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FAQ - Frequently Asked Questions

Auto Accident FAQ
Social Security Disability FAQ

Right now, you’re bound to have quite a few questions. That’s normal! Here are some helpful answers that will begin to put things into perspective. Keep in mind that every case is different, so please call us for all the answers regarding your unique situation.

Workers' Compensation FAQ

• What must an employee do when an injury occurs?
  
• What should be done if the employer fails or refuses to report an injury?
• Who provides and directs medical treatment?
• What happens if in an emergency the employer fails or refuses to provide medical treatment?
• What are the rules for chiropractic treatment?
• Do I have to go to the doctor that WC sends me to?
• What are the workers' compensation benefits?
• When do I become eligible for lost wage compensation?
• At what rate of pay are wage compensations made?
• How long is the employee eligible to receive lost-time weekly benefits?
• When can reimbursement for sick travel be collected?
• Do I get compensation for pain and suffering?
• What is partial disability?
• Who determines partial disability?
• Who is required to provide workers' compensation coverage?
• What happens when the employer refuses to acknowledge the claim?
• Who is my employer's workers' compensation insurance carrier?
• Do I need an attorney?
• What kind of attorney do I need? Or how do I choose an attorney?
• How is my workers' compensation claim settled?
• Reaching a settlement through mediation
• How does Workers' Compensation affect my Social Security benefits?
• What happens at a workers' compensation hearing?

What must an employee do when an injury occurs?
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. (In many cases, the WC representative on site will help fill this form out and send it to the North Carolina Industrial Commission (NCIC)). It is recommended that the injured worked keep a copy of the form. Back to Top

What should be done if the employer fails or refuses to report an injury?
Call (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.

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.

If you are not represented by an attorney, you can call the Ombudsman at the NCIC (800) 688-8349 or locally at (919) 807-2501. Back to Top

Who provides and directs medical treatment?
The employer or its insurance company, subject to any NCIC orders, provides and directs medical treatment. The Commission may permit the employee to change physicians or approve a physician of the 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. Back to Top

What are the rules for chiropractic treatment?
If the employer or the employer’s insurance company 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 NCIC. Back to Top

Do I have to go to the doctor that WC sends me to?
You do have the right to ask the Industrial Commission for permission to see a doctor of your choosing. However, if you are treated by your own doctor without getting permission, you may jeopardize your benefits. You should seek legal assistance or contact the Industrial Commission if you have a question about changing doctors or getting a second opinion.
Back to Top

What are the workers' compensation benefits?
Your employer, or your employer's insurance company, is required to compensate you or your family for injuries or death that may occur while you are working. Here's what you are entitled to:

• Weekly benefits while you are unable to work.
• Payment of your medical expenses.
• A lump sum payment for partial or total disability resulting from a workrelated injury

If you are injured on the job, you may be entitled to compensation, regardless of who is at fault. The only requirement is that the injury or illness occurred while you were performing your normal job duties. Complaints may include back injury, burn injury, falls, hazardous inhalation, cuts and injury to all parts of the body.

If you are injured on the job, your employer must pay for your medical expenses, and you should receive two thirds of your wages while you are unable to work. You may also sue any third party other than your employer or coworkers who caused your injury. Back to Top

When do I become eligible for lost wage compensation?
No workers’ compensation for lost wages is due for the first seven (7) days of lost time unless the lost time exceeds 21 days. Therefore, the first check will not include payment for days 1-7. Payment for those days will be made should the time out of work continue beyond 21 days.
Back to Top

At what rate of pay are wage compensations made?
66.6% of the average weekly wage, not to exceed $730.00 (maximum for 2006) per week. The maximum for 2005 was $704.00. The maximum weekly benefit is adjusted annually.

How long is the employee eligible to receive lost-time weekly benefits?
Until the employee is able to return to work.

When can reimbursement for sick travel be collected?
Employees are entitled to collect for mileage for medical treatment in workers' compensation cases provided you travel 20 miles or more round trip. Special consideration is 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 NCIC.

Do I get compensation for pain and suffering?
Workers' Compensation does not compensate for pain and suffering, only loss of wages as determined by the NCIC and receipt of medical treatment.

What is partial disability?
Permanent partial loss of use of a member of the body or temporary inability to earn the same wages in any employment as earned at the time of the injury.

Who determines partial disability?
The NCIC and the NC General Assembly by statute determines partial disability based on the impairment ratings of physicians, or evidence of loss of wage earning capacity.

