American workers spend almost half of their waking hours at work. Each year, workplace accidents cause approximately 7,000 job-related deaths and 15 million nonfatal injuries nationwide. If you are injured or become ill, either physically or mentally, because of your job, you may be entitled to worker’s compensation benefits. These laws are designed to provide injured workers with partial wage replacement and other benefits, as well as medical expenses. As a general rule, injured workers are prohibited from suing their employers but may sue another company which is wholly or partially responsible for their injuries.
In North Carolina, the top 4 hazards causing death in the construction industry are Falls (improperly constructed scaffolds, defective ladders, faulty guardrail systems); Electrical (wiring hazards, ungrounded power tools, frayed extension cords); Struck-by Hazards (falling debris, vehicles, nail guns); and Caught-In Hazards (poor trench construction). Attorney Michael Workman has substantial experience representing injured construction workers.
Representative Cases:
Six-figure settlement to 35-year-old worker who lost 3 fingers in stamping machine accident because his employer failed to install safety guard.
Confidential settlement to 42-year-old man who sustained severe tinnitus (constant, high-pitched squealing sound in his ears) when a chemical drum he was ordered to clean exploded.
On his second day on the job, father of 4 young children killed in violent explosion when a highly flammable gas became trapped inside a plastic processing machine.
Young father sustains permanent back injuries when a defective, misinstalled handrail gave way and allowed him to fall 12 feet, cracking the small of his back on a cement floor.
Frequently Asked Questions
The following summary from the North Carolina Industrial Commission's website includes answers to some of the most commonly asked questions about North Carolina Workers' Compensation:
Q: Who is required to provide workers' compensation coverage?
A: Any employer who employs three or more employees.
Note: Every executive officer selected or appointed and empowered in accordance with the charter and bylaws of a corporation is considered an employee of such corporation. For example, a corporation with two officers and one employee would be required to provide workers' compensation coverage. Any employer in which one or more employees are employed in activities that involve the use of or presence of radiation is required to have coverage.
Q: What must an employee do when an injury occurs?
A: Report the injury to the employer, in writing, immediately and in any event within 30 days. Print out a Form 18, fill it out, sign it, and make two copies.
Mail the original Form 18 to:
N.C. Industrial Commission
Statistics Section
4334 Mail Service Center
Raleigh, NC 27699-4334
Mail the first copy of this Form 18 to your employer certified mail, return receipt requested, and keep the receipt when it comes as proof of mailing.
Keep the second copy of this Form 18 for your file.
Q: What should be done if the employer fails or refuses to report an injury?
A: Telephone the Claims Administration Section at (919) 807-2506 to make sure that your Form 18 has been received by the Industrial Commission, and to get the file number assigned by the Industrial Commission to your claim.
Q: Who provides and directs medical treatment?
A: The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The Commission may permit the employee to change physicians or approve a physician of employee's selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.
Q: What are the rules for chiropractic treatment?
A: If the employer grants permission to seek medical treatment from a chiropractor, the employee is entitled to 20 visits if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the employer.
Q: When can reimbursement for sick travel be collected?
A: Employees are entitled to collect for mileage for medical treatment in workers' compensation cases at the rate of 25 cents a mile for travel prior to June 1, 2000; at the rate of 31 cents a mile for travel between June 1, 2000 and January 17, 2006; and at the rate of 44.5 cents a mile for travel on or after January 18, 2006, provided they travel 20 miles or more round trip. Special consideration will be given to employees who are totally disabled.
Note: The Industrial Commission has given the self-insurers and insurance carriers permission to pay drug and travel expenses directly to the employee without approval from the Commission.
Q: What happens if, in an emergency, the employer fails or refuses to provide medical treatment?
A: The employee may obtain the necessary treatment from a physician or hospital of his own choice, but must promptly request the Commission's approval.
Q: When do I become eligible for lost wage compensation?
A: No compensation is due for the first seven (7) days of lost time unless the disability exceeds 21 days. Therefore, the first check will not include payment for days 1-7. Payment for those days will be made should the disability continue beyond 21 days.
Q: How often are compensation payments made?
A: Weekly.
Q: At what rate of pay?
A: 66 2/3% of the average weekly wage, not to exceed $674.00* (2003 maximum) per week.
* The maximum weekly benefit is adjusted annually.
Q: How long is the employee eligible to receive lost-time weekly benefits?
A: Until the employee is able to return to work.
Q: What is permanent partial disability?
A: Total loss or partial loss of use of a member of the body or inability to earn the same wages in any employment as earned at the time of injury.
