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What Can I Expect Workers’ Compensation to Cover?

Workers’ Compensation law can be a very complicated process. What you do right after the injury can have a very important impact on the future of your claim. If you, a friend or family member have been hurt on the job, you may be wondering what benefits you can expect to receive to heal, as well as cover the expenses of the injury and missed work. 

The Process: An Overview

If you get hurt while on the job, your employer should give you a copy of a Form 18 Report of Injury to complete and send to the NC Industrial Commission. Depending on cost of medical care, the employer may be required to complete an Industrial Commission Form 19. The claim is overseen by the North Carolina Industrial Commission

The employer’s insurance company will make a decision to accept or deny your claim for benefits. It is incredibly important to report the injury verbally and in writing right away (keep a copy of the written report for yourself), ask for them to direct medical care and be sure to tell the doctor that your injury is work related. It is also important to speak to an attorney and learn about your rights. The insurance company may want to take a recorded statement from you as a part of their investigation into your claim. You should absolutely speak to an attorney before agreeing to give any such statement. 

What Makes My Claim “Covered?”

Workers’ compensation law can’t possibly list every injury that would be covered. Instead, they are categorized and defined as “By Accident” and “Occupational Disease.”

Injury by Accident

The North Carolina Workers’ Compensation Act defines an “injury by accident” as an unlooked for or untoward (unexpected) event that interrupts your usual work routine. Examples include:

  • Slips, trips and fallsMan with broken leg wondering if his injury is covered by workers' compensation
  • Being struck by an object or machine
  • Overreaching or overextending
  • Getting a body part trapped or stuck

Your injury must also “Arise Out of and in the Course and Scope of” your employment. Basically, the phrase “arising out of” refers to the origin or cause of the accident. You must show a causal connection between your employment and the injury. The phrase “course and scope of employment” refers to the time, place and circumstance surrounding your injury. For the workplace injury to occur during the course and scope of your employment, you must be engaged in an activity which you are authorized to undertake and which furthers the employer’s business. If the injury occurs while you are performing a task in the same way you always perform it (bending down to lift a box and your knee pops), chances are the claim will be denied.

Occupational Disease

“Occupational Diseases” are specific conditions which are listed in the North Carolina Workers’ Compensation Act. These conditions include:

  • Asbestosis
  • Silicosis
  • Synovitis
  • Tenosynovitis
  • Bursitis
  • Exposure to certain chemicals and toxins

There is also a “catch all” provision which defines an “occupational disease” as any disease where your job exposed you to a greater risk of contracting the disease than members of the public generally and that your exposure significantly contributed, or was a significant causal factor, in the disease’s development. Common occupational diseases under this provision include:

  • Arm and hand injuries such as carpal tunnel syndrome and cubital tunnel syndrome
  • Shoulder problems such as rotator cuff syndrome
  • Other repetitive motion injuries

Back Injuries (A Special Exception) 

An injury to the back does not have to be “by accident.” Workers who sustain a back injury are entitled to workers’ compensation benefits if they can show the injury was the result of a “specific traumatic incident.”  In a general sense, a worker can be in his or her usual work routine and sustain a back injury lifting, pushing, pulling, etc. and still be entitled to workers’ compensation benefits.

What Are the Different Types of Benefits 

You may be entitled to benefits for lost wages, permanent disability, medical compensation and vocational rehabilitation.

  • Temporary Total Disability Benefits (TTD) – Weekly benefits when you are unable to work in any capacity for a period of up to 500 weeks.  Benefits are usually calculated at the rate of 66 2/3 percent of your average earnings at the job where your injury occurred over the year preceding the injury.
  • Temporary Partial Disability Benefits (TPD) – Weekly benefits when you can do some work but are earning less than you were at the time of your injury for a period of up to 500 weeks.
  • Permanent Partial Disability Benefits (PPD) – Benefits to compensate for permanent damage to the body part(s) injured.
  • Medical Treatment – Payment for medical and rehabilitative care necessary to effect a cure, provide relief, and lessen the period of disability. Benefits could include doctor’s visits, prescriptions, diagnostic testing, physical therapy and even surgical costs.
  • Vocational Rehabilitation – Services designed to help the injured worker get back to “suitable employment” after an injury. Services can include counseling, job analysis, job modification, placement, training and continued education. 

Call Wilson, Reives & Silverman to Discuss Your Case

Your initial consultation with our Board Certified Workers’ Compensation

Attorney is free. If you have a worker’s compensation claim, please be sure to call our attorneys before you sign anything. You can greatly reduce your benefits by signing something you may not fully understand.

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