How Are Workers' Compensation Benefits Determined?

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Workers’s compensation benefits are determined by a variety of factors.  One of the first questions is whether the injured worker is able to return to their job?  When a worker is injured on the job they are sent to a physician to determine the extent of their injury.  The physician may allow the worker to return to work and they will receive their regular salary as they perform their regular work duties.

On the other hand, the physician may determine the employee cannot work their regular job and may allow the worker to work, for example, only 20 hours per week.  If they are seriously injured, the physician may not allow them to return to the job until they reach what is known as “maximum medical improvement” or “M.M.I.”.  If the worker is unable to work their full schedule or a partial schedule, the employer’s workers’ compensation insurance company must compensate the injured worker’s benefits, such as salary, the worker would had received if they had not been injured.

Normally, the injured worker receives two-thirds of their average weekly wages lost due to the injury. The worker usually receives a weekly paycheck from their employer’s workers’ compensation insurance company to compensate the worker due to the lost time because of the injury.

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You may ask why only two thirds of the average weekly wages?  The general consensus is if the worker is receiving “full” benefits or 100% of their usual income, the worker would have no “incentive” to return to work.  Also the worker does not have to pay transportation cost or wear and tear on a vehicle if they are at home injured. Therefore, the North Carolina Industrial Commission has ruled that two-thirds of the worker’s salary is fair compensation.

The worker should receive these benefits until they are allowed, by the physician, to return to work or until a settlement is reached with the insurance company of the employer.

If you have been injured while at work it is important to contact a North Carolina workers’ compensation lawyer immediately.

What Injuries are NOT Covered by Workers’ Compensation Laws?

North Carolina Workers' Compensation Lawyers | Duncan Law, PLLCThe first question to ask is whether your employer falls under the Workers’ Compensation Act.  Generally speaking, an employer with three or more employees is required to carry workers’ compensation insurance.  As a result, if your employer has only two employees, they are most likely not required to carry workers’ compensation insurance and any injury you sustain would not be covered under workers’ compensation.  However, it will depend on the structure of the legal entity of the business and they type of business, so this number may be more or less.

You must also be an employee to receive workers’ compensation benefits.  Contract “employees” or independent contractors are not covered by the workers’ compensation act, so an injury incurred while working as a contract “employee” may not be covered by workers’ compensation

Next, is the injury sustained by an accident while performing your assigned job functions?  This question can best be answered by comparing what injuries can and cannot be covered by workers’ compensation.  Injuries you incur while on the job and while performing your job duties are generally included in a workers’ compensation claim.

Examples of Injuries Included in Workers’ Compensation:

If you work in a warehouse and a crate falls and breaks your foot as you are attempting to remove it from a shelf, the injury would be considered a workers’ compensation claim.

You are a sales person and while at a customer’s location you are accidentally hit by a forklift, this would most likely be a workers’ compensation claim.

Examples of Injuries NOT Included in Workers’ Compensation:

You are chasing a fellow employee in the parking lot after work, and you trip, fall and break your foot.  This would most likely not be considered a workers’ compensation claim.  You are obviously at work, but you are not performing your job duties when the accident occurred.

You are a sales person and you stopped to buy gas.  When you went into the store to purchase a cup of coffee, you slip and fall and you break your leg.  You may have a claim against the store where you fell, but you would most likely not have a workers’ compensation claim.

As you can tell by these examples, a workers’ compensation claim requires the accident occurred while you were an employee performing your job functions. Like most areas of the law, workers’ compensation claims can become pretty complex. To learn more, contact our Charlotte, NC workers’ compensation lawyers or our Greensboro, NC workers’ compensation lawyers.

Can I Still Get Workers' Compensation Benefits If I Return to Work?

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Returning to work after suffering an injury at work can be a risky move.  If your claim says that you are completely unable to work and then you return to work while you are still able to receive workers compensation benefits, then your employer no longer has to continue paying your workers compensation benefits.

Injury at Work | Charlotte, NC & Greensboro, NCThere is an option to have a trial return to work.  According to North Carolina Statute  §97-32.1, this is where you will return to work for a certain amount of time (up to 9 months), during this period you can still receive partial benefits from your employer.  You would have to file certain forms and paperwork to do this.  You want to make sure your employer and the Industrial Commission are fully aware that this is simply a trial period and you are not returning to work permanently at the current time.  If you make a full return to work then your compensation benefits will be terminated.  If during this trial period it is determined that you are still unfit to work then you can continue to receive full benefits that will be unimpaired by your trial return to work.  The trial period can only last for a maximum of nine months.