Who is required to provide workers' compensation coverage?
Any employer who regularly employs three or more employees whether part-time or full-time.

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.

What happens when the employer refuses to acknowledge the claim?
When liability for payment of compensation is denied, the NCIC, 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 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.

(b) Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers' compensation claim.

Who is my employer's workers' compensation insurance carrier?
Contact NCIC Statistics at (919) 807-2506 for your employers' insurance coverage to verify period of coverage and with what insurance carrier or contact the Third-Party Administrator handling the employer's claims during that injury date.

Do I need an attorney?
You will need an attorney, if any of the following applies:

• If any part of your case has been denied.
  
• You are not receiving medical treatment.
  
• You are out of work without any income.
  
• Have an accepted claim but are unable to return to your previous work position.
  
• You are dissatisfied with your current medical treatment.
  
• You have been terminated.
  
• You have been released to return to work but do not feel capable of doing so.
  
• You have a significant injury claim that will result in a permanent disability.

What kind of attorney do I need? Or how do I choose an attorney?
Many attorneys say they handle workers’ compensation cases when in fact, they do not have the experience, nor the knowledge, to help you navigate through this complicated process. Look for certifications such as Board Certified Specialist by the NC Board of Legal Specialization. Also, make sure the attorney you choose regularly handles the kind of work you need. A good attorney will:

• Monitor medical treatment.
  
• Make sure you receive the best medical treatment possible.
  
• Make sure your weekly checks are on time and that you are receiving the correct amount of money every week.
  
• Ensure you are receiving all benefits to which you are entitled.
  
• Advise you on options regarding returning to work, and/or dealing with restrictions and your employer.
  

How is my workers' compensation claim settled?
There are different ways to “settle” workers’ compensation claims:

1) Clincher Agreement – A clincher is a compromise settlement agreement, where once you’ve signed this agreement, you give up all rights to future workers’ compensation benefits for the particular injury in exchange for a sum of money.
2) Forms 21 and 26. If you sign one of these forms, your workers’ compensation case may remain open but you will be giving up certain rights and the rights you retain will be limited in time. An experienced attorney can help you decide whether you are making a decision that is best for you.

Reaching a settlement through mediation
Mediation is often an effective tool to reduce the costs, risks and delay of litigation. A mediation is conference between some, or all, of the parties involved in the case:

• injured employee
• employer
  
• workers' compensation carrier
  
• attorneys for both parties
  
• A third party, a mediator, selected by agreement of the plaintiff (employee) and defendant (employer and insurance company), comes to the conference to hear both parties' versions of the case, and then tries to help the parties reach a compromise on the matter.
  
  The mediator then goes back and forth between the parties carrying offers and demands, as well as facilitating discussion on the issues in the case, discussing the applicable case law, etc. If the parties are able to reach an agreement,then a Memorandum of Settlement is signed and the case is officially settled. If the parties, do not reach an agreement then, assuming there remain contested issues, the case moves on to a hearing in front of a deputy commissioner of the North Carolina Industrial Commission.

How does Workers' Compensation affect my Social Security benefits?
If you are receiving Social Security benefits, long-term disability benefits or some other type of compensation for your disability, there may be an offset or reduction in your benefits if you also receive workers’ compensation benefits. It is important that you see an attorney to make sure that you are receiving the full benefits to which you are entitled.

What happens at a workers' compensation hearing?
In the workers' compensation practice, a hearing is a formal presentation of the case, by all interested parties in front of a deputy commissioner (judge). The Deputy Commissioner presides over a trial of the issues, and renders a decision on the claim. An order is typically issued as follows:

• Parties have 60 additional days to take any medical doctor (expert) depositions, followed by another 30 days to draft contentions and submit a proposed opinion and award.
  
• Contentions drafted by the parties are written closing arguments on the case, which discuss case facts, case law and present arguments on behalf of their client.
  
• A proposed opinion and award that each party drafts, discloses what the party feels the deputy commissioner should find as Findings of Fact in the case, legal conclusions and what the award should be in the matter.
  
• The deputy commissioner reviews both parties' submissions, and then enters an Order of the Court, ruling on the matter.
  
  The biggest difference between mediations and hearings lies in who has control over the result of the case. At mediation, the parties each have input and a degree of control over the result in the case whereas at a hearing, the judge makes the sole determination of the outcome.