First step is to determine if you are covered by workers compensation insurance. The NC Workers’ Compensation Act of 1929 covers employees of employers that consistently employ three or more people. It provides a relatively certain means to receive treatment and financial recovery from injuries that arise from the course of employment, while protecting employers by providing limited liability or “no fault” coverage.
The North Carolina Industrial Commission recommends the following steps if you have been injured at work:
1. Report your injury to your Employer and seek out appropriate medical treatment.
2. Tell your health care provider that your injury is related to your work and the name of your employer.
3. Follow your physician’s instructions for medical treatment. The goal of the Workers’ Compensation System in North Carolina is to ensure that you get good health care to restore you as nearly as possible to the health and ability to work that you had prior to your injury.
Following these simple steps will ensure that your injury is properly reported, you receive appropriate health care quickly and that your employer can initiate workers’ compensation medical benefits.
A Brief History of Workers’ Compensation
The Industrial revolution of the 18th and 19th centuries brought in an era of extreme cruelty and hardship for most workers in the industrialized parts of the world. Men, women, and children were forced to work 14 to 18 hours per day in unsafe and unsanitary conditions. Wages were so low entire families had to work simply to avoid starvation. Factory workers were considered to be less valuable than the machinery they used, and when injured they were simply discarded like a broken piece of equipment.
In the late 1800′s labor activists seized on the idea that if industry felt like workers were simply part of the machinery of industry, then like machinery industry should pay for “repairs” to workers as well. The debate over working conditions and medical assistance for workers continued for many years.
The concept of a worker’s compensation plan, was at last passed in England in 1897. Under the plan, workers would receive medical insurance benefits after sustaining an injury by accident.” In return, workers were barred from suits against their employers for negligence.
In the United States our Federal government and individual states have used the British system as a model for worker’s compensation. The North Carolina Worker’s Compensation Act of 1929 was taken mostly from Federal “Longshore and Harbor Worker’s Compensation Act” enacted by the U.S. Congress in 1927. It seems, much of the language in that Act, appears to be copied verbatim from the British Act of 1897.
Do you have a claim under the Workers’ Compensation Act?
Are you Covered?
The first issue is to determine whether you and your employer are subject to the Act. The North Carolina Workers’ Compensation Act covers employees of employers that consistently employs three or more employees or have in effect workers’ compensation insurance. Casual employment is not covered as well as independent contractors. In addition, agricultural employees are not covered unless the employer regularly employs ten or more full time, non-seasonal agricultural workers.
To be covered, the accident must have occurred within the state or, if the accident occurred outside of North Carolina, the contract for employment must have been made inside the state, the employers principal place of business is in this state, or the employees principal place of employment is within North Carolina.
Further, the claim must be filed with the Industrial Commission within two years after the accident or your right to workers’ compensation shall be forever barred. HOWEVER, the Industrial Commission has allowed late filings in certain circumstances so this should not be considered an absolute make or break in a workers’ compensation case.
There are two ways to determine coverage. First is by “Injury” and second is by “Occupational Disease”:
Worker’s Compensation – On the Job Injuries/Occupational Disease
Injury by Accident
In workers’ compensation claims, “only injur[ies] by accident arising out of and in the course of the employment” are covered. N.C. Gen. Stat. 97-2(6). Almost any variance from the regular work routine may be considered sufficient to be called an accident. However, no variance or unusual event in the regular work routine suggests no accident and therefore is not compensable. This means you should share every factual aspect of the event with your lawyer so the accident can be fully understood and brought forward to support the claim.
Arising out of
It is important that the injury by accident “arise out of” the employment. Was the injured employee’s activity a function or duty of employment. There must be some busness connection to the activity to bring it into the Act.
Course of Employment
“In the courts of the employment” means that the injury occurred during the period of employment at a place where the job was expected to take the employee and the activity of the employee is within the scope of employment. For example, injuries in the parking lot at the place of employment is typically covered, but driving to or from work is not typically covered.
2. Occupational Diseases
N.C. Gen. Stat. Section 97-53 lists twenty-seven occupational diseases which are compensable. An occupational disease is any which is proven to be due to causes and conditions which are characteristic of and peculiar to a particular occupation, but excludes all ordinary diseases of life to which the general public is equally exposed. The obvious issue here is the increased risk of the disease due to the employment and so the question for the treating medical provider becomes: “Do you have an opinion satisfactory to yourself with a reasonable degree of medical certainty that the employee was by virtue of his or her exposure of the substance in the employment placed at an increased risk of contracting the disease?” If the exposure at work was a significant contributing factor, then it will be compensable.
If the claim is compensable, you are entitled to 66.66% of your average weekly wage. These benefits are tax free. The important, yet tricky question, is determining the average weekly wage.
Present and Future Medical Needs
The employer can be held responsible for present and future medical needs if such treatment is necessary to effect a cure, give relief, or lessen the employee’s period of disability, to the extent that the treatment is causally related to the occupational injury. Medical care may include attendant care, present and future psychological needs, and may necessitate the development of a life care plan.
At some point in every workers’ compensation claim, the question is asked whether the claimant will physically and mentally be able to continue doing the job, and then, if so, is this a job that is likely to remain available to the claimant for an indefinite period of time into the future? Depending on the answers to these questions - the claimant may also be entitled to vocational rehabilitation.
The North Carolina Worker’s Compensation Act of 1929, was passed to provide two main forms of protection. It provides employees with a relatively certain means to receive treatment and financial recovery from injuries that arise out of the course of their employment and also provides employers with limited liability in most work related injury cases.
In most cases, the Act is “no fault” and compensation is provided regardless of fault, on the part of employee or employer. Every employer in North Carolina is required to have Worker’s Compensation insurance coverage or qualify as a self-insured employer, if they regularly employ three or more employees. Agricultural employers are required to have coverage if they employ ten or more full time, non seasonal workers.