The North Carolina Workers’ Compensation Act was developed to help people who were injured at work. Workers’ compensation helps injured workers and families who might otherwise struggle to cover the costs of daily living and medical expenses while recovering from an injury.
Unfortunately, sometimes legitimate claims are denied. There are several reasons a workers’ compensation claim could be denied, but all workers are entitled to an appeal should they feel the decision is wrong.
If you’ve been injured at or through your work, you may be entitled to wage-loss benefits and medical expenses for the work-related injury. Contact our North and South Carolina Workers’ compensation law firm to learn more.
At the DeMayo Law Offices,Your North Carolina Law Firm™, our greatest reward is helping injured people and their families. We would be proud to represent you and your workers’ compensation claim.
Call us toll-free at (877) 333-1000 to schedule a free case consultation or fill out our form online.
Workers’ compensation reimburses medical expenses (past, present, and future) as well as any related lost wages. It doesn’t cover non-economic damages like pain and suffering, mental anguish, etc.
When injured workers collect workers’ compensation, they are no longer entitled to seek compensation from their employer through a personal injury claim.
However, it’s possible that an injured worker or surviving family member may be able to sue a third party whose negligence contributed directly to the injury or death. A third party, for example, is not the immediate employer but could be an equipment manufacturer or other business associated with the employment.
You may find that the workers’ compensation you receive for your injury or illness is much less than you were expecting or doesn’t cover all of your expenses. It’s important to contact an experienced workers’ comp claims and work injury law firm should this circumstance arise. A workers’ compensation lawyer will work with your employer and their insurance company to ensure you receive the benefits you deserve after being injured at work.
Have you been injured on the job? Call (877) 333-1000 to schedule a free consultation or tell us about the accident online.
Certain medical conditions are specifically identified as workplace exposure diseases, and are listed in North Carolina General Statute 97-53. These include:
If an employee develops one of these conditions, it is presumed that the workplace increases their risk of developing the disease.
It is important to take the following steps when reporting your injury and applying for workers’ compensation benefits.
The very first thing you need to do after being hurt at work is to notify your employer — preferably in writing. Type or email a letter explaining what happened and be sure that you keep a copy for yourself.
If you’ve already reported the injury orally, make a note of the date, the time, the name of the person you talked to, their position in the company, and their exact response. Then, follow up with a written letter to the employer, confirming the oral report. The sooner you have something in writing, the better.
This step is crucial, as claims are often denied because the injured worker waited too long to report the injury. Insurance companies are frequently unwilling to issue payment for accidents that weren’t reported immediately.
However, if some time has passed since the injury and you haven’t made a report, please don’t assume that it’s too late. Go ahead and notify your employer anyway — right now. Time matters!
In North Carolina, Workers’ Compensation is handled by the N.C. Industrial Commission. Employees have a responsibility to file a claim with the Commission soon after being hurt at work. Failure to do so promptly can permanently cause you to lose your rights to compensation under the system.
In South Carolina, Workers’ Compensation is handled by the Workers’ Compensation Commission.
The workers’ compensation claims process can be very confusing and frustrating. There are important time limits that govern your ability to file a workers’ compensation claim. If you need help with filing a claim after being hurt at work or would like to speak to someone about the process of making a workers’ compensation claim please contact DeMayo Law Offices,Your North Carolina Law Firm™, by calling our toll free number (877) 333-1000.
If your workplace accident caused severe or life-threatening injuries, someone might have already rushed you to an Emergency Room for urgent medical care. Otherwise, you’ll need to arrange for medical attention on your own.n.
Remember: you are not a doctor. Do not assume that you can diagnose the extent of your injuries on your own. Often, pain and complications may not occur until after an accident has happened; a doctor will be able to determine the true nature of your workplace injuries and the treatment(s) necessary for your recovery.
Documented doctor’s visits are very important to your workers’ compensation claim as they are evidence of your injuries. By visiting a doctor and getting treatment for your workplace injury, you can take the necessary steps to get better while creating an accurate record of your workplace injuries.
Workplace injury victims often misunderstand their rights under the North Carolina Workers’ Compensation system. Claims are often unfairly reduced or denied because injured parties may not have realized what they are entitled to under the laws of the North or South Carolina workers’ compensation system.
Working with a workers’ comp attorney will ensure that you understand your case and legal rights. Your workers’ comp lawyer can handle all the complications for you, taking the headache and hassle out of your workers’ compensation case.
Your employer and their insurance company have lawyers working for them. Having an experienced workers’ compensation lawyer on your side can help ensure that your workers’ comp claim is addressed, and your rights are protected.
