Workers Comp Practice Areas
Getting hurt on the job in North Carolina likely means that you’re entitled to workman’s comp benefits. Let our experienced law firm ensure that you get all the benefits you’re entitled to.Learn More
Thousands of construction workers are injured in serious accidents every year. When this happens to you, make sure that the work comp insurer doesn’t play games with your rights.Learn More
Whether your factory accident involved machinery, manual labor, or anything else, we can help you ensure the success of your work comp claim and get the most compensation possible.Learn More
Many people don’t realize that car crash injuries suffered on the job could qualify for workers compensation. Contact our work comp attorneys today to explore your options.Learn More
Work-related illnesses and even hearing loss can result in significant medical expenses and lost productivity, making it critical to file for workers compensation to recover your losses.Learn More
CARPAL TUNNEL SYNDROME
Many suffering workers don’t realize that CTS and repetitive motion injuries can qualify them for workers compensation. Contact our North Carolina law firm today to get started on your claim.Learn More
When you suffer mesothelioma due to work-related asbestos exposure, you deserve to be compensated. You don’t have to suffer the consequences of the cancer alone.Learn More
Has your workers comp claim been unfairly denied by the insurance company? Our experienced workers comp lawyers will help you build your appeal so that you can get your claim approved.Learn More
ABOUT RICCI LAW FIRM, PAWhen you’ve suffered an on-the-job injury, you need a workman’s comp law firm that is committed to you and has the resources and experience necessary to win your work comp claim.
Experienced North Carolina Work Comp Attorneys
At the Ricci Law Firm, PA, our team of experienced workers compensation lawyers has over sixty years of combined experience helping injured North Carolina workers. If you’ve been hurt on the job and need help getting your benefits, we are the law firm for you. Having handled cases from all over the state, we know the workman’s comp system, judges, insurers, and other parties that could impact your case.
Brian Ricci, our firm’s founder, puts a premium on getting the results that our clients need. He is a North Carolina workers comp lawyer who has been recognized for his dedication and commitment. At different points in his legal career, Brian has served as a member of the Board of Directors of the Workers Injury Law & Advocacy Group and the NC Bar Association Workers’ Compensation Section.
Even beyond our founder, the Ricci Law Firm, PA’s attorneys have a stellar reputation within the North Carolina legal community, and our lawyers have achieved a number of accomplishments. These include 10.0 Avvo ratings, as well as induction into the Million Dollar and Multi-Million Dollar Advocates Forums, Super Lawyers, and the National Trial Lawyers Top 40 Under 40.
*For more information about criteria for inclusion in the Top 40 Under 40, Super Lawyers, the AVVO ratings, Million Dollar Advocates Forum, and Multi-Million Dollar Advocates Forum see www.justice.org, www.wilg.org, www.bbb.org, www.iowaworkcomplaw.com, www.avvo.com, www.thenationaltriallawyers.org, www.bianc.net,www.nclawspecialists.gov, www.ncaj.com, www.milliondollaradvocates.com. Each case is different and must be evaluated on its individual facts. No representation is made that similar results will be achieved in future cases.
Why Choose the Ricci Law Firm, PA?Getting properly compensated for a work injury requires selecting a top work comp lawyer. Choose the Ricci Law Firm, PA and get the most money for your on-the-job injury.
Whether your work comp claim has been denied or you’re just getting started with the process, getting the best outcome and maximizing your compensation isn’t easy. Your workers compensation will ultimately come from an insurance company driven by profits, so you know they’ll be eager to resolve your claim quickly and for as little as possible.
The Ricci Law Firm, PA has won million-dollar results for our clients. We know how to ensure that the work comp insurer doesn’t unfairly deny your claim or get away with cutting your work comp benefits short. We pride ourselves on seeing to it that the injured workers who come to us for legal help get the full range of benefits available to them, thereby allowing them to recover to the fullest extent possible.
