Check Out Our Podcast: The Verdict
When you’re injured at work, you might assume workers’ comp will cover everything, from lost wages to pain and suffering. But the reality is very different. In this episode of The Verdict, lead workers’ comp attorney Brian Groesser joins Clarke to break down exactly what benefits you’re entitled to—and what you’re not—under North Carolina workers’ compensation law.
Brian explains the two sides of every comp claim: medical coverage and wage replacement. You’ll learn how benefits like Temporary Total Disability (TTD), Temporary Partial Disability (TPD), and Permanent Partial Disability (PPD) are calculated, why average weekly wage matters so much, and how insurance companies often get it wrong. They also tackle one of the most frustrating truths: workers’ comp does not pay for pain and suffering.
Here’s what we discuss in this episode:
🏥 Medical benefits covered – Treatment, prescriptions, travel, surgeries, and more.
💵 Wage replacement – TTD, TPD, and PPD checks are based on your average weekly wage.
📉 Common underpayments – Insurance carriers often miscalculate wages, costing workers thousands.
🚫 No pain & suffering – Unlike auto accidents, workers’ comp does not compensate for this.
0:00 – Benefits you’re entitled to
2:21 – Do insurance companies ever get it wrong?
5:37 – Why not full wages?
6:58 – Other benefits
Workers comp, pain and suffering, lost wages, medical benefits, insurance, insurance companies
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Clark: I'm Clark Speaks, the catastrophic injury lawyer. Welcome to the Verdict. Hi, I'm Clark Speaks. Welcome to the Verdict. I'm HM here with Brian Grosser. Brian, can you tell me about, um, in North Carolina? What, uh, benefits am I entitled to, uh, after a work workplace injury, assuming it meets the definition of a compensable accident?
Brian Grosser: It's a great question. It's the one thing that I probably talk with clients about the most. And that is what you are not entitled to, because workers comp is an exclusive remedy. And that also means that there are exclusive benefits that you're entitled to. I think I talked a little bit about this in the prior episode where there are two components to your case. There's the medical side of it and there's the indemnity side of it. The indemnity side is dealing with your wage loss. We'll get into that in a minute. The medical side is talking about the treatment and getting your treatment covered. Whether it's your prescriptions or your, uh, travel to and from a, uh, provider. The treatment itself, you know, the MRI is, the injections, all of the surgery, all of those things, those are all covered under medical benefits. That's the first side. Second side is talking about indemnity and that's the wage loss. So if you are out of work, you could be entitled to something that's called TTD benefits, Temporary total disability benefits. This is going to try and replicate your net earnings on a weekly basis. This is why it's important if you give us a call to get your wage records to us early on so that we know. Because a lot of times insurance carriers will just estimate this amount. Oh, he was making $10 an hour and working 40 hours a week. His average weekly wage is $400. What they're going to pay you is 2/3 of that because again, they're going to pay you post tax earnings. That's what those weekly checks are going to be. But it's based on an estimate on their end. We want to know what your actual wage records are. When we get your wage records, we see you worked a lot of overtime and you were paid time and a half during that. And so really your average weekly wage was $600, not $400. We don't know that unless we have your wage records. So typically we get that from the employer. And that's something that we do on our end. We track that down and get the forms and the wages. But you can also do that in terms of tracking down your pay stubs or tracking down a W2 and showing us, no, this is what I made. And so that we can have a better idea that now you are making more money than what the insurance carrier is paying you. Those are what are called TTD benefits, temporary total disability benefits.
Clark: Let me ask you a question. When the insurance. When people try to do this by themselves and they, uh, have an interaction with the insurance company just about this one, this average weekly wage issue, do the insurance companies ever get it wrong and pay them less than they should?
Brian Grosser: They get it wrong all the time. Uh, it's a frequent thing that I see.
Clark: How would somebody know if the, uh, insurance company was paying them less than they should?
Brian Grosser: A lot of times I hear from a client saying, I just don't feel like I'm being paid. Correct. I feel like I'm supposed to be making more. But they don't know because this isn't a paycheck. This is a compensation check coming from a workers comp carrier. They don't know what it technically represents and what it's supposed to reflect. They just think that this is what they're owed because the person that is adjusting their claim, that is the professional, tells them this is what they're owed. Right. They don't know what it's based upon. They don't know why they came to the figure that they did. They just assume that it's correct. I've had cases where, you know, the employee didn't reach out to me until a long time after they'd been receiving money and you find out they were underpaid by like $10,000. You know, the case had been open for a year, year and a half, and they were getting underpaid at that level. I mean, that's a rare circumstance, but it's a common circumstance that you are underpaid. 50 bucks a week, 100 bucks a week, you know, and that may not seem significant in a short term view, but if your case is staying open like I talked about before, often cases stay open for a month, a, uh, year, year and a half. If you're getting paid underpaid $50 or $100 a week, that adds up.
