Winston-Salem Workers’ Compensation Lawyer

An injured worker’s rights are determined by the Workers’ Compensation Act. The Act was first passed in 1929. It has since been amended many times and is constantly being interpreted by court and Industrial Commission decisions. The Commission has its own Rules regarding procedures, working with rehabilitation specialists, discovery and time limits. The law also addresses the admissibility of evidence, legal procedures necessary to assert your claim, and the time period during which you must institute the procedure or be forever barred from asserting your claim. As such, the law can present a complex web that may trap the unwary. Insurance companies recognize the soundness of the advice of retaining counsel and they employ many attorneys. Many companies have “in house” attorneys who work solely for the company. Depending on the circumstances of your accident, the employer or insurance carrier may have discussed the matter with their attorney within a few hours after the incident. Obviously, employers and insurance companies think it is important to have an attorney protecting them. What Should I Look for in Selecting a Lawyer to Represent Me? Before hiring a lawyer, a prospective client should research the firm he or she is considering hiring. Ask for information about the lawyer’s education, training and experience. Find out if the lawyer has been Board Certified as a specialist in workers’ compensation in North Carolina. Ask the lawyer to tell you about his or her experience dealing with cases similar to yours. Ask the lawyer to go over the fee contract with you in detail, and be sure you understand how you will pay the lawyer’s fee and costs at the end of the case. Ask about the possible adverse consequences if your case is lost. Ask if your lawyer intends to handle your case alone, and if you are told that other lawyers outside the law firm will be asked to assist, find out what the fee arrangements will be. EMP is available to serve your needs with regard to workers’ compensation claims. If you have been injured or have sustained an occupational disease during the course of your employment, we can advise you regarding the laws that affect your case, represent you in the pursuit of your claim(s), and obtain the workers’ compensation benefits to which you are entitled. At EMP, your initial consultation is free. You will speak with an attorney, rather than a paralegal or an investigator, about your case. Following the conference, the attorney will provide you an evaluation of your case. Both you and the firm will then decide whether to enter into an attorney-client relationship.

The insurance company may hire a medical consultant to manage your medical care or a vocational consultant to help you return to work. Please be aware that one of these consultants’ goals is to help you but they have been hired by the employer or insurance company. They write regular reports about their contacts with you. Please do not discuss anything with them which you do not wish to appear in a report to the insurance company.

It is common for insurance companies to hire private investigators to observe injured workers periodically, especially in cases of serious injury. Please be aware that you may be under surveillance at any time. Normally, if you are not doing anything you are not supposed to be doing, the surveillance is only for a short period. The insurance company uses private investigators to seek evidence that you are not as hurt as you have indicated to your doctors, or that you are receiving temporary total disability benefits at the same time you are earning wages. Insurance companies will also look at all your social media, including Facebook, Instagram and similar sites to determine what you are doing while you are out of work. You should always be accurate and honest in what you tell your medical providers and the insurance agents. Tell your doctor you cannot perform certain activities, such as yard work, sports, shopping, housework, lifting children, only if you actually cannot perform these activities. If your doctor has written you out of work, then do not work “on the side” or “under the table.” If the insurance company obtains evidence that you are not as hurt as you have indicated to your doctors, or that you are receiving weekly benefits at the same time you are earning wages, this could have an adverse impact on workers’ compensation benefits to which you are entitled, including immediate termination of benefits you are receiving. The insurance company may accuse you of insurance fraud. Proof of insurance fraud can result in criminal prosecution. The bottom line is be honest with your doctor, your employer, the insurance company and your attorney.

If your claim is voluntarily paid or the Commission issues an order that the employer is liable for your injury or occupational disease, you may be entitled to one or more of the following benefits: Temporary Total Disability (TTD): This is a weekly disability payment which is usually 2/3 of your average weekly wages at the time of your injury or occupational disease. You are eligible to receive TTD during the period your treating physician indicates you cannot earn wages due to your injury. N.C. Gen. Stat. § 97-29. Temporary Partial Disability (TPD): This is a weekly disability payment which is usually 2/3 of the difference between your average weekly wages before your injury at the time of your injury or occupational disease, and your weekly wages based on your reduced earning capacity after your injury or occupational disease. Benefits are limited to 300 or 500 weeks depending on when you were injured. N.C. Gen. Stat. § 97-30. Permanent Total Disability (PTD): This is a weekly disability payment which is usually 2/3 of your average weekly wages at the time of your injury or occupational disease. If you are unable to return to any work because your injury or occupational disease, you may be eligible for payment weekly benefits for 500 weeks or the remainder of your life depending on when you were injured. N.C. Gen. Stat. § 97-29. Permanent Partial Disability (PPD): This is a weekly disability payment based on the percentage of permanent impairment to body members (or parts), including but not limited to: back, arm, leg, hand, foot, finger, toe, and organs. A physician determines the percentage of permanent impairment, or “rating”, to the body part, and your payment is determined by multiplying the percentage of impairment by the number of weeks allowed for that body part under the Act by your weekly compensation rate. The schedule of body parts is set forth in N.C. Gen. Stat. § 97-31. Medical Expenses: The employer or its insurance carrier must pay all of your reasonable and necessary medical expenses arising out of your injury or occupational disease. There is no co-pay. Keep your medical appointments, including physical therapy and diagnostic tests, as scheduled. If you cannot keep an appointment for a good reason, call the doctor’s office in advance and reschedule your appointment. However, you should make every effort to attend medical appointments as scheduled, or the insurance company may accuse you of failure to cooperate in your medical rehabilitation. Do not make appointments with doctors not authorized by the insurance company, unless you have approval from the Commission. If you do see a doctor without prior approval from the insurance company or the Commission, you risk being responsible for payment of the medical expenses you incur for this treatment. Sick Travel and Prescriptions: The employer or its insurance company reimburses you for mileage to and from doctors and hospitals, provided the trip is more than ten (10) miles one way or twenty (20) miles round-trip. They also reimburse you for your prescriptions prescribed by approved treating physicians. Use Forms 25P and 25T to claim reimbursement for these expenses. In cases of hardship, the employer or insurance carrier will sometimes authorize direct billing of prescription medication by an approved pharmacy. In some cases, injured workers are entitled to more than one of the above weekly benefits, but the choice or “election” of one type of benefit may prohibit the election of a more valuable benefit. Before choosing between benefits or signing a settlement agreement, you should consult an attorney.