We have offices all over North Carolina, including in Greenville, Raleigh, Rocky Mount, Wilmington, and Charlotte. We provide workers comp representation to North Carolinians when they need it most, and our attorneys always look out for the best interests of our clients. We provide counsel you can trust and advocacy you can depend on.
Our North Carolina workers comp lawyers take pride in the level of client satisfaction we’ve achieved, and our reviews and testimonials speak for themselves. If you’ve suffered a work injury, contact the Ricci Law Firm, PA today. For a free consultation to discuss your workers comp case, just complete the form on this page or call us at 252-752-7785.
North Carolina Work Comp Attorneys
When you suffer an injury on the job and need to take time off work so that you can focus on your recovery, having the financial support provided by workman’s comp can put your mind at ease. Worrying about how you’ll support yourself and your family during this challenging time can make your recovery all the more difficult.
Unfortunately, many work injury victims find themselves waiting on a claim approval or dealing with denials when they need access to their benefits now. A North Carolina workers comp lawyer at the Ricci Law Firm, PA will stop at nothing to secure the funds you need to maintain your standard of living while you are recuperating and unable to work.
NC Requirements for Workman’s Compensation Approval
The state of North Carolina requires every employer who employs more than three employees to carry workers compensation protection on their insurance policies. In order to be approved for workers comp benefits, you need to establish that your illness or injury was directly caused by the conditions of your work environment.
Injured employees often have the mistaken belief that they must have been working for the company for a minimum amount of time or put in a minimum number of hours each week in order to qualify for workers compensation.
Fortunately, this isn’t the case, as every employee—from the date of his or her hiring—will be covered by the employer’s workers comp policy should a work-related injury or illness occur. As long as you’re able to demonstrate the correlation between the duties of your job and the injuries you sustained, you should be able to obtain approval for workers comp benefits.
However, there are circumstances in which the insurance company has the right to deny your claim. Some of these reasons may include the following:
- Failure to report your accident to your employer within thirty days
- Failure to report your claim to the North Carolina Industrial Commission within two years
- You were under the influence of drugs or alcohol at the time of your injuries
- You violated the company’s code of conduct by roughhousing or working off the clock
- You were committing a crime when you suffered the injury
The above-mentioned situations are valid reasons why an insurance company might deny your claim. A work comp attorney from the Ricci Law Firm, PA will examine the details of your case to determine whether a strong case can be made to appeal the denial.
Conditions Qualifying for Workers Comp Benefits in North Carolina
As long as you are able to establish that your health condition was caused directly by the circumstances of your work environment, you should be entitled to workers comp benefits. That doesn’t stop the insurance company from denying claims that seem complicated or difficult to prove, however.
For instance, people who suffer from work-related mental health conditions, hearing loss, stress-related injuries such as carpal tunnel syndrome, or a pre-existing condition that worsened due to work environment are still entitled to workers comp benefits.
Even though the insurance company—and potentially your employer—is likely to fight these types of claims, you will still need these benefits while you are out of work. If you are an injured worker suffering from any of these conditions, or some other injury that the insurance company says isn’t covered, reach out to our North Carolina workers comp attorneys for assistance.
What the Insurance Company Will Cover
When you are filing a claim for workers compensation benefits, you might not be aware that you are entitled to receive multiple types of benefits in addition to a portion of the wages you are unable to earn. These include job training and/or education, coverage of your medical expenses, and death benefits provided to surviving family members. Read on to learn more about North Carolina work comp benefits.
Your Weekly Workers Comp Benefits
Once you’ve been approved for workers comp, the insurance company will provide you with a weekly check based on your calculated compensation rate. You will be eligible to receive these benefits until you are able to return to work, or until you’ve reached the maximum number of weeks allowable based on the type of job-related disability you are dealing with.
You can use these benefits as you see fit; however, most injured workers will use their benefits to support their household by making rent and mortgage payments, paying the utility bills, making car payments, and covering insurance premiums and other expenses.
Vocational Training and Education
In addition to your weekly benefit check, the workers comp insurance company can provide job training or education opportunities for those who won’t be able to return to their previous position due to the severity of the injury and those unable to find gainful employment in the same field they worked in prior to their work injuries.