Clark: And guess what happens when they're. It's extrapolated out into the future. Uh, if you do do it at a. Under, uh, undervalue.
Brian Grosser: Right. Yeah. It's just you want to make sure that you are being paid correctly because your case hinges on that average weekly wage. Not only does it depend on your weekly checks that we were talking about with TTD checks, but there's A thing called ppd, Permanent partial Disability. This is the rating that a doctor typically assigns at the end of a case. And it's supposed to reflect the amount of usage that you lost with that body part because of your injury. So let's just hypothetically say that you had a back injury that required surgery. By statute, your back is worth 300 weeks of PPD benefits. If he assigns you a 10% rating, you get 10% of those 300 weeks. So you get 30 weeks of benefits just by having a rating, Nothing else. Just the rating. It doesn't even matter if you're back to work or not. You get that no matter what as a rating. But if you have your average weekly wage calculated incorrectly, that's
00:05:00
Brian Grosser: what that number is based off of, right? It's 30 weeks based off of that figure. If the figure is inaccurate, you're going to get paid less. You want to make sure that you have the accurate average weekly wage before you progress because it's going to impact all of your benefits. TTD benefits, PPD benefits, Temporary partial disability benefits, meaning that if you came back to work and you're making less wages, the carrier's supposed to make up the difference. Those are called TPD benefits. All of these benefits are impacted by the value of that average weekly wage. And if you are being underpaid, you're going to be underpaid throughout your entire claim for all of those benefits.
Clark: So you mentioned 2/3 of the average weekly wage. This is a part that people have questions about, in my experience is like, wait a minute, why wouldn't I get my full, full weekly wage? Why am m. I, why am I being penalized for being hurt? Can you explain that to us?
Brian Grosser: Absolutely. And so the reason why is, it's like I said just a few minutes ago, it's supposed to reflect your post tax earnings. You may make $400 a week with company X, but you get paid. Um, I'm not a math major, but whatever. Two thirds. Roughly two thirds the difference. Let's just make it easy. $300 a week, you get paid with company X, right? That's your gross earnings. It's $300 a week. But your take home pay after Medicare is taken out, Social Security, uh, other items, state income tax, federal income tax, all those things are taken out. You're actually bringing home $200 a week. Yes, you made 300, but you're bringing home two. Your TTD check is supposed to reflect that. Because you receive that money tax free, the IRS is not taxing you on your Weekly checks. Likewise, at the back end of your claim, when you settle your case, you're not taxed on that either. So if you, if you, if you settle for $100,000, it's tax free, right? It's because the benefits are supposed to reflect your post tax earnings. They are post tax benefits. That's why.
Clark: Are there other benefits that a person after a, uh, workers campus compensation claim is entitled to?
Brian Grosser: You know, it's not really. I mean, I'm, and this is why I say, like, I talk to folks more about what you're not entitled to. Right? Like the emotional distress that you went through, the pain and suffer. That's the biggest one in workers comp. I've been through so much pain and so much suffering through this, I feel like I should be compensated for it. I always feel bad telling them, but that's. The insurance carrier doesn't, uh, I don't mean to be crass, but the insurance carrier doesn't care. Like that's not something that they owe. They don't owe for your pain and suffering. That may be something that you be entitled to if you were in a car accident outside of work, but it doesn't apply to workers compensation. You are literally only titled to those medical benefits that I talked about. And your wage loss benefits, whether it's full wage loss, which is ttd, or partial wage loss, which is tpd, and then the rating, which is permanent partial disability benefits. That's it. That's really what you're entitled to. And when you are looking to settle a case, it's often a forecast of how long, if you are out of work, which many workers, um, are at that point, how long are you going to be out of work? And that is a reflection of future TTD benefits, temporary total disability, those weekly checks that we're talking about. That's it. There really aren't any other benefits that you're entitled to in a workers comp. And that frustrates people because they say, well, I've got so much more going on than just my wage loss. It's the trade off of being in the workers comp system.
