case.
A: Most employers in North Carolina are required by law to have workers’ compensation insurance. If a business has three or more employees, the employer should have workers’ compensation insurance. If a business has one or two employees, it is up to the employer whether they obtain workers’ compensation insurance. If they do not have it, they may be liable if someone gets hurt at work, including themselves.
A: All reasonable, necessary medical treatment should be covered by workers’ compensation insurance. In most instances, you will not have a difficult time having procedures covered after you have been approved. Be sure to get all referrals and recommendations from your doctor in writing so that you have proof that your medical care is necessary.
If you voluntarily choose to seek additional care such as massages or other similar procedures to make yourself more comfortable during your recovery process, it is unlikely that these costs will be reimbursed. If you have questions, you can always check with your attorney or your workers’ compensation insurance company.
A: In some situations, workplace injuries lead to permanent disabilities. There are several things that can happen in these cases, and your path ultimately depends on whether you can continue to work.
Temporary disability payments can help you recover. However, if your injury is permanent, you may be eligible for permanent disability payments. These can supplement your income and help you adjust to your new reality.
If you can continue to work with reasonable accommodations, you may be able to retain your job. However, if you have been prevented from doing other things, you may still be eligible for disability insurance. You may need to work limited hours to remain eligible for disability benefits.
In many cases, workers’ compensation may also have payment options for workers who were permanently injured in the workplace.
A: No. Just as with any insurance claim, workers’ compensation injuries must be reviewed and approved by an insurance adjuster. The individual adjuster in your case may find that you do not meet the requirements for workers’ compensation. For instance, if you were under the influence of alcohol at the time of your injury, the adjuster may deny your claim. They can also deny your claim if they believe that the injury happened outside of work, but you facilitated a workplace incident on which to blame your injury and collect workers’ compensation.
Unfortunately, if workers’ compensation denies your claim, you are financially responsible for your own medical bills, time away from work, and other expenses. This is a cost that few families can afford without notice. Even if you have medical insurance, the deductible may cause financial problems for your family.
Hiring an attorney can help you get your claim approved, appeal the process, and navigate your injury with every possible benefit. Our experts know how to go through these claims, and we often know about options that would otherwise be unknown to our clients.
A: The first step in creating a workers’ compensation claim is to report the injury to your employer. Your employer will have to make a report and review the situation. They likely will not prevent you from filing a workers’ compensation claim, but they do need to be aware of what happened for the process to move along. Your employer can also give you information about how to file a claim through their workers’ compensation insurance.
Before you file a claim with the insurance company, you should have an attorney represent you. This ensures that your statement does not ruin your claim and that the insurance company does not take advantage of your position.
A: In some cases, you may be able to go back to work while you are still under a doctor’s care for a workers’ compensation claim. Your ability to do so depends on your doctor’s opinion and recommendations. If you were hurt at work while doing something other than your day-to-day tasks, it may be entirely possible for you to do your job without causing yourself any further harm. However, if you have a repetitive motion injury or an injury that affects a part of your body that is necessary to your job, you may have to wait to be fully cleared by your doctor before returning to work.
Employers are required by law to provide reasonable accommodations to all employees who request them. Reasonable accommodations are any small changes that can help the employee do their job correctly and safely. For example, if you sprained your ankle at work and you are a cashier, getting a chair for your station may be a reasonable accommodation that will allow you to continue doing your job.
An unreasonable accommodation would be to ask your employer to give you entirely different tasks or a different role to allow you to keep working.
A: Yes. Unfortunately, employees do not always survive their workplace accidents. In these situations, workers’ compensation will be paid to the deceased’s family. Usually, these payments are equal to 75% of the worker’s average weekly income. For example, if your loved one made $4,000 per week, workers’ compensation would likely pay $3,000 per week if they died because of a workplace accident. These payments must go on for a minimum of 500 weeks. The payments should be made to the deceased’s direct dependents, usually their spouse and children.