In summary, many pieces to a workers’ compensation case exist. Documenting the injury, getting necessary medical treatment, filing paperwork, and following procedures (often involving insurance companies and lawyers) can make for a difficult time, especially when you are injured and don’t understand your rights.
Please remember that stringent time limits are in place concerning workplace injuries, and if you wait too long, you can lose your right to the compensation you may be entitled to.
There are several reasons a legitimate claim could be denied or limited. The most common reason is that injured workers fail to meet the state deadlines for filing or forms aren’t correctly completed.
Other reasons a claim could be denied include:
In North Carolina, any injury or illness must be reported orally and in writing to the employer within 30 days of the accident. Workers must also formally file the claim (Form 18) with the North Carolina Industrial Commission. This form establishes a legal injury claim on the victim’s behalf and must be filed within two years of the injury.
In South Carolina, you must report a work-related accident to your employer within ninety (90) days; however, it is best to report your injury to your employer as soon as possible, so there is no confusion about what happened or when it occurred. To file a claim, an injured worker (or dependent) must complete Form 50 (workplace injury claim) or Form 52 (workplace death claim) and submit it to the S.C. Workers’ Compensation Commission before the 2- year deadline.
If you receive a letter from the Commission denying the claim, note the appeal deadline, and contact a workers’ compensation law firm immediately.
To appeal the decision, you must first notify the North Carolina Industrial Commission or the South Carolina Workers’ Compensation Commission, as the case may be, of your intent to appeal within 14 days of the denial. You will attend a mediation conference with your workers’ compensation lawyer, and the mediator will make a recommendation based on the evidence in your claim. The appeal process will start with a hearing with a judge, which will require organization and evidence gathering to ensure a fair outcome. Presenting detailed medical records, medical bills, and other evidence can be key to your success at this step. Having a workers’ compensation attorney experienced with workers’ compensation appeals is very important, as the process can be complex.
Workers’ compensation laws are complex, but you don’t have to fight for the benefits you deserve alone. With convenient locations throughout North and South Carolina, theDeMayo Law Offices workers’ comp lawyers are dedicated to helping injured workers maximize their benefits.
Call us at (877) 333-1000 to schedule a free case consultation or tell us about the accident online to get started today.
Your workers’ comp attorney is the best source for information about your claim, but here are some answers that may help you with the questions you may have.
Workers’ compensation is a state-required insurance program required for employers with 3 or more employees to compensate employees who are injured or who get ill from work-related incidents. Workers’ compensation is a system that pays for medical costs and lost wages resulting from the work-related injury or illness. For an employee to benefit from workers’ compensation, they are not allowed to sue their employer for negligence.
Nearly all work-related injuries are covered under workers’ compensation, regardless of who caused the injury. Also, if you are injured and want to receive workers’ compensation, you do not have to prove negligence or prove liability.
If your injury is the result of a self-inflicted incident, a crime you were committing, or if the injury occurred because of conduct that violates company policy, workers’ compensation may not cover the resulting costs or lost wages.
No. Workers’ compensation can cover the cost of the injury or any lost work if you sustain an injury like carpal tunnel syndrome due to continued use or misuse. However, proving that your injuries are the direct result of your employment may be difficult. If you would like to receive workers’ compensation, contact DeMayo Law Offices as soon as possible. Our workers’ compensation lawyers may be able to help you.
In North Carolina, you must wait seven days after your injury before you start receiving benefits, unless your disability lasts for at least 21 days. If you miss 8 to 21 days of work, you will receive benefits for those days. If you miss more than 21 days of work, you will receive benefits for the entire time, including the first week of your injury. The compensation rate for wage benefits is two-thirds of your average weekly wage (AWW). Medical benefits are paid immediately following the injury, with no waiting period. In South Carolina, you are entitled to temporarily lost pay if you are entirely laid off for longer than 7 days (or temporary compensation). The eighth calendar day after your inability to work is when you become eligible to start collecting temporary pay. You are eligible to receive benefits beginning on the first day of your incapacity if you are entirely off the job for more than 14 days.
There is no time limit in North Carolina for injuries that occurred before June 24, 2011. For later cases, benefits can continue for up to 500 weeks, with a possible extension in certain circumstances. Benefits stop when you return to work or when your employer files an ‘Application to Terminate Benefits’ with N.C. Industrial Commission. In South Carolina, you should receive interim compensation payments until you are fully cleared to return to work without any restrictions. The employer’s representative will send you two copies of Form 15 with Section II completed informing you that your payments have been discontinued and why you are allowed to return to work within 150 days of being notified of the accident. Fill out Section III of the form to request a hearing if you disagree that your payments should stop and send it to the Commission’s Judicial Department.
