Workers’ Compensation – Frequently Asked Questions

When faced with a potential Workers’ Compensation claim, many individuals are faced with a multitude of questions that they do not have the answers to. This list of questions was complied from most of the questions that our potential clients have brought to us here at Minick Law. Each answer gives a brief response to the question with the hope of fully answering the question. This list is by no means a comprehensive list of all the questions that you may have, but it at least provides a starting point for you on your Workers’ Compensation claim. To have all your questions answered, please Contact Us for a free initial consultation on your Workers’ Compensation claim.

What should I do if I’m injured on the job?

An injury on the job is a serious issue. If you are injured, whether or not you think it is a serious injury, you should make sure to report it to your supervisor. If you don’t report it and it turns out to be a serious injury that would make you eligible for a Workers’ Compensation claim, there won’t be any report or paperwork to back up your claim.

What is Workers’ Compensation law and how is it different than normal law?

Typically, legal claims involving bodily injury are handled through the civil court system. They follow the normal judicial process and are handled by judges in a courtroom. Workers’ Compensation law is different however since it is a quasi-judicial branch that has been established by the State. In North Carolina, Workers’ Compensation is heard through the North Carolina Industrial Commission. This commission has established its own procedures and rules, which have the authority of law. Since Workers’ Compensation is completely different than normal judicial proceedings, a normal attorney who handles personal injury cases may not be experienced or qualified enough to handle your Workers’ Compensation claim.

When reporting your injury, make sure to inform your immediate supervisor. If another coworker or a manager witnessed your injury, make sure to bring them along with you to report the injury. When you arrive at the first medical center to evaluate your injury, make sure to tell them exactly what happened so that they can make a detailed report.

When informing your supervisor or a medical center of your injury, your Workers’ Compensation claim will be stronger if you can give a detailed account of what happened, where it happened, and how your injury occurred. The more details you can provide, the better.

To file a Workers’ Compensation claim, you must file a report called a Form 18 with the North Carolina Industrial Commission within two years of the injury. This form is available on the North Carolina Industrial Commission’s website and by calling them at 800-688-8349.

If I’m hurt and can’t do my job, can I be fired?

Under the Family Medical Leave Act, your employer must hold your job open for you for twelve weeks. However, once these twelve weeks passes, your employer has no duty to hold your job.

If after returning to your job with restrictions, you are fired, there is a presumption that you have been fired due to the injury. This firing is illegal. If this occurs, your employer must be able to prove that the firing was due to some other reason besides your firing. If you dispute this issue, the company almost always loses.

What are my options if I am not a legal citizen of the United States?

The legal status of your citizenship is not in dispute when it comes to Workers’ Compensation. Even if you are in the country illegally, you are still eligible for the same Workers’ Compensation benefits and protections as any other worker. However, when you file a Workers’ Compensation claim, it is likely that your status as an illegal immigrant will be revealed and you will be deported. Although this is a bleak outcome, if you are severely injured enough that you will not be able to work, you are still allowed to file a Workers’ Compensation claim, so it is still in your best interest to file a claim. Even if you are deported, you may still get a good Workers’ Compensation settlement.

How does my lawyer get paid?

Your lawyer’s fee will be paid on a contingent basis. Typically, your lawyer will get 25% of the money that they obtain for you in a settlement.

Will the health insurance plan I receive through work continue to be paid?

Workers’ Compensation does not require that your company continue to pay your health insurance. However, under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you are still eligible to maintain the health insurance provided by your company as long as you pay for the insurance yourself. Workers’ Compensation will however pay for the medical expenses related to your injury.

How long will the entire process of a workers’ compensation case take?

The time frame for Workers’ Compensation cases varies from case to case. However, having a long drawn out Workers’ Compensation claim works in your favor. As long as your case is not resolved, the insurance company working on it must maintain the information, have insurance adjusters working on it, and keep it on their books. As such, you should not be in any rush to settle or end the claim. It is important to decide if you will ever be capable of going back to work, whether you could find employment if you tried, or if you require additional education to be able to rejoin the workforce.

How will the insurance company treat me?

