WILMINGTON and CHARLOTTE, North Carolina—Christopher Miranda, Workers’ Compensation Paralegal for Speaks Law Firm, P.C., answered some of the most frequently asked questions about North Carolina workers’ compensation law in a recent interview. Miranda, who has been a paralegal since 2003, and a member of the Speaks Law Firm staff since 2019, also noted the three most common mistakes he sees clients make concerning their workers’ compensation cases.
How does North Carolina define workers’ compensation?
“What they deem to be a compensable case and a non-compensable case is pretty clear. If you are injured at work and sustain an injury by accident or a specific traumatic incident, you will likely have an accepted workers’ compensation case. What does an injury by accident mean? It’s some interruption of or deviation from your normal work duties. If you’re walking down the hallway and trip over your own two feet, that’s probably not going to be compensable because there’s no injury by accident, no interruption or difference in your usual thing. But if you’re walking down the hallway and you trip over a rug that’s not sitting properly, or the floor is wet, unknown to you, and you fall and injure yourself, that’s likely going to be a compensable case.”
If someone gets injured at work, what should they do first?
“They have to report it to their manager or supervisor right away, because you want to have a record of the fact that it happened. People will often say, ‘Well, I’ll be okay in the morning,’ then go home, and wake up feeling like, ‘Oh my gosh, what happened?’ And they never reported it. When they haven’t reported the incident right away, there’s a chance that someone either at work or the insurance company can say, ‘Well, we don’t know that it happened at work. We don’t know what you did when you went home.’ Reporting it right away is crucial.”
When a worker gets injured in North Carolina and reports it immediately to their supervisor, how should they expect them to respond?
“We hope the employer is going to file an incident report for them, so that there’s a record of what the employee says happened. We hope they’re going to offer the employee some medical treatment to get checked out, whether it’s at an urgent care or any variant of that. If you’re complaining of severe pain or if it looks like you might have a broken limb, you need to go to the emergency room. We want the employer, the supervisor, to file a written report for you, then get you some medical treatment. Most employers probably don't have a list of places their employees can go if they get hurt, but they should at least be familiar with the urgent care that’s down the road or across the street where they can just say, ‘Go over there and get yourself checked out so we can see what your injuries are.’”
What can an injured North Carolina worker expect from the state’s workers’ compensation law?
“If you have a compensable injury, the employer and the insurance company direct your treatment. You’re entitled to medical benefits. If you’re out because of your injury on doctor’s orders, they should pay you a wage benefit, which is referred to as Temporary Total Disability (TTD). It’s based on your average weekly wage over the previous 52 weeks. You’re paid two-thirds of your average weekly wage, and there are no additional taxes taken out. So, if you’re making $900 a week, you’re going to get a check for $600 a week from the insurance company until your doctor either releases you to work full duty with no restrictions or they give you some restrictions your employer can accommodate.
“At some point in your treatment, your doctors are going to say that you’re good to go and can return to work, but under specific restrictions. They’ll give you what’s called a Permanent Partial Disability (PPD) Rating. It’s a percentage taken off a chart published by the North Carolina Industrial Commission. There’s a formula to determine what the award should be. Under North Carolina law, in an accepted workers’ compensation case, the employee is entitled to medical treatment, wage benefits, and payment of their permanency rating.”
What happens if an employee becomes totally disabled after a work accident and can no longer perform their job, even with accommodation?
“If the employee is completely disabled, different things can happen, some dependent on age and what they've done for a living. In many instances, the insurance company is going to hire a vocational rehabilitation expert to help our client find employment. That could take different forms. Sometimes blue collar workers don't have a good working knowledge of computers, or the software that most people use. They may start with basic computer skills courses. Hopefully, they will help them complete a resume.
“If somebody does not have a high school diploma that they may need for future employment, sometimes they'll send them to GED classes. It depends on the person and the situation. At Speaks Law, we advocate for whatever is the best option for our client.”
Are all employers In North Carolina required to carry workers’ comp insurance?
“If you are an employer with three or more employees, you are required to have workers’ comp insurance, and if you are actively involved in the workings of the business, then you're included as one of those people.
“If I have a company and I've got two guys doing work for me, and one of them gets hurt, and I don't have a policy, they can pursue me as an uninsured employer, which involves the Attorney General's office getting involved, and lots of fines and penalties, and all this other kind of stuff, and then potentially payment to the injured worker.