Workers’ compensation insurance should also pay for funeral and burial expenses up to $10,000.
A: Not without an attorney present. Workers’ compensation insurance companies are businesses that have their own profits and interests in mind. The more they must pay for an injury, the lower their profit margins. Because of this, they will use every possible opportunity to avoid responsibility for an injury. If you give a statement without legal representation, you may inadvertently tell the insurance company something that implies fault or ruins your case. The insurance company may ask leading questions that cause you to relinquish your rights. It is dangerous to speak to insurance companies alone.
Unfortunately, insurance companies often use predatory tactics to protect their profits. They may have a private investigator follow you to ensure that your daily activities line up with your claim. Although this is more common in high-cost injuries, it can happen to anyone. When you have an attorney to represent you, you can make a statement that protects you, your family, and your workers’ compensation claim.
A: It is unlawful for businesses to use your accrued PTO, sick leave, or similar funds to pay for your workers’ compensation. In fact, your PTO should be unaffected by any time off that you must take because of a workplace injury. However, you may not continue to accrue PTO while you are out for a workers’ compensation injury. Otherwise, PTO and workers’ compensation should remain unrelated.
A: No. If you are eligible for additional programs beyond your workers’ compensation benefits, you must apply for them. This is one reason why having an attorney is so helpful in these situations. Not only can we help you navigate your workers’ compensation claim, but we can also help you determine whether you can get additional support. Injuries can be a significant financial strain, and additional support may be crucial for your family.
A: After your case has been approved, you should begin to receive workers’ compensation payments within 4 to 8 weeks. However, this does not mean that you need to wait that long for medical care. If you are being reimbursed for medical expenses, keep copies of all bills and payment records so that the insurance company can pay you back for any money that you spent out of pocket.
A: Although it is not legally required that you have a workers’ compensation attorney, it is in your best interest to hire one. There are many places in the workers’ compensation claim process that may alter or ruin the results of your case. Because financial support is so crucial during this time, it is unwise for you to risk the outcome by navigating your case alone.
Insurance companies often try to take advantage of workers who are making claims. Insurance companies are businesses whose bottom line is more important than their clients. They will try to avoid paying for your injury, even if it is legitimate, just to save money. They may even use extreme tactics to get out of their obligation to pay for your injury. An attorney can help protect you from the tactics of the insurance company and give you added security throughout your claim.
Finally, an attorney can help you determine if you are eligible for any programs outside of workers’ compensation. In some cases, injured workers are eligible for social security, disability, or unemployment benefits on top of their workers’ compensation support. Our attorneys have significant experience with these programs and can help you determine whether you are eligible for any and assist with the applications if you are.
A: In some situations, individuals perform their job duties while away from company property. For example, individuals who work for the postal service spend more time walking in neighborhoods than on USPS property. However, if you are performing your job duties, you should still be eligible for workers’ compensation benefits.
Unfortunately, getting hurt away from workplace property while still performing your job makes your claim a bit more complicated. In these scenarios, it is especially important for you to have a qualified workers’ compensation attorney to help you navigate your claim. You may have to provide additional evidence, which can be hard to obtain on your own.
A: The fault of the injury should not matter in your workers’ compensation case. If you caused the accident or injury, you should still get workers’ compensation. There are some exceptions to this.
If you were responsible for the injury because you made a mistake, you still get workers’ compensation insurance coverage.
In most cases, the person at fault for the accident is irrelevant. This is a major difference between workers’ compensation insurance and other types of insurance. However, if someone else’s negligence caused your accident, you may be able to file a personal injury claim against them on top of your workers’ compensation claim.
If you are facing a workers’ compensation claim, it is important that you have the legal support that you need to be successful. Our team is highly experienced in workers’ compensation cases and can provide you with the legal counsel that you need to receive a financial settlement. Although these cases are difficult, we are confident that we can represent you and achieve a positive result.
For more information about our services, please contact Ayers, Whitlow & Dressler online.
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