THE WORK COMP BLOG

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Workers' Compensation Claims: Three things that can happen

Three (3) things can happen if you file a workers’ compensation claim. The insurance carrier may accept the claim and pay your medical bills and send you weekly checks, which are two-thirds of average weekly wage over the last fifty-two (52) weeks. The carrier may agree to pay only medical expenses, and only while the company is trying to determine if your injury is work-related. If they decide that it is NOT work-related injury, then they can stop paying for medical treatment. Finally, the carrier may deny your injury was work-related.

A claims adjuster will be assigned to your case to help ensure your weekly checks and medical bills are paid, as well as to arrange recommended medical care. However, a claims adjuster works for the insurance company and his or her goal is to get an injured worker back to work as quickly as possible while spending the least amount of money on medical treatment.

Adjusters are always on the lookout for ways to stop weekly checks. The law requires them to get a court order before checks can legally be stopped. Before a court order can be signed, adjusters or their lawyers must file a written application to terminate a worker’s benefits (Form 24). The most common grounds for stopping checks are non-compliance (such as failing to attend physical therapy, training classes, or doctor appointments) and refusal to return to work when offered a job position.

An injured worker is given seventeen (17) days to respond to the Form 24. If the Form 24 was filed for non-compliance, the defendants must prove that the employee had not been compliant, and the employee must then prove that that he or she has complied, or has a good reason for not complying.

If the Form 24 was filed as a result of an employee refusing to return to work to a job the employer has deemed to be suitable position, the injured worker must prove that the job was unsuitable. Form 24 hearings are held by telephone conference.

This information is only a generalization and should not be construed to be legal advice. Every workers’ compensation case has different facts that must be evaluated by an experienced workers’ compensation attorney.

P: 828-252-2852

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FREQUENTLY ASKED WORKERS' COMPENSATION QUESTIONS

Q. How long do I have to file a workers’ compensation claim?

A. NC law requires you to file a written notice of accident with the NC Industrial Commission within thirty (30) days of your injury. You should file the claim regardless of the extent of injury since many small hurts can become major injuries over time. Since the Courts are forgiving of late filings up to two (2) years from the date of accident, you should not hesitant to file your claim even if more than thirty (30) days have passed. While reporting claims can cause some grief from employers, more heartache happens when insurance companies refuse to pay medical bills and other damages because of late filings.

Q. How much $ will I get from WC due to an on-the-job injury?

A. NC law permits an injured worker to receive 66%of his or her pre injury gross wages for each week they are unable to work. This salary continuation or temporary total disability (TTD) payment continues until the worker returns to work at the same job or a “suitable” position making similar wages. If the worker cannot return to a job making similar wages, they are entitled to additional benefits depending on the extent of loss of earning capacity. Each year, the maximum TTD is increased. In 2005, the maximum TTD was $704.

Q. I was involved in a car accident while working. Can I make a claim against the car insurance in addition to the workers’ compensation insurance company?

A. Yes. You will likely have a workers’ compensation claim regardless of how the car accident occurred. If the wreck was caused by someone else’s negligence, you will also have a personal injury claim against the responsible party. You should consult a lawyer familiar with both personal injury and workers’ compensation law to make sure these claims are brought in proper legal procedure. Failure to coordinate both claims could result in enforceable liens of one or both of the insurance payouts.

Q. What injuries are covered by Workers’ Compensation?

A. Workers’ Compensation law covers any accident on the job. An “accident” covered by Workers’ Compensation law includes any unusual or unexpected injury, not only accidents in the sense most of us think of them. Health problems related to work conditions that are developed over time are also covered. Back injuries that can be traced to work are also covered under NC law. You should consult a qualified lawyer to determine whether your work injury is covered by Workers’ Compensation law.

Q. When is my first WC disability check due?

A. WC law requires the insurance company to pay you 66% of your pre injury gross wage for each week you are unable to work. The first check is due on the 14th day after the injury. No compensation is due for the first seven (7) days of lost time unless you are out of work over twenty-one (21) days. If you miss more than twenty-one (21) days of work, a check for the first week of missed work becomes due.

Q. Can I draw Workers’ Compensation weekly checks and Social Security checks at the same time?

A. Yes, but your Social Security check will be reduced or offset by the amount of your Workers’ Compensation check. Social Security law mandates an offset of disability checks when your combined income totals 80% of more of your pre injury earnings. Federal law requires that you report all income or benefits that you receive while receiving Social Security checks. The offset or reduction in Social Security benefits can be lessened or minimized by careful planning and legal wording in your Workers’ Compensation settlement. You should consult a qualified lawyer to help you maximize your payments from each source.

Our Video Library is not closed-captioned.  Instead of embedding our videos, we have created posts for them, where full transcripts of can be found.
Click on the links below to view the video and its transcript.

Workers’ Compensation Overview on Vimeo

Workers Compensation Overview

Workers’ Compensation Injuries and the Complex nature of the law on Vimeo

Workers’ Compensation Injuries and the Complex Nature of the Law

Waiting Periods for Workers’ Compensation Benefit Payments

Waiting Periods for Workers’ Compensation Benefits

NC Workers’ Compensation Elements of Settlement

NC Workers’ Compensation Elements of Settlement

Settlements of Workers’ Compensation Claims on Vimeo

Settlement of Workers’ Compensation Claims in North Carolina

Pre Existing Conditions and Work Comp in North Carolina

Pre-existing Conditions and Workers’ Compensation Claims

NC Workers’ Comp Covers Many Different Kinds of Injuries

NC Workers’ Comp Covers Many Different Kinds of Injuries

Reopening Workers’ Compensation Cases

Reopening Workers’ Compensation Cases

Can’t Return To Work After an Injury

Workers’ Compensation Benefits When You Cannot Return to Work

Specific Traumatic Injuries

Specific Traumatic Injuries Under Workers’ Compensation

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I was very satisfied with David Gantt’s expertise and knowledge in all aspects handling my case. He dealt with all the paperwork and contacted all necessary providers to get my medical history – it was extremely hassle free! He communicated and counseled me on what to expect – being very forthcoming (he’s a straight shooter)!…

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2019 Google Review

May 9, 2019

Very nice and friendly service. They always answered any of my questions. Had a great experience working with them on my disability case. I highly recommend there services! After trying for 6 years and 2 unfavorable decisions, David and his team did a great job representing my case and won. I appreciate there time and…

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May 9, 2019

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2019 Google Review

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Avvo Review 2019

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April 10, 2019

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2019 Google Review

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Avvo Review 2019

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2019 Google Review

March 9, 2019

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October 8, 2018

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