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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. Can my employer fire me while I am on workers’ compensation?

A. No. The Retaliatory Employment Discrimination Act (REDA) specifically prevents employers from firing you because you filed a WC claim against them. REDA protects you from any firing, demotion, punishment, or other retaliatory action the employer may try to take against you. You may be able to sue for monetary damages for a REDA violation. REDA also covers co-workers who testify in WC hearings on behalf of an injured worker. For guidance in filing a REDA claim, you should contact the NC Department of Labor at (919) 807-2796 or 1-800-NCLABOR.

Q. What type of physical ailments are considered disabling under WC law?

A. The key to the question of whether you are disabled under WC law or not is based on how the physical or mental ailment(s) you have impact your ability to earn money. No exact listing or threshold exists in NC law for what determines a disability. If you are unable to work at the same job you held down before the accident, you are likely disabled under our law. NC law recognizes both physical and mental disabilities.

What time limit do I have to file WC?

As soon as possible, you should file a Form 18, Notice of Accident, with the IC and employer, informing them that you wish to make a claim. While N.C. law requires this Form 18 to be filed within 30 days, an absolute time limit of 2 years may be applicable to your claim depending on the facts. After your claim is settled, time limits also exist for reopening the case. This form can be obtained by e-mailing our office or calling the IC at 828-348-4107.

Q. What if my work injury causes or exacerbates my depression or other mental illness?

A. Work injury related depression and other mental impairments may be compensable under NC Law. Our appellate courts are regularly expanding the consideration of mental and physical ailments that result from your employment and/or inability to work after a physical injury. If you believe your work injury caused or deepened any mental difficulty you might have possessed before or after the actual injury, you should fully discuss your thoughts with your mental counsellor. The Industrial commission is increasingly aware of and open to the concept that mental ailments can be as significant as physical ones.

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. How do lawyers get paid for handling WC cases?

A. Generally, lawyers will charge a contingent fee of 25% of the settlement. Contingent fees are payable only if the case is successful. While most fees are set at the settlement of the case, some fees are collected while the claim is pending. Charging legal fees at any time without approval of the NC Industrial Commission is a Class 1 misdemeanor crime in our State. Most lawyers will advance the expenses of a claim with the understanding that these costs will be recovered when the matter is settled.

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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2019 Google Review

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2019 Google Review

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April 10, 2019

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2019 Google Review

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2019 Google Review

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