This enables injured North Carolina workers to find a new position once they’ve reached optimum health and are no longer able to collect workers comp benefits.
ALL of Your Medical Expenses
State law requires that the medical expenses that have accrued due to the injuries you sustained at work be covered by the insurance company. Your employer and their work comp insurer have the right to choose your physician; however, if you are unhappy with the doctor they select, you will be able to find one of your own at the insurance company’s expense.
You can continue receiving medical treatment and care until your physician determines that you have reached maximum medical improvement. At this time, they may decide that you no longer need treatment or care, or they will let you know if you’ll need to return on a quarterly or yearly basis and if you will need to continue to take prescription medication to treat your condition.
For families who have lost a loved one due to a work-related injury or illness, the insurance company will provide death benefits equivalent to 66.66 percent of the decedent’s average weekly wages to the surviving spouse and minor children for up to 500 weeks from the date of the family member’s death.
Children under the age of eighteen will be able to continue receiving benefits until they reach eighteen years of age, while the surviving spouse will be able to collect benefits for a maximum of 500 weeks.
In cases where the surviving spouse is unable to support themselves due to a disability, he or she will be entitled to collect workers comp benefits for the rest of his or her life, or until able to remarry. The insurance company will also provide up to $10,000 in funeral and burial expenses.
How Your Workers Comp Benefits Will Be Calculated
In nearly every type of workers compensation claim, the injured employee will be entitled to a portion of his or her average weekly earnings prior to getting injured on the job. However, the way in which an employee’s average weekly earnings are calculated will vary on a case-by-case basis. Below, we have described the different ways that your average weekly wages can be calculated.
Your Average Weekly Wages
Workers comp benefits are calculated based on your average weekly wages prior to your injury. The amount that you’ll be eligible to receive will be approximately 66.66 percent of your average weekly wages. The insurance company will calculate your average weekly wages by taking the gross income that you’ve earned over the last fifty-two weeks and then divide that by fifty-two weeks to obtain your average weekly wages.
For example, if you earned $65,000 in the past year, the insurance company will divide $65,000 by fifty-two weeks, and your average weekly wages Will be $1,250. of this $1,250, you will receive 66.66 percent, or $833 as your compensation rate. This will be done for employees who have been working for their employer for at least one year.
When You Haven’t Been in Your Position for at Least One Year
If you haven’t been working for your employer for at least one year, don’t worry: You’re still covered by your employer’s workers comp insurance policy. Your average weekly wages will simply be calculated a little differently than someone who has worked there for one year.
Let’s say you’ve been working for your employer for three months and have earned a total of $12,000. Your total gross income of $12,000 would be divided by the twelve weeks that you’ve worked for your employer, and your average weekly wage would be $1,000. Your compensation rate will be 66.66 percent of the $1,000, meaning that you’ll receive $666 each week.
If neither of the above situations apply to you, the insurance company will use the average weekly wages of a similar employee who is paid at the same rate per hour as you are, or they may decide to calculate your average weekly wages based on what you were expected to make if it hadn’t been for the injuries you sustained.
Calculating your average weekly wages correctly is critical to ensuring that you get the most out of your workers compensation benefits. Your work comp lawyer from the Ricci Law Firm, PA can make sure that this calculation is done accurately by the insurance company, as they are typically looking for ways to minimize the amount that they are required to pay you.
The Different Levels of Disability in NC Work Comp
When you suffer a work-related illness or injury and are unable to work for a period of time, or even permanently, you are considered to be disabled under North Carolina law. There are four different ways that your disability will be classified:
Temporary Partial Disability (TPD)
When your injuries classify you in the TPD category, you will be able to begin collecting workman’s compensation benefits from the seventh day that you are out of work. If your injuries last at least twenty-one days, you’ll be able to collect benefits for that first week you were out of work, as well.