In the event your employer or its insurance carrier deny your claim and refuse to pay benefits, it is required to file Form 61, Denial of Workers’ Compensation Claim, within fourteen (14) days of its notification of your claim. The Form requires a detailed statement of the reasons your claim is denied. If you disagree with the denial, you may request a hearing by completing a Form 33, Request for Hearing. It can take several months for a claim to be scheduled to be heard by a Deputy Commissioner. Prior to the hearing, the Commission generally orders the parties to participate in a mediation conference. If the case does not settle at mediation, and the hearing is held, the Deputy Commissioner generally leaves the record open after the hearing for a period of 60 days to allow the parties to take doctors’ depositions. After the record is closed, it will usually take the Deputy Commissioner several months to render a final decision called an Opinion and Award. If any party disagrees with the decision, an appeal to the Full Commission may be filed. If any party disagrees with the decision of the Full Commission, an appeal to the North Carolina Court of Appeals may be filed. Hotly disputed workers’ compensation cases can often take years to be resolved through the court system. If your claim is denied, you may wish to consult with an attorney.

Should I Report the Injury? Yes! The Workers' Compensation Act requires that you notify your employer in writing of an injury within 30 days. If you sustain an injury while working, you should immediately report the injury to your supervisor. You should also promptly file a written notice of your claim with the Commission, preferably on a Form 18. You must file a written claim for benefits and/or medical treatment with the Industrial Commission within two (2) years from the date of your injury, or two (2) years from the date a doctor tells you that you have an occupational disease. You should not postpone filing your claim. You should file it immediately after becoming aware of your accident or occupational disease. Even if you believe your injury is minor, promptly and timely filing a written notice of your claim with the Commission will preserve your claim in the event that later your symptoms require medical treatment or you become disabled from work due to your injury. Failure to file your claim within two years will likely bar you from receiving workers’ compensation. Should I Request Medical Treatment? Yes! If you are injured due to an accident at work or believe you are experiencing symptoms of an occupational disease, you should seek medical treatment from an appropriate doctor or hospital. If you have not already done so, you should notify your employer that you have been hurt and are seeking medical attention. If your employer or its insurance carrier have accepted liability for your injury, or agreed to pay benefits under the Act, they may select the doctor. If you disagree with your employer or its insurance carrier regarding the selection of a doctor or hospital or medical procedure, you may request approval from the Commission to change doctors. Should I Talk About the Injury? You should limit your conversations concerning the facts of your injury or occupational disease to those individuals who are required to obtain such information, such as your supervisors, your company’s human resources department, and your treating physicians. In most cases, shortly after the accident or notification of an occupational disease, the injured worker will be contacted by a representative of the employer’s workers’ compensation carrier. The representative will ask to interview you, usually via telephone, and often will want to record the conversation. The recorded statements is often used as a basis to deny claims. If you provide information to the insurance carrier, it should always be accurate and honest. Any statement or information provided by you concerning the facts of the accident or the injuries may be used in Court. Prior to providing any information, you may wish to consult with an attorney regarding your rights and the legal issues in the case.

The North Carolina Workers’ Compensation Act requires that employers pay benefits and reasonable medical expenses for on the job injuries or occupational diseases suffered by employees. If you have been injured or contracted an occupational disease during your employment, you may have a claim for workers’ compensation benefits. Types of injuries which are covered by the Act include injuries by accident such as back injuries and broken bones, crushed limbs, and head injuries, and occupational diseases such as exposure to chemicals, repetitive motion injuries and other diseases unique to a particular occupation. Claims for workers’ compensation benefits are filed with the North Carolina Industrial Commission (the “Commission”) in Raleigh, North Carolina. The general contact information for the Commission is as follows: North Carolina Industrial Commission 4319 Mail Service Center Raleigh, NC 27699-4319 (919) 807-2501 or (800) 688-8349 Web Site: www.ic.nc.gov “Knowledge is Power.”Insurance companies and administrators for self-insured employers are knowledgeable about workers’ compensation and often will use that knowledge to attempt to minimize their payment to injured workers. We recommend that injured employees consult with an attorney experienced in workers’ compensation before negotiating with an insurance company or a self-insured employer.