Although the insurance company is motivated to make a profit and maintain its bottom line, there are many regulations and laws that they must follow in order to handle your Workers’ Compensation claim. Even so, insurance companies do not make a profit by paying out large settlements. As such, they will attempt to pay as little as possible on each claim. Also, since most insurance companies are massive corporations with hundreds if not thousands of Workers’ Compensations claims that they are currently working on, your case may not be their highest priority.

What medical treatment does Workers’ Compensation cover?

Workers’ Compensation covers any medical treatment that is required for your injury. This covers everything from pain prescriptions to Viagra if they are required for treatment of your injury.

Do I have to see a doctor hired by my employer?

Generally, the insurance company requires you to go to a primary or urgent care facility. However, these medical facilities are not trained for specific specialties like orthopedic injuries. If you want to see another doctor, talk with your insurance adjuster about seeing another doctor. Make sure to specifically request a specialist if your injury requires one. If they will not allow you to see another doctor, you may petition the Industrial Commission to order the insurance company to let you see another doctor.

What does an insurance adjuster do?

After you report your injury to your employer, your employer will then notify the insurance company of your claim. Generally, an insurance adjuster will contact you within a few days to discuss your claim. The adjuster may ask you to record a statement about the accident. You are required by law to do this. As long as you give an accurate and truthful account of what happened, you have nothing to worry about. Also, although the adjuster may sound sympathetic to your injury, you must always remember that the adjuster is working for the insurance company. As such, their goal is to settle the claim for as little as possible.

When can I expect to start receiving my benefits checks?

After reporting your injury, your benefit checks should being to come within a few weeks of the accident. However, the insurance company may require initial medical record and have you make a statement before benefit checks are paid.

What are my options if my checks keep coming in late?

If your benefit checks are not consistently late, you have nothing to worry about. However, if your benefit checks do not show up on time consistently, the insurance company could be hit with a 10% penalty. Also, if you have to hire a lawyer in order to obtain your benefit checks, the insurance company may be required to reimburse you for your lawyer’s fees.

What should I do if my checks stop coming?

Under Workers’ Compensation law, your benefit checks should not stop coming until you are able to return to work or your case is settled. The insurance company does have two complicated procedures they can use to stop sending benefit checks, but they are rarely used due to their complexity and hassle for the insurance company. Generally, there should not be any stoppage of your benefit checks.

What should I do if the checks I receive are for the wrong amount?

In order to prove that your benefit checks are for the wrong amount, you must be able to provide records showing that there is a discrepancy. This job is best suited for a lawyer, who can correct the mistake and get you any back pay necessary to fix the problem.

Should I settle the case if the insurance company is pressuring me to accept their offer?

You should never feel like you should be forced to settle simply because the insurance adjuster or company would like to resolve your claim. This is especially true if a doctor has just released you since you are still unsure of how the injury will affect you in the long-term. It would be foolish to settle for a lump sum if you are unsure of how you will feel in the future due to the injury.

At what point should I accept a settlement?

Nobody should really answer this question except for you. With all Workers’ Compensation cases, you should determine how much money it would take to put you in the same position you were in before the accident. This could be any amount of money depending on the severity of your injury. If you have been severely hurt or permanently disabled, you shouldn’t settle your case until you are offered enough money to be able to comfortable recuperate or live the rest of your life in dignity. If your injury was not that severe, it should be enough money to allow you to live until you are either able to go back to your original job or find a new one.

In determining whether you should settle, you should consider all of the facts and information available to you in making a decision. You should also consult with an experienced Workers’ Compensation lawyer for any advice on the matter. First and foremost, you should always consider your family’s financial well-being and its ability to survive if the recipient were to die. You should also consider your future earnings capacity. Finally, you should consider your age and how close you are to retirement and Medicare.

What are my options if my claim is denied?

If you are informed that you claim for Workers’ Compensation is denied, you should not hesitate to contact an experienced Workers’ Compensation lawyer. Typically, the only way you will be able to receive any kind of compensation or settlement after your claim has been denied is through adequate representation. By denying your claim, the insurance company has determined that it shouldn’t have to pay for you or your medical bills from the injury. At this point, you have the ability to have the Industrial Commission hear your claim and determine whether you have an adequate claim to be compensated for. However, this action is a process and has a limited time frame for making the request. As such, you should hire an experienced Workers’ Compensation attorney to represent you in this matter.