TPD benefits can be paid for up to 500 weeks while you are able to return to a lesser-paying position or work fewer hours during your recovery. The amount that you’ll receive will be 66.66 percent of the difference between your current earnings and your pre-injury average weekly wages.
For example, if you are currently earning $400 per week and your average weekly wages prior to your injury were $750, you’ll be able to collect $233 each week from your employer’s workers comp insurance company.
Temporary Total Disability (TTD)
If you are classified as having a TTD injury, you will collect work comp benefits while you are unable to work and in recovery. The same seven-day waiting period applies for TTD benefits. You can collect TTD benefits for up to 500 weeks, although an extension may be granted in certain situations. Workers receiving TTD benefits will receive 66.66 percent of their average weekly wages.
Permanent Partial Disability (PPD)
You can be classified as having a PPD injury if you have reached your maximum medical improvement, as determined by your treating physician, but you suffer from a permanently disabling condition as listed in the North Carolina index of scheduled injuries.
This list describes the different body parts that can be affected and how many weeks you are able to collect benefits because of the disability. For example, if you lost a thumb in your work-related accident, you can collect 66.66 percent of your average weekly wages for up to seventy-five weeks.
Permanent Total Disability (PTD)
Employees will be considered permanently totally disabled if they’ve suffered from total paralysis of all four limbs; if they’ve been diagnosed with a severe traumatic brain injury; when they’ve lost any combination of both eyes, legs, arms, or feet; and in cases where they’ve suffered second- or third-degree burns on over 33 percent of their body.
PTD benefits, at a compensation rate of 66.66 percent of average weekly wages, are paid for the injured worker’s lifetime.
Your physician will determine which classification of disability your injuries place you in. If you have an objection to the impairment rating you’ve been given, you are entitled to get a second opinion from another doctor of your choosing at the expense of the insurance company.
However, it’s important to note that the insurance company can, in turn, also get a second opinion from a doctor of their choosing, making it imperative to work with one of our experienced North Carolina workers comp lawyers.
Reasons for a Claim Denial
There are countless reasons why an insurance company might deny even the most deserving person’s right to workers comp benefits. Some of these reasons are valid as discussed above, but there are also many reasons that are simply invalid, made only so that the insurance company can get out of paying you the money you are entitled to.
It is not uncommon for injured workers to have difficulty obtaining approval for their workers comp benefits. After all, the insurance company is a for-profit business and loses money every time they pay out on a claim. If you’ve been issued a denial for any one of the following reasons, speak with your attorney about filing an appeal:
- The insurance company believes you are exaggerating the seriousness of your injuries
- The insured believes that you can perform the duties of your position despite your injuries
- There was an error in the filing of your paperwork
- The insurance company claims you have a pre-existing condition that you failed to disclose prior to your hiring, and that pre-existing condition is what caused you to become injured or ill
- You did not provide adequate medical documentation to prove the extent of your condition
Oftentimes, these types of details can be addressed by discussing them with the insurance adjuster responsible for your workers compensation claim. A workers comp lawyer from the Ricci Law Firm, PA can submit additional medical records, arrange an independent medical exam, and correct any issues with paperwork or other important documents to get your claim denial overturned.
If working with the insurance company doesn’t secure the approval you need to begin collecting workers comp benefits, our next step will be to file an appeal.
Appealing a Denied Workers Comp Claim
Appealing a denied workers comp claim can seem like a daunting task, but having your case heard by an impartial party can only benefit your case. Your appeal will be heard by the North Carolina Industrial Commission’s (NCIC) board of commissioners, and in some cases, an administrative law judge.
Very similar to a court case, the NCIC will listen to both sides of the story, and both your employer and their insurance company will have the opportunity to present evidence and discuss the reasons why they have chosen to deny your claim. In turn, your lawyer will present supporting evidence that demonstrates your need for financial support through workers comp benefits.
After the NCIC has heard all of the details of your case, they will deliberate and deliver a decision based on the evidence that has been presented. At this stage, your denial could be reversed and your claim approved, allowing you to start collecting your workman’s comp benefits.