Clark: Well, and if a person was in an automobile accident, you know, they might be able to recover pain and suffering, but they also might be limited by the amount of insurance that is involved. So for example, a person could be very seriously injured in an automobile accident and have tremendous medical bills, tremendous lost wages, and not receive all of that because the driver that hit him maybe only had a $30,000 or $50,000 policy. So there are pluses and minuses for each of these different things. But, uh, the wind up is you're better off, I think, if you have an advocate in your corner who understands these things and can help you get the maximum recovery you're entitled to under the law. Uh, Brian, thank you for talking to me about this. Uh, when we come back, I'd like to talk to you about third party claims, that is, cases that have a component of workers compensation and a component of third party liability, ordinary tort liability, those types of things. So join us next time. Thanks for joining us. Don't forget to subscribe and follow us to stay up to date with our weekly episodes. We'll see you next time.
00:09:33
Clark: I'm Clark Speaks, the catastrophic injury lawyer. Welcome to the Verdict. Hi, I'm Clark Speaks. Welcome to the Verdict. I'm HM here with Brian Grosser. Brian, can you tell me about, um, in North Carolina? What, uh, benefits am I entitled to, uh, after a work workplace injury, assuming it meets the definition of a compensable accident?
Brian Grosser: It's a great question. It's the one thing that I probably talk with clients about the most. And that is what you are not entitled to, because workers comp is an exclusive remedy. And that also means that there are exclusive benefits that you're entitled to. I think I talked a little bit about this in the prior episode where there are two components to your case. There's the medical side of it and there's the indemnity side of it. The indemnity side is dealing with your wage loss. We'll get into that in a minute. The medical side is talking about the treatment and getting your treatment covered. Whether it's your prescriptions or your, uh, travel to and from a, uh, provider. The treatment itself, you know, the MRI is, the injections, all of the surgery, all of those things, those are all covered under medical benefits. That's the first side. Second side is talking about indemnity and that's the wage loss. So if you are out of work, you could be entitled to something that's called TTD benefits, Temporary total disability benefits. This is going to try and replicate your net earnings on a weekly basis. This is why it's important if you give us a call to get your wage records to us early on so that we know. Because a lot of times insurance carriers will just estimate this amount. Oh, he was making $10 an hour and working 40 hours a week. His average weekly wage is $400. What they're going to pay you is 2/3 of that because again, they're going to pay you post tax earnings. That's what those weekly checks are going to be. But it's based on an estimate on their end. We want to know what your actual wage records are. When we get your wage records, we see you worked a lot of overtime and you were paid time and a half during that. And so really your average weekly wage was $600, not $400. We don't know that unless we have your wage records. So typically we get that from the employer. And that's something that we do on our end. We track that down and get the forms and the wages. But you can also do that in terms of tracking down your pay stubs or tracking down a W2 and showing us, no, this is what I made. And so that we can have a better idea that now you are making more money than what the insurance carrier is paying you. Those are what are called TTD benefits, temporary total disability benefits.
Clark: Let me ask you a question. When the insurance. When people try to do this by themselves and they, uh, have an interaction with the insurance company just about this one, this average weekly wage issue, do the insurance companies ever get it wrong and pay them less than they should?
Brian Grosser: They get it wrong all the time. Uh, it's a frequent thing that I see.
Clark: How would somebody know if the, uh, insurance company was paying them less than they should?
Brian Grosser: A lot of times I hear from a client saying, I just don't feel like I'm being paid. Correct. I feel like I'm supposed to be making more. But they don't know because this isn't a paycheck. This is a compensation check coming from a workers comp carrier. They don't know what it technically represents and what it's supposed to reflect. They just think that this is what they're owed because the person that is adjusting their claim, that is the professional, tells them this is what they're owed. Right. They don't know what it's based upon. They don't know why they came to the figure that they did. They just assume that it's correct. I've had cases where, you know, the employee didn't reach out to me until a long time after they'd been receiving money and you find out they were underpaid by like $10,000. You know, the case had been open for a year, year and a half, and they were getting underpaid at that level. I mean, that's a rare circumstance, but it's a common circumstance that you are underpaid. 50 bucks a week, 100 bucks a week, you know, and that may not seem significant in a short term view, but if your case is staying open like I talked about before, often cases stay open for a month, a, uh, year, year and a half. If you're getting paid underpaid $50 or $100 a week, that adds up.
Clark: And guess what happens when they're. It's extrapolated out into the future. Uh, if you do do it at a. Under, uh, undervalue.