What if I want to sue my company because of the injury?

Unfortunately, Workers’ Compensation generally prevents a worker from filing a suit against their employer for negligence in order to protect the employer. This also is to prevent an individual from “double dipping” or receiving Workers’ compensation benefits and collecting a judgment against their employer. As such, this also means that you can still collect Workers’ Compensation even when the accident is due to your own negligence. Workers’ Compensation was also designed to serve as an insurance policy to pay for any injuries resulting in the workplace, not as a means to punish your employer.

Why have I noticed someone following me with a camera or video camera?

In order to maintain its profitability and prevent fraud, insurance companies will sometimes hire a private investigator in order to make sure that your claim is not fraudulent. The private investigator is trying to catch you engaging in activity that would show that you are not actually injured or faking an injury. If the private investigator is able to obtain evidence showing that you are not actually injured, the insurance company will avoid having to pay out on a settlement and thus avoiding a loss to their profitability. If you believe that you are being spied on, you should contact a lawyer immediately.

What does a Vocational Rehabilitation Counselor do?

A vocational rehabilitation counselor is an individual hired by the insurance company to work with you to get you back to work as soon as possible. Although they seem like they may be friendly and helpful, you must always remember that they are working for the insurance company and therefore do not have your best interests at heart. Their sole purpose is to get you back into the workforce regardless of whether you are actually ready both physically and mentally. You should also not allow them to come to your house, since like the private investigator, they will be looking for any evidence that may show you are able to work. If the insurance adjuster or insurance company representative mentions a vocational rehabilitation counselor, you should contact a lawyer immediately.

What does Maximum Medical Improvement mean?

A Maximum Medical Improvement (MMI) is when a doctor indicated that you have reached a point where you have healed as much as you are going to. At this point, the doctor will release you and designate what, if any, restrictions your injury may place on you. The doctor will also give you a rating, which is a number, based off his professional opinion, of the degree of injury you have. This is generally the point at which the insurance company will know the full extent of your injury and begin to pressure you to settle or undergo vocational rehabilitation.

What are my options regarding Social Security Disability?

Generally, you should only apply for Social Security Disability if you were hurt badly enough to keep you out of work for six months or more. Although you may apply, your application will likely be denied, regardless of your medical condition. However, many individuals appeal their denials and are successful in getting Social Security Disability. Since dealing with the entire process of Social Security Disability is quite difficult, you should contact an experienced Workers’ Compensation attorney to help you with your case.

Is there any money available to go back to school to be able to get back to my pre-injury earnings?

There is money available for education if the only way to get back to your pre-injury level or earnings is through more school. Typically, either the insurance company or the North Carolina Department of Vocational Rehabilitation may provide the funds for more education.

What is mediation?

Mediation is the process of reaching an agreement regarding a settlement without involving the judicial process. In order to reach an agreement, a mediator acts as an impartial observer and attempts to help both parties figure out a compromise that will work for both parties. Mediation is typically held in a neutral location with both sides meeting in a room and individually. The mediator will observe both sides and try to argue the merits of each side’s arguments. Although you are not required to participate in mediation, with a good mediator and a experienced Workers’ Compensation lawyer, most cases can be settled in a way that works for both parties.

What is a Functional Capacity Evaluation?

A Functional Capacity Evaluation (FCE) is an examination by a physical therapist to determine how disabled you are due to the injury. Once your Doctor has evaluated you and determined you have reached your Maximum Medical Improvement, he will assign a rating that designates how disabled you are. In determining this rating, the doctor will use the results of the FCE to make a decision.

What are Restrictions and why are they important?

Restrictions are physical limitations imposed by your doctor due to the nature of your injury. Restrictions limit what physical acts you are incapable of doing without injury or harm. These restrictions may be anything from limiting how much you can lift or carry to whether you can work outside. Restrictions are very important in a Workers’ Compensation claim because they limit what type of jobs or work you may be capable of doing in the future. As such, they are important in your settlement negotiations with the insurance company.

Is there any other useful information I should know?

The important thing to remember throughout this process is that you should not be scared. Although the insurance company appears to have the upper hand since they are experienced and knowledgeable in the area, if you hire an experienced Workers’ Compensation attorney, you can level the playing field and resolve your claim in a manner that benefits you.

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