If the decision of your appeal is to uphold the insurance company’s denial of your clam, we can move forward by bringing your case to court and having it heard by a judge and/or jury.
Filing a Civil Lawsuit Against the Liable Party
Although the work comp insurance company will provide a weekly benefit check, education and job training, and death benefits where applicable, these benefits are often not enough to fully support your family while you are out of work.
In situations where someone else is responsible for causing the work accident that you were hurt in, you may be able to pursue a civil lawsuit against the liable party to recover the remainder of your losses. Workers comp laws are designed to deter these types of lawsuits from happening; however, in some cases filing a civil suit is appropriate.
If a third party outside of your employer was responsible for causing you harm, if your employer or a coworker caused your injuries intentionally or in malice, or if your employer has not provided you with workers compensation protection as mandated by North Carolina law, you will be entitled to file a personal injury claim against the person or persons responsible for your injuries.
Some of the damages our attorneys can help you seek include the following:
- The remaining 33 percent of your lost wages
- The damage to your potential future earnings
- Loss of enjoyment of life
- Emotional distress
- Property damage
- The loss of companionship and love
- The loss of household services
- Pain and suffering
- The effects of disfigurement
In addition to these losses, the judge might determine that you are entitled to an award of punitive damages. These are designed to punish the viable party for egregious or intentional actions that caused you harm. The hope is that such severe penalties will deter future similar occurrences from affecting others.
Free Consultation with a Work Comp Lawyer in North Carolina
If you have received a denial letter from the insurance company after filing your workers compensation claim, or if you have additional questions regarding your case, reach out to the experienced attorneys at the Ricci Law Firm, PA.
Your North Carolina workers compensation lawyer will be able to address any of your concerns, work with the insurance company on your behalf, and do everything possible to obtain the benefits you are entitled to.
We are pleased to offer free consultations to all prospective clients. You can take advantage of this opportunity by completing the contact form we have provided at the bottom of this page or by giving our office a call at 252-752-7785.
North Carolina Workers Comp FAQ
Will I have to go to court for a work comp claim?
You should always prepare for the possibility of going to court. If your claim was approved, you won’t have to worry about going to court, as you’ll already be able to collect workers comp benefits. You might need to go to court if the insurance company is unreasonable in overturning your claim denial and if the North Carolina Industrial Commission upholds the denial on appeal.
At that point, we would bring your work injury case to court where an impartial judge would review the evidence presented. Going to court can seem like a daunting task, but you’ll have an increased chance of having your workers compensation claim approved when one of our workers comp lawyers in North Carolina represents you.
How much does it cost to hire a workers compensation attorney?
In workman’s comp cases, lawyers work based on an attorney contingency fee. This essentially means that you won’t be required to pay anything up front and until after your lawyer wins your case. The amount that you’ll pay will be a percentage of your settlement or award.
The percentage of your winnings will vary on a case-by-case basis and will need to be approved by the North Carolina Industrial Commission (NCIC) and is usually around 25 percent.
For example, if you and your attorney have agreed to a 25 percent attorney contingency fee, the fee is approved by the NCIC, and you are awarded a sum of $50,000, you would pay your work comp attorney $12,500. This fee can be automatically deducted from your settlement so that you don’t have another bill you’ll need to worry about after your case has been closed.
How long can I collect workers comp benefits?
It’s easy to assume that you would be able to collect workers comp benefits until you are able to return to your position or find other gainful employment. While this is true to some degree, how long you’ll be eligible to receive workers compensation benefits for will depend on the type of injury you suffered.
For employees who are considered temporarily totally disabled or temporarily partially disabled, you can collect workers comp for a maximum of 500 weeks with the possibility of an extension of benefits on a case-by-case basis. Alternatively, workers who are considered permanently partially disabled will be assigned a maximum number of weeks depending on which part of the body has been injured as per the North Carolina list of scheduled injuries.
Workers with permanent disability will be entitled to permanent total disability benefits for the rest of their lives.
