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What Do I Get Out Of This?

By:  Patrice N. Ray

Often, people who have had a work-related injury call me because they are not quite sure what they are entitled to under workers’ compensation laws. They are often confused about the workers’ compensation system and often have been given incorrect information about their benefits by employers, friends, friends of friends, or random people that they meet. Simply put, workers’ compensation laws provide for payment of medical compensation and loss of earning capacity that occurs as a result of an injury that occurs on the job.

Medical compensation includes, but is not limited to, medical services, hospital services, rehabilitation services, sick travel, medicines and future medical treatment. If the medical expense is one that can reasonably be required to cure, relieve, or lessen the period of disability, it is covered under the Workers Compensation Act (“the Act”). However, since the employer has to pay for this medical compensation, the law allows the employer to direct treatment within the boundaries of the law. Although the Act give employers and their workers’ carriers authority to direct treatment, they cannot unilaterally act for their own benefit and many of their actions are subject to approval by the North Carolina Industrial Commission, the body that governs workers’ compensation claims.

In addition to the medical compensation, the Act allows for payment of the injured workers’ loss of earning capacity due to disability. For workers’ compensation purposes, disability means the incapacity, because of the injury, to earn the wages that the injured worker was paid at the time of the injury. The types of benefits available to injured workers are: temporary total disability (TTD), temporary partial disability (TPD), permanent partial disability (PPD), and permanent and total disability. Temporary total disability is paid when an injured worker is totally unable to work for a temporary period of time. Temporary partial disability is paid when an injured worker is able to return to work but in a limited capacity or at a reduced wage. Permanent partial disability is paid when the injured worker has a permanent injury that prohibits the injured worker from returning to the same type of job that he had before the injury and results in him/her having to accept a job that pays less than the pre-injury job. Permanent partial disability may also be paid according to a specified schedule when the injured worker has a permanent injury to a body part. Lastly, permanent and total disability is paid when the injured worker is permanently incapable of earning wages. Workers compensation law provides specific methods for determining the amount of benefits the injured worker is entitled to under each of the four types of disability benefits. The injured worker is entitled to the disability benefits as long as they are disabled.

Before the injured worker can begin to receive disability benefits, the injured worker must have missed seven days from work. The seven days do not have to be consecutive and includes any day(s) that the injured worker did not earn full wages. During the seven-day waiting period, the injured worker may use any paid time off, vacation, or sick leave. After the seven day wait, the injured workers can begin to receive benefits. The injured worker is not eligible to receive payment for the first seven days, or the seven-day wait, until he or she has missed a total of 28 days.

What is not covered under workers’ compensation law? The Act does not provide pain and suffering as a remedy for the injured worker. When workers’ compensation laws were enacted, an injured worker had to first prove that his or her employer was negligent in some way in order to be compensated for a work-related injury. Revision of workers’ compensation laws did away with that requirement. Now, the only thing that must be shown is that an employment relationship existed between the injured worker and the employer at the time of the injury, that the injured worker was accidentally injured while acting within the scope of his or her employment and that the injury arose from the injured worker’s employment.

Workers’ compensation laws also do not allow an injured worker to sue his or her coworker for any injuries that result from the coworkers’ negligence. While an injured worker can sue his employer for negligence in workers’ compensation claims, it is allowed only in very limited circumstances.   If you have any questions about your specific case and what you may be entitled to, please contact Patrice Ray to further discuss your claim.

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