Your employer has the first opportunity to choose the doctor who treats you. You may request a change in doctors from the Industrial Commission if you can show that a change is necessary to cure your condition or help you return to work. You may also ask another doctor for a second opinion on your injury.
In South Carolina, your employer has the authority to select your treating physician. If you seek treatment from any doctor of your choosing, your employer’s representative may refuse to pay your medical bills for work-related injuries. As a result, you must request that your employer refer you to a doctor of their choosing. Do not assume the referral was approved if your injury necessitated emergency treatment and the emergency room referred you for follow-up care.
Certain mental health conditions may be eligible for workers’ compensation benefits if they arise from your employment. North Carolina workers’ comp laws are relatively restrictive in this respect. You must be able to prove that you developed a mental condition, such as anxiety or depression, as a result of a specific workplace accident. The general stress you experience in your everyday job would not count, even if it caused you to develop a mental condition.
Workers in South Carolina who suffer from mental health injuries, such as crippling anxiety and stress, may also be eligible for recovering workers’ compensation benefits. To be eligible, the injured worker must demonstrate that the anxiety or stress is caused by “extraordinary and unusual” work conditions or that the condition is a result of a physical injury sustained on the job.
If the death is related to a workplace injury or a disease acquired in the course of employment, you may be able to collect compensation if it is within six years of the date of injury or onset of disability, or within two years from a final determination of disability. You should discuss this situation with an experienced workers’ compensation attorney.
Certain employees are not eligible for workers’ compensation under North Carolina law. These include casual employees who don’t work regular hours, domestic or household employees, farmworkers on farms with fewer than ten employees, certain railroad employees, and federal government employees. Federal employees are covered under the Federal Employees’ Compensation Act.
It is possible to receive benefits if your employment exposes you to COVID-19. You must prove that your work exposed you to a greater risk than the general public and that your job exposed you to the disease. To establish an injury by accident claim, you must show that you contracted COVID-19 due to an accident arising from your employment.
No, but there are situations where you may be able to sue your employer for gross negligence. For instance, if they do not offer workers’ comp benefits. Some legal loopholes may let you file a lawsuit. Your employer may tell you that you can’t sue, so it’s a good idea to speak to one of the workers’ compensation attorneys at DeMayo Law Offices to learn more about your options.
With this in mind, let’s review some of the rare scenarios where you could sue your employer.
Workers’ compensation functions like insurance – however, collecting these benefits prohibits workers from suing their employer for injuries.
To receive workers’ compensation, you must be employed at the time of the injury, and the injury must result from the employment. In other words: injuries must be caused by whatever tasks are required by the job.
This rule also extends to illnesses sustained while working (e.g., lung cancer or mesothelioma) and cumulative trauma such as carpal tunnel syndrome. Benefits can be provided temporarily while the injury heals or provided in perpetuity, depending on the circumstances.
Workers’ compensation claims are awarded based on strict liability: this means fault or negligence doesn’t have to be proven or assigned to a particular party in order to collect benefits.
All North Carolina employers who employ three or more workers must obtain workers’ compensation insurance or qualify as self-insured employers. If an employer fails to provide this coverage, they could face stiff financial penalties or be charged with a misdemeanor or felony and possibly imprisoned. All injured workers who qualify are entitled to workers’ compensation, and neglecting to provide these benefits is a criminal offense.
Settlement after mediation for a client who fell at work while doing inventory and suffered multiple fractures to both legs and face. (Mecklenburg County, 2009).
Settlement for a client who was injured when a tractor-trailer driver fell asleep and hit client’s vehicle in the rear causing serious injuries, including the loss of an eye and reconstructive surgery. (Cabarrus County, 2010).
Settlement for a client who was injured in an automobile accident while on the job when another driver ran into the rear end of his vehicle while stopped in traffic. Client received serious back injuries requiring surgery (Burke County, 2012).
Settlement after mediation for a client who fell into a hole while working causing serious injuries to client’s back and legs.
Settlement after mediation for a client who fell at a worksite and broke his back. (Mecklenburg County, 2009).
Settlement for a client who was injured at work when he fell backwards and hit his head on a forklift truck. (Lincoln County, 2007).
Settlements for client who was injured while driving a vehicle for his employer when another vehicle crossed the center line hitting the vehicle the client was in resulting in a broken back and other injuries. (Gaston County, 2006).
settlements for a client who was injured in an automobile accident, while on the job, when another vehicle crossed the center line and hit client’s vehicle head-on. Client’s leg and ankle were fractured requiring multiple surgeries (Davie County, 2012).