How much will my benefits be for?
This depends on your average weekly wages prior to your injury. Your average weekly wage will determine what’s known as your compensation rate, or the amount that your weekly benefits will be for. There are a few ways that the state allows for your average weekly wages to be calculated.
If you worked for your employer for at least one year, your average weekly wage will be calculated by taking the total amount you’ve earned over the last fifty-two weeks and then dividing it by fifty-two weeks. For example, if you earned $75,000 over the year, the $75,000 would be divided by fifty-two and your average weekly wage would be approximately $1,442.
If you had not yet worked for your employer for at least one year at the time of the on-the-job injury, we would take the total amount you’ve earned so far and divide that by the number of weeks you’ve been working for the company. So, if you made $30,000 over a span of five months, we would divide $30,000 by twenty and your average weekly wage would be $1,500.
If neither of these methods is applicable to your case, your average weekly wage would be calculated based on the wages of another employee of similar pay rate or it would be estimated based on what you would have been expected to earn if you hadn’t been injured. You’ll be entitled to 66.66 percent of your average weekly wage as your compensation rate, not to exceed $992 as of 2018.
What will my North Carolina workers comp benefits cover?
The insurance company will provide you with a weekly benefit check that can be used however you see fit, similar to the way you would be able to spend the paychecks you earned prior to your injuries. In addition, any medical expenses that you incurred due to your work-related injury or illness will be covered in their entirety by the insurance company providing your workers compensation benefits.
Another area workers comp covers is education and/or job training if you, for reasons beyond your control, are unable to either return to your previous position or obtain gainful employment elsewhere.
Should a work injury or illness cause the death of a loved one, the deceased employee’s spouse and dependent children will be entitled to death benefits.
Will the work comp insurance company cover funeral costs?
Yes, the employer’s insurance company will provide a maximum of $10,000 for funeral and burial expenses if an employee dies from a work-related illness or injury. The surviving spouse and minor children of the decedent will also be entitled to death benefits that amount to approximately 66.66 percent of the deceased’s average weekly wages.
The dependent children will collect their benefits until they reach the age of eighteen, and the surviving spouse can collect benefits for up to 500 weeks. However, if the surviving spouse is unable to support themselves due to a disability, the spouse can continue receiving benefits for the remainder of his or her life or until remarrying.
What happens if I reach the maximum number of weeks I can collect?
Once you reach the maximum number of weeks allowed based on the type of disability classification you fall under, you will no longer be eligible to continue receiving workers comp. In some cases, you may be able to request an extension if you are still unable to work due to your condition or if your condition has become worse over time.
If your physician determines that you are permanently disabled, you will become eligible for either permanent total disability (PTD) benefits or Social Security Disability. If you are approaching the final weeks of your workers comp benefits and will need to continue receiving financial support, get in touch with a North Carolina work comp attorney from the Ricci Law Firm, PA to discuss the details of your case.
How long do I have to file my workers comp claim?
You should notify your employer of the details of your work-related injury or illness within thirty days of the incident. Failure to do so can result in a denied claim.
All workers comp claims need to be filed with the North Carolina Industrial Commission within two years of the date of the accident that caused your injuries or within two years of the date you were diagnosed with a condition related to a work-related injury or illness.
Does workers comp cover illnesses?
Absolutely. You can collect workers compensation benefits for a work-related illness, also known as an occupational disease. In order to do so, your workman’s comp lawyer must establish that you became sick due to circumstances at work.
For instance, if you work as a coal miner and are routinely exposed to coal dust and then develop pneumoconiosis (also known as black lung disease) as a result, your employer’s workers comp insurance policy should provide you with benefits during your recuperation.
Does workers comp cover hearing loss in North Carolina?
Individuals who work in an industry where they’ve been exposed to powerfully loud noise (often experienced by construction workers, for example) may find themselves dealing with hearing loss over the years. This can dramatically affect their ability to complete the responsibilities of their position.