“There are some exceptions, and the farming and logging industry are two of them.”
You mentioned that an injured employee should report the injury right away to their employer. But by law, how much time do they have to do it?
“An employee must give the employer written notice of the accident within 30 days of it taking place. Or, if it’s something like carpal tunnel, it has to be 30 days from the date of the first diagnosis. The law allows 30 days, but we encourage everyone to report a work injury as soon as you possibly can. Report it verbally to your supervisor, then put something in writing if it’s something that doesn’t require transportation to a hospital immediately. Otherwise, verbally is usually the first thing that’s going to happen.
“If an ambulance shows up to take somebody to the hospital because they fell off a roof, we would consider that notice, although I’ve seen carriers in the past try to say, ‘Well, who did he report it to?’ after the ambulance arrived. What did they think was going on? We’re pretty sure they knew about it, but that’s what insurance carriers do. I worked for a carrier, so I get it. They’re just doing their job. We don’t like it, but they’ve got to do it.
“We talk to injured people. We talk to insurance companies. We talk to defense attorneys. And we understand the process, so we can bring some value to your case – not necessarily monetary value, but we can help you get the treatment you deserve or need, because our involvement allows injured folks to concentrate on getting better rather than having to chase after the insurance companies or the defense attorneys or their employers to find out what's going on. That's where our experience is valuable to them.”
It sounds like having a good workers’ compensation attorney on their side is beneficial.
“We have several different handouts that explain the do's and don'ts of a workers’ compensation case in North Carolina. Surveillance can be done, and you may or may not know that it's being done. You have to listen to what the doctors tell you. We also have handouts about different things that are going to happen at some point in your claim. We make sure that our clients are as well informed as possible, so there's no confusion at the end of the case when we're explaining why negotiations are taking place, or why their case is worth what it is worth. We try to manage expectations as early as possible.”
How does a workers’ compensation case differ from a personal injury case?
“If you get in a car wreck and break your arm, you can make a whole bunch of arguments. I couldn't play golf. I couldn't play baseball. I couldn't pick up my kids. But in workers’ comp, they don't have to consider any of that. Pain and suffering is not a component of workers comp in any sense or form.
“We try to mention that pretty early on (to a client). Worker’s compensation is strictly for whatever medical issues the injury caused.”
What are some of the most common mistakes people make in workers’ comp cases?
“Not reporting their injury. Somebody will hurt themselves, and if they've been a blue collar worker doing construction or manufacturing, they tend to work through these injuries. If it's minor and you work through it, that's well and good. But how do you know that it's minor?
“Another mistake is if they work for a small company and feel like they've got a good relationship with their employer, they will get medical treatment and then say that it happened at home or it happened while they were doing something else. Instead of saying, ‘Hey, I got hurt when I fell off the roof at work,’ they'll say, ‘I was doing something around the yard.’ They're trying to protect their employer, but it damages their claim because it's all about what's in the medical records. And if it says in the medical records, ‘I got hurt at home,’ how do we prove it's a workers’ comp case?
“It's hard to get past that. Sometimes you can. If an ambulance shows up at the job site, then it happened at the job site. But if you got in your car and drove to the emergency room or urgent care, and said, ‘I got hurt at home’, it's difficult.
“If somebody is a long-term employee and has been loyal to the company they're working for, the mistake they make is thinking their employer is going to do the right thing. Sometimes they're going to, and sometimes they're not.
“The insurance company makes the decisions, and they don't have that loyalty to you. Your boss may love you, but when it comes down to your medical treatment and other things involved in your claim, he's not deciding. The company has this coverage (workers’ compensation) for a reason: to protect them in case one of their employees gets hurt.”
For more information, visit Speaks Law Firm, with offices in Wilmington and Charlotte.
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From a mother and father picking up their kids to a friend driving home from work, accidents happen every day and can affect anyone. When disaster strikes, it’s important to have someone in your corner who knows the law and has experience handling personal injury cases. Our team of Wilmington personal injury lawyers has been helping injured victims seek justice and fair compensation for over 20 years. We put our clients first every time and fight hard for the compensation they need to support themselves and their families after an accident.
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