Settlement for a man who was kicked in the face by a horse, fracturing his eye socket, injuring his eye, and causing a concussion. This client also had some cognitive impairment from his head injury. (Union County, 2015).
Settlement for a client who suffered serious injuries while working on the job. (Guilford, 2007).
Settlements for a client who was injured while on the job when the vehicle the client was driving was struck in the rear by another vehicle causing various injuries. (Gaston County, 2004).
Settlement for the estate of a truck driver who suffered a heart attack when he was trying to put out a fire on his trailer cause by faulty brakes and ignition of the brake fluid from overheating. (Union County, 2014).
Settlement for a client who was injured when he lifted a heavy bag of coins, causing him to rupture a disc in his low back. The client had to have a low back surgery to remove the ruptured disc and to fuse the area of his spine where the disc was removed. The client was unable to return to his job due to lifting restrictions and chronic low back pain. (Mecklenburg County, 2014).
Settlement for a client who received serious neck, back, and shoulder injuries that required surgery after bags of coins fell on the client when the client was working inside of a vault. (Mecklenburg County, 2014).
Settlement for a client who was injured when working as a lineman and he contacted an overhead powerline, causing severe electric shock, burns, tissue damage to his hand and foot, and damage to his heart. This client was unable to return to his job of lineman. (Wilkes County, 2017).
Settlement for a client who was repairing a power box on a light pole and was shocked by high voltage electricity, causing a brain injury and seizure disorder. This client became disabled from working because of his injuries. (Mecklenburg County, 2016).
Settlement for a client who was injured on a construction site when he lifted a heavy metal board, causing him to rupture a disc in his low back. The client had low back surgery and a spinal cord stimulator implanted. The client now has permanent restrictions of no heavy lifting. (Mecklenburg County, 2014).
Settlement for a client who injured his back while carrying some metal boards at a job site. Back surgery was required after the injury. (Mecklenburg County, 2014).
Settlement for a client who received serious burns that required skin grafting and resulted in permanent nerve damage when a chemical tank exploded (Lincoln County, 2011).
Settlement for a client who received serious injuries to his head, neck, shoulders, and back when a 2,000-pound pallet broke and fell on him as he was unloading a trailer (Mecklenburg County, 2011).
Settlement for a client who was on the back of a trailer, pulling a pallet when it broke, causing him to fall and hit his head and suffer from back and neck injuries. (Accident took place outside of NC, 2009).
Settlement for a client who received serious injuries to his whole body when he fell 28 feet to the ground from a bucket lift after the safety harness broke. (Caldwell County, 2011).
Settlement for a client who was working in a bucket lift when his soft harness broke causing him to fall 28 feet to the ground. He suffered multiple injuries to the head, neck, back, arms and legs. (Caldwell County, 2006).
Settlement after mediation for a client who sustained a back injury while picking up heavy cable at work. (Catawba County, 2013).
Settlement for a client who lost his hand while cleaning a grinding machine. (Duplin County, 2013).
Settlement for a client who was injured at work when a patient fell on her leg causing serious neck and back injuries. (Catawba County, 2013).
Settlement for a client who received serious back injuries while working on an automobile assembly. (Cabarrus County, 2012).
Settlement for a client who received head and other serious injuries after falling 20 feet to the ground while working on a roof. (Mecklenburg County, 2011).
Settlement for a client who suffered brain and other injuries after falling 20 feet off a roof. (Michigan, 2009).
Settlement for a client who was injured when he fell off a dumpster and injured his neck. The client required a two-level fusion surgery in his neck and ongoing pain management treatment. (Mecklenburg County, 2017).
Settlement after mediation for a client who was injured in an automobile accident while on the job, causing serious head and back injuries. (Mecklenburg County, 2013).
Settlement for a client who lost his leg when a log fell off a conveyor belt and hit the client. (Catawba County, 2007).
Settlement for a client who fell off a bench while painting causing head and spinal injuries. (Guilford County, 2007).
Settlement for a client who injured his knee while pulling a box of electrical material. (Mecklenburg County, 2007).
Do you have questions about a denied workers’ compensation claim? The North and South Carolina workers’ compensation attorneys at DeMayo Law Offices are here to help. We can guide you through the process from start to finish, so that no detail is missed. The success of workers’ compensation claims often depends on providing accurate and complete information, according to strict deadlines. Our firm has decades of experience helping clients obtain the compensation and benefits they deserve for their injuries. We take pride in our ability to serve all our clients with personalized care and top-quality legal advice.
We have convenient office locations throughout North and South Carolina. Call (877) 333-1000 to get started now.