For this reason, you should be entitled to receive workers compensation benefits, as your hearing loss was caused by the conditions of your work environment.
Will workers compensation cover a stress-related condition?
It depends. If your stress-related condition was caused directly by the requirements of your position, or if you were involved in a traumatizing accident at work that has resulted in a stress-related condition, then yes, the insurance company should be responsible for covering your expenses while you take time off work to focus on your recovery.
Will workers comp cover my mental health condition?
Although these are often more difficult to prove, in the majority of cases employees can be awarded workers compensation benefits due to a mental health condition. The key to winning a claim for a mental health issue is that it must have developed over the course of your employment or, if it was a pre-existing condition, been exacerbated by the conditions of your work environment.
What is the North Carolina Industrial Commission?
The North Carolina Industrial Commission (NCIC) is a state-run agency that is responsible for the regulation and oversight of the NC Workers Compensation Act as well as other state programs. The NCIC is involved in nearly every aspect of every workers comp claim that happens across the entire state.
When you come to an agreement regarding your workers comp attorney contingency fee, the NCIC must approve it. When you first file your claim for benefits, it also needs to be filed with the NCIC. If you are initially denied when you apply for workers comp and want to appeal, your hearing will be with the NCIC board of commissioners and/or an administrative law judge.
In terms of the NC Workers Compensation Act, the goal of the NCIC is to ensure that claims are serviced efficiently, to work as a mediator when disputes arise, to work with employers to reduce work-related accidents, and to investigate potential violations of the NC Workers Compensation Act.
Can I appeal a denied workman’s comp claim?
Yes, and you should! It is not uncommon for insurance companies to deny a workers compensation claim. There are some valid reasons why an insurance company can deny your claim, while others are unreasonable.
In some cases, your North Carolina workers comp attorney can work with the insurance adjuster assigned to your claim to have the denial overturned, but other circumstances might require bringing your case in front of the North Carolina Industrial Commission. The Board of Commissioners will hear the details of your case and determine whether the denial should be upheld. If it is, you still have the option of bringing your case to court.
If I have a pre-existing condition, can I still collect workers compensation benefits?
This will vary on a case-by-case basis. If you have a pre-existing condition, you should expect the insurance company to fight your claim no matter what, making it important to retain a North Carolina workers comp lawyer from the Ricci Law Firm, PA.
Insurance companies will frequently fight these claims by either asserting that you failed to disclose your condition prior to your hiring, or by saying that your pre-existing condition is responsible for causing your injuries—not the conditions of your work environment. These are some of the most difficult claims to appeal with the insurer.
Your attorney will gather supporting medical evidence to establish that your pre-existing condition was worsened by the requirements of your position so that you are able to collect the workers compensation you need to continue supporting yourself while you focus on your recovery.
Can I work a second job while collecting workers comp?
Typically, you cannot work a second job while receiving workers compensation benefits. The purpose of workers comp is to replace a portion of the income you would have made if you hadn’t been injured. If the insurance company believes you are able to work, they will most certainly not approve your claim.
However, if you are able to work a lesser-paying position either with your employer or another company, you would be able to collect workers comp benefits and the insurer will calculate your compensation rate at 66.66 percent of the difference between your average weekly earnings prior to your injury and the amount you are currently able to earn.
You should never work a second job while collecting workers comp without first notifying the North Carolina Industrial Commission of your change in wages.
Will I have to undergo an independent medical exam (IME)?
You are not legally obligated to submit to an independent medical exam, although doing so can certainly help your case. However, it’s important to note that the physician examining you in your IME is going to be hired by the insurance company and will more than likely be looking for signs that you are exaggerating the extent of your condition or that you are otherwise capable of working.
An IME can be beneficial to your case if the insurance company needs further medical documentation of your injuries. Your work comp attorney can review the details of your case to determine whether submitting to an IME will be beneficial or detrimental to your workman’s comp claim.
What is “maximum medical improvement”?