Brian Grosser: Right. Yeah. It's just you want to make sure that you are being paid correctly because your case hinges on that average weekly wage. Not only does it depend on your weekly checks that we were talking about with TTD checks, but there's A thing called ppd, Permanent partial Disability. This is the rating that a doctor typically assigns at the end of a case. And it's supposed to reflect the amount of usage that you lost with that body part because of your injury. So let's just hypothetically say that you had a back injury that required surgery. By statute, your back is worth 300 weeks of PPD benefits. If he assigns you a 10% rating, you get 10% of those 300 weeks. So you get 30 weeks of benefits just by having a rating, Nothing else. Just the rating. It doesn't even matter if you're back to work or not. You get that no matter what as a rating. But if you have your average weekly wage calculated incorrectly, that's
00:05:00
Brian Grosser: what that number is based off of, right? It's 30 weeks based off of that figure. If the figure is inaccurate, you're going to get paid less. You want to make sure that you have the accurate average weekly wage before you progress because it's going to impact all of your benefits. TTD benefits, PPD benefits, Temporary partial disability benefits, meaning that if you came back to work and you're making less wages, the carrier's supposed to make up the difference. Those are called TPD benefits. All of these benefits are impacted by the value of that average weekly wage. And if you are being underpaid, you're going to be underpaid throughout your entire claim for all of those benefits.
Clark: So you mentioned 2/3 of the average weekly wage. This is a part that people have questions about, in my experience is like, wait a minute, why wouldn't I get my full, full weekly wage? Why am m. I, why am I being penalized for being hurt? Can you explain that to us?
Brian Grosser: Absolutely. And so the reason why is, it's like I said just a few minutes ago, it's supposed to reflect your post tax earnings. You may make $400 a week with company X, but you get paid. Um, I'm not a math major, but whatever. Two thirds. Roughly two thirds the difference. Let's just make it easy. $300 a week, you get paid with company X, right? That's your gross earnings. It's $300 a week. But your take home pay after Medicare is taken out, Social Security, uh, other items, state income tax, federal income tax, all those things are taken out. You're actually bringing home $200 a week. Yes, you made 300, but you're bringing home two. Your TTD check is supposed to reflect that. Because you receive that money tax free, the IRS is not taxing you on your Weekly checks. Likewise, at the back end of your claim, when you settle your case, you're not taxed on that either. So if you, if you, if you settle for $100,000, it's tax free, right? It's because the benefits are supposed to reflect your post tax earnings. They are post tax benefits. That's why.
Clark: Are there other benefits that a person after a, uh, workers campus compensation claim is entitled to?
Brian Grosser: You know, it's not really. I mean, I'm, and this is why I say, like, I talk to folks more about what you're not entitled to. Right? Like the emotional distress that you went through, the pain and suffer. That's the biggest one in workers comp. I've been through so much pain and so much suffering through this, I feel like I should be compensated for it. I always feel bad telling them, but that's. The insurance carrier doesn't, uh, I don't mean to be crass, but the insurance carrier doesn't care. Like that's not something that they owe. They don't owe for your pain and suffering. That may be something that you be entitled to if you were in a car accident outside of work, but it doesn't apply to workers compensation. You are literally only titled to those medical benefits that I talked about. And your wage loss benefits, whether it's full wage loss, which is ttd, or partial wage loss, which is tpd, and then the rating, which is permanent partial disability benefits. That's it. That's really what you're entitled to. And when you are looking to settle a case, it's often a forecast of how long, if you are out of work, which many workers, um, are at that point, how long are you going to be out of work? And that is a reflection of future TTD benefits, temporary total disability, those weekly checks that we're talking about. That's it. There really aren't any other benefits that you're entitled to in a workers comp. And that frustrates people because they say, well, I've got so much more going on than just my wage loss. It's the trade off of being in the workers comp system.
Clark: Well, and if a person was in an automobile accident, you know, they might be able to recover pain and suffering, but they also might be limited by the amount of insurance that is involved. So for example, a person could be very seriously injured in an automobile accident and have tremendous medical bills, tremendous lost wages, and not receive all of that because the driver that hit him maybe only had a $30,000 or $50,000 policy. So there are pluses and minuses for each of these different things. But, uh, the wind up is you're better off, I think, if you have an advocate in your corner who understands these things and can help you get the maximum recovery you're entitled to under the law. Uh, Brian, thank you for talking to me about this. Uh, when we come back, I'd like to talk to you about third party claims, that is, cases that have a component of workers compensation and a component of third party liability, ordinary tort liability, those types of things. So join us next time. Thanks for joining us. Don't forget to subscribe and follow us to stay up to date with our weekly episodes. We'll see you next time.
00:09:33
