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If you are injured on the job, you no doubt have many questions about workers’ compensation. Your first question might be “What is workers’ compensation, exactly?” followed by “Do I qualify for workers’ comp?” The answer to these questions will vary from state to state, but here is some general information about North Carolina. Keep in mind, this information is not a substitute for legal advice, and you best option would be to take advantage of a free initial consultation with an experienced workers’ compensation attorney.
In short, workers’ compensation is insurance that pays for your medical expenses and a portion of your wage loss while you are recovering from a work-related injury. Your employer pays for this insurance and when you sustain a compensable workers’ compensation injury, the insurance company provides you with benefits.
In the state of North Carolina, if you qualify for workers’ compensation and you are out of work as a result of your injury, you should receive, on a weekly basis, 66 2/3% of your pre-injury average weekly wage, not to exceed the maximum compensation rate. The maximum compensation rate is based on the year in which you were injured, and the North Carolina Industrial Commission publishes these rates on their website. If you are earning less money than you used to make as a result of your work injury, you should consult with an attorney about receiving partial wage loss benefits.
In addition to lost wages, if you have a compensable workers’ compensation claim, the workers’ compensation insurance carrier will direct your medical treatment, and pay for all authorized medical treatment related to your injury.
Only an experienced workers’ compensation attorney who has reviewed your claim in depth can provide you with an answer to this question, and oftentimes the facts specific to your case with determine the answer. However, in short, in order to qualify for workers’ compensation benefits:
❖ Your injury must be work-related.
❖ You must be an employee of the company that you are filing the workers’ compensation claim against, and the business must have or be required by law to have workers’ compensation insurance.
❖ The injury must be a result of an accident or otherwise a compensable occupational disease.
In North Carolina, your injury must be directly linked to your employment, meaning the injury happened while you were working for your employer. While this may seem like a straightforward requirement, there are times when whether or not you were working when injured can be less clear. For example, if a person has clocked out of work and is heading home for the day, but is still on the employer’s premises when injured, then the injury will likely be considered work-related. In other cases, when an employee is commuting to and from work and is injured in an automobile accident, the question as to whether the commute was associated with the employee’s work is a fact-specific inquiry.
You can only file a workers’ compensation claim if you are an employee of the business you are filing your claim against. In addition, the business you are filing the claim against must be a business that is required to carry workers’ compensation insurance. Some very small businesses are not required to carry workers’ compensation.
In North Carolina, a business with at least three employees would usually be required to carry workers’ compensation insurance. There are some exceptions to this rule. If your employer does not have workers’ compensation insurance, or is not required to have workers’ compensation insurance, then there may be other sources of compensation.
Lastly, your injury must be the result of a work-related accident or compensable occupational disease.
In order for the injury to be considered the result of an accident, something unusual, unlooked for, or untoward must have caused you to get hurt. Alternatively, your injury could qualify as an occupational disease.
Every case is different, and whether or not your case meets this standard, requires a review of the facts. If the insurance company has denied your claim, stating that you did not sustain an “injury by accident,” contact an attorney for a free initial consultation, as they may be able to help you obtain workers’ compensation benefits.
Attempting to manage a workers’ compensation claim on your own can be overwhelming. If you have questions regarding how to protect your right to workers’ compensation benefits, contact us today for a FREE initial consultation.