Essentially, maximum medical improvement (MMI) is when the physician who has been providing your treatment and care determines that your condition has stabilized and that you are at a point where your physical condition isn’t expected to improve any further.
Since your healing period has ended, there are a couple of different ways that your North Carolina workers comp claim can proceed from here: You can seek a permanent partial disability benefit, you could begin to search for suitable employment, or you could settle your workers comp claim. Continue reading to learn more about these options.
Obtaining Permanent Partial Disability Benefits
Once you have reached MMI, you could be examined by your physician and assigned a permanent partial disability (PPD) rating. This is when, based on your affected body part and impairment rating, you’ll be able to collect a set disability benefit.
For example, if you lost a hand after being involved in a work-related accident, your compensation rate was set at $650, and your physician determined that you are 25 percent permanently partially disabled, your PPD benefit would be calculated by multiplying the 25 percent impairment rating by 200.
This is the number of weeks you’re able to collect workers comp for after losing a hand, and then multiplying that by your compensation rate of $650. In this example, your PPD benefit would be calculated at $32,500.
Searching for Suitable Employment
At the appointment where your physician determines that you’ve reached MMI, he or she will also inform you of work restrictions you might have going forward within your field of employment. For example, you might not be able to lift anything over twenty-five pounds, or you might require a ten-minute break every hour.
Finding suitable employment can often be challenging for someone with permanent limitations. Once you reach MMI, “suitable employment” refers to a position that is available to you that is within fifty miles of your current address and considers any mental or physical limitations you might have.
The point of suitable employment is that you don’t have to work in a position that has been modified to meet your physical and mental capabilities.
Settle Your Workers Comp Claim
When the time comes to consider settling your workers comp claim, it will be a big decision. Often referred to as a “clincher agreement,” settling your workers compensation claim means that all of your current benefits will stop, as will your medical treatment and care, and that you will instead receive a lump-sum settlement.
At that point, your claim would be considered completely resolved. In many cases, for workers who will need ongoing medical care, settling your claim can be detrimental for your case since you’ll no longer have those medical expenses covered by the insurance company.
You will need to discuss your case thoroughly with your North Carolina workers comp lawyer to determine whether it is within your best interests to enter into a clincher agreement.
What is an occupational disease?
An occupational disease is a condition that you develop that was directly caused by the profession you work in. For instance, construction workers who are routinely exposed to asbestos are often subsequently diagnosed with mesothelioma in later years.
Another example would be individuals who work in office settings at a computer all day. The repetitive motion of typing can often result in a diagnosis of carpal tunnel syndrome (CTS).
People who suffer from occupational diseases have the right to expect their workers compensation claim to be approved, as there will be distinct evidence that demonstrates that their condition was caused by the conditions of their work environment.
What if my employer doesn’t want to file the claim with the insurance company?
Unfortunately, it shouldn’t come as a surprise if your employer wants to avoid reporting your accident to the insurance company. Whenever an employer has an employee who needs to file a workman’s comp claim, the employer’s insurance premiums can increase upon the policy’s renewal.
Some employers will even retaliate against their employees for seeking workers comp benefits, despite the fact that doing so is very much against the law. If your employer has chosen not to file your workers comp claim, you can do so yourself by filing Form 18 with the North Carolina Industrial Commission.
This will jumpstart the process so that you can begin collecting your workers comp benefits as soon as possible. If you find that your employer has retaliated against you by demoting, terminating, or harassing you, speak with your North Carolina work comp attorney.
Will I still have my job when I return to work after recovering?
The NC Retaliatory Employment Discrimination Act prevents your employer from terminating your employment simply because you sought or were approved for workers compensation benefits. Your employer is under no obligation to keep your position open while you are out of work, but they must allow you to return to work when you are cleared by your physician.
However, North Carolina is an at-will state for employment purposes. This means that any employer can terminate an employee at any time as long as their reasoning isn’t a violation of the law. Terminating you for taking time off to recover from your injuries would be a violation of the law, so get in touch with the Ricci Law Firm, PA if this happens to you.