In summary, in most situations if you fully return to work you will no longer receive workers’ compensation payments.  However, you have a couple options other than fully returning to work. First, you can go back to work on a limited basis and receive reduced payments. A second option is returning to work for a trial period and, if you then decide you are not ready for a full return, then your full payments will resume and be unaffected.  The main point is if you and your doctor both feel you are not ready to return to work then you should consult your workers’ compensation attorney before deciding to return to work. Returning to work prematurely will cause you to lose any future benefits.

How Do Attorney's Fees Work in a Worker’s Compensation Case?

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Most attorneys’ fees in a workers’ compensation case are based upon a contingency fee arrangement between the attorney and the injured worker. A contingency fee arrangement is when an attorney agrees to provide legal services to the injured person and is usually only paid in the event the injured worker is successful in their case. If the injured worker is unsuccessful and receives no compensation, then the attorney is usually paid no money for their time and effort on the workers’ compensation case.

In North Carolina, the North Carolina Industrial Commission, sometimes called the worker’s compensation board, determines the attorneys’ fees paid to the attorney.  The Commission usually makes this determination based upon the retainer contract between the attorney and the client/injured worker. The Commission must approve all settlements to injured workers and the fees that are paid to the attorney.

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Most attorney-client retainer agreements specify a percentage of the total payment of the claim that is to be paid to the attorney. The percentage paid to the attorney in most workers’ compensation cases is somewhere between 25% and 33%.  This is usually determined by the complexity of the case. To learn more about how we can help you with your workplace injury contact us today.

Can I See My Own Doctor If I’m Injured at Work?

In a workers’ compensation case you are not able to choose your own doctor. As a general rule, your employer has the right to choose a doctor to treat your injuries. The doctor chosen does not have to be your own personal doctor and is, instead, likely to be a doctor that your company regularly uses.

Can My Employer Fire Me If I’m Injured at Work?

No, your employer cannot fire you simply because you have been injured at work and filed a workers’ compensation claim. Any employer who uses retaliatory action such as terminating you from your job due to an injury sustained on the job could be violating a North Carolina law known as the Retaliatory Employment Discrimination Act, also known as “REDA”. If an employer violates this law by terminating you because of your injury on the job, you should contact a workers’ compensation attorney immediately. In this event, you can bring a court action against the employer and seek damages from the employer. The court may order you to be reinstated to your old position and order that you be compensated for your for lost wages, benefits, and seniority.

Can I Sue My Employer if I’m Injured at Work?

As an employee, you cannot sue your employer for a work related injury. If the injury has occurred within the scope of your employment, you must claim your injury through the workers’ compensation system. The workers’ compensation system was set up as a form of insurance for both you and your employer. The system is looked at as a “no fault system” which means that injuries are viewed as an unavoidable aspect of work relationships and there is no need to prove that your employer or a certain person caused your injury.

Will I Have to go to Court for My Workers’ Compensation Case?

Emergency & Hospital Sign | Workers' CompensationNot technically. However, you may have to go in front of the group who hears workers’ compensation claims in North Carolina called the Industrial Commission. Workers’ Compensation is a unique area of law. Unlike other areas of the law, if you have a workers’ compensation claim you do not go in front of a jury or even a traditional judge. The current workers’ compensation laws were developed to keep claims of injured workers out of the court.

One of the main reasons that the Workers’ Compensation Act keeps work injury claims out of the traditional court system is to increase efficiency in handling injured workers’ claims. Someone injured in a car accident or by a medical doctor may have to wait years until their case goes in front of a judge or jury. The government understood that someone working to provide for their family cannot go that long without a reliable income. Therefore, when someone is injured on the job in North Carolina they have their workers’ compensation case go in front of one of the Industrial Commission’s Deputy Commissioners if it does not settle beforehand at mediation. The Deputy Commissioner is similar to what most people think of as a judge in regular court.

This hearing in front of one of the Deputy Commissioners of the Industrial Commission will be very similar to a trial, though. We will present your case to the Deputy Commissioner using exhibits, witness testimony and they will eventually hear from your treating physician by way of depositions.

The Deputy Commissioner will review all of the exhibits and testimony, including the treating physician’s deposition, and make a determination on compensability.

Work Injuries Covered Under Workers Compensation Laws

Workers Compensation is a government system set up to provide support to employees that have been injured “on the job” or in the scope of their employment. It’s important to know which types of injuries are covered by workers’ compensation laws.

Workers’ Compensation Timeline

The typical worker’s compensation case varies depending upon the facts of the case. Usually the employee is injured on the job by an accident. There are six common steps to handling a workers’ compensation claim.