Q: Who determines permanent partial disability?
A: The Commission based on the impairment ratings of physicians or evidence of consideration of wage earning capacity.
Q: What happens when the employer refuses to acknowledge the claim?
A: When liability for payment of compensation is denied, the Commission, claimant, his or her attorney (if any), and all known providers of health care shall be promptly notified of the reason for such denial. The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the denial of liability.
(a) If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.
(b) Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers' compensation claim.
Q: How long does it normally take for medical bill approval?
A: Medical Fees has to wait for the insurance carrier to send the bill. Once it is received, bills are approved on a daily basis. After approval, Medical Fees sends the insurance carrier or self-insured a medical bill analysis, stating the approved amount.
Q: How long should a medical provider have to wait for reimbursement?
A: G.S. §97-18(i) states "If any bill for services rendered under G.S. §97-25 by any provider of health care is not paid within 60 days after it has been approved by the Commission and returned to the responsible party, or within 60 days after it was properly submitted, in accordance with the provisions of this Article, to an insurer or managed care organization responsible for direct reimbursement pursuant to G.S. §97-26(g), there shall be added to such unpaid bill an amount equal to ten per centum (10%) thereof, which shall be paid at the same time as, but in addition to, such medical bill, unless such late payment is excused by the Commission."
Q: Who is my employer's workers' compensation insurance carrier?
A: Contact Statistics at (919) 807-2506 for your employers' insurance coverage. We need to verify period of coverage and with what insurance carrier or Third-Party Administrator handling their claims during that injury date.
Q: What is my claim number?
A: Contact Statistics at (919) 807-2506.
Q: How can an injured worker be referred to Medical Services?
A: We have a referral form which provides us with important information when completed. These forms may be requested by telephone at (919) 807-2616 or by letter request to the N.C. Industrial Commission, 4340 Mail Service Center, Raleigh, North Carolina 27699-4340. Referrals are accepted from anyone.
Q: I did not know that the Industrial Commission had Nurses. How much do their services cost?
A: Nurses have worked for the Industrial Commission for more than 22 years, and their services are free.
Q: Do I have to work for the State to qualify for Medical Services from the Industrial Commission?
Q: Do I have to allow my Rehabilitation Provider in the examining room while I am being examined by my doctor?
A: No. Workers have a right to a private examination by their doctors. We do encourage the worker to allow the provider to meet with both the worker and the doctor immediately following the examination when the doctor discusses his/her findings and makes his/her recommendations for treatment. This will allow everyone to be aware of and understand treatment plans and expectations.
Q: Your doctor has told me that you can go back to work, but your employer does not have a job for you or your job is now too physically demanding. Can Commission help you?
A: Since you have reached the medical improvement expected following your injury, we would refer you to the N.C. Division of Vocational Rehabilitation for reemployment, counseling, and guidance.
About:
Telephone:
General questions and disputes in cases; coverage information
Ombudsmen: (800) 688-8349, (919) 807-2501
Filing and case status
Dockets: (919) 807-2504
Application of the Act, Settlement Agreements, and change of physicians
Executive Secretary: (919) 807-2575
Appeals, Rules, and Policies
Commissioners: (919) 807-2500
Medical Bill Approvals
Medical Billing Section: (919) 807-2503
Rehabilitation Assistance
Workers' Compensation Nurses: (919) 807-2616
Workplace Safety Programs
Safety Section: (919) 807-2603
Hearings in Contested Cases
Dockets: (919) 807-2504
Pending Occupational Disease Claims
Occupational Disease Section: (919) 807-2502
Publications and Forms
Main Number: (919) 807-2527
Form Agreements, Attorney Fees
Claims Section: (919) 807-2502
Personnel and Contracts
Administrator: (919) 807-2500
Workers' Compensation Fraud
Fraud Section: (888) 891-4895,(919) 807-2570
Mediation of Claims
Mediation Section: (888) 242-5757, (919) 807-2586
Notice
This summary by the Industrial Commission is not intended to answer all questions regarding workers' compensation or all problems arising under the Workers' Compensation Act. For more information about workers' compensation, see the N.C. Industrial Commission's Annual Bulletin. See also Questions for Business and Industry and Questions for Insurers.
For further information, contact:
North Carolina Industrial Commission
4340 Mail Service Center
Raleigh, North Carolina 27699-4340
Main Phone: (919) 807-2500
Fax: (919) 715-0282
Ombudsmen: (800) 688-8349, (919) 807-2501
Fraud Investigations: (888) 891-4895 (in North Carolina), (919) 807-2570
