The Workers’ Compensation Act is a no-fault legislative system designed to compensate employees who get injured on the job. Any employer with three or more employees is required to have insurance coverage or be self-insured to cover injured workers. As a general rule an accident must have occurred while employed which was the cause of disability and/or the need for medical treatment. Occupational disease claims are also covered by the Act. 100% of all reasonable and necessary medical care is paid for by the employer and disability compensation is 66 and 2/3 of the average weekly wage of the employee. Determining the correct average weekly wage is important because all compensation in the future is based on this determination. There is also a cap (or limit) on the amount of weekly benefits that can be obtained. The maximum amount varies from year to year.
This system has been in place in North Carolina since 1929 and periodically is changed by the legislature. Significant changes were made in 1994 and 2011. Lawyers who practice in this field need to keep up with current changes legislatively, as well as changes to the Industrial Commission Rules made by the North Carolina Industrial Commission, the administrative body in Raleigh that administers the Act. There are six Full Commissioners who hear appeals from Deputy Commissioners, who take evidence and render decisions as to whether an employee has a compensable claim, and if so, the amount of disability benefits to be awarded. These hearings are conducted in the county in which the injury occurred. Appeals to the Full Commission are heard in Raleigh.
The Workers’ Compensation Act can be complex if the injury is serious and disability continues for a long period of time. Thousands of claims are processed each year without any attorney involvement. However, individuals may need to seek counsel to make sure that the Act is being applied according to the statute. Mr. Jernigan is board certified in this field and is the author of North Carolina Workers’ Compensation Law and Practice. The lawyers in this firm do not charge a consultation fee to evaluate a claim and they would be more than willing to discuss your claim confidentially.
One of the most common mistakes made by employees is not notifying the employer of the injury. A Form 18 (Notice of Accident) should be filed with the Industrial Commission within 30 days of the accident. There is a two year statute of limitations which will completely bar the claim, absent fraud by the employer or other equitable arguments. The purpose of these notice requirements is to make sure the employer knows about the injury and can investigate and provide medical care.
Any accident involving negligence of a party that causes injury to another is potentially subject to civil litigation. This firm handles only serious injuries, including death claims. Under North Carolina law, as a general rule, if the injured party contributes in any way to their own injury they are not entitled to recover anything from the negligent party who may primarily have been responsible for the injury. If a party is injured in the workplace the injured employee’s only remedy is against the employer under the Workers’ Compensation Act. In short, the employee cannot bring a claim against his employer in civil court and get a jury trial for compensation. In that case, the employee is limited to fixed amounts of compensation provided under the Act. Keep in mind that if the injury occurs at the workplace or while in the course and scope of employment and the injury is caused by someone not connected to the employer, two claims exist: (1) a claim for workers’ compensation benefits and (2) a claim against the non-employer negligent party. How these two systems interact can be complicated. The employer who steps in and pays immediate benefits has a lien on any money recovered under a civil law suit. This lien can be reduced or eliminated under certain circumstances.
In civil litigation the concept is that the injured individual should get full damages for all injuries sustained. These damages would include monetary compensation for 100% of lost wages, pain and suffering, permanent injury to body parts, scarring, future economic losses caused by the injury and other damages. The amount of insurance coverage of the defendant in a civil claim is important but often this information cannot be obtained until a law suit is filed. If you have been involved in a serious accident we encourage you to call our office and seek a free consultation.
The Jernigan Law Firm is committed to fighting fraud. Leonard Jernigan is actively doing research and has given many presentations on employer fraud to audiences all over the country. For your convenience we have compiled a list of the Top Ten fraud cases for each year. Fraud of any kind in workers’ compensation cases should not be tolerated, but as the Top Ten lists below reveal, the overwhelming fraud in dollar amounts is done on the employer side of the fence. These corrupt employers drive up costs of the system for honest employers, and N.C. taxpayers have to pay for medical care and other benefits for workers’ not covered who get injured on the job.
If you suspect fraud, contact the N.C. Department of of Insurance at (800)546-5664.
Check out the Top Ten Fraud cases in the news for 2009-2016:
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