Workers’ Compensation is a system that provides certain benefits to workers who sustained a compensable injury by accident arising out and in the course and scope of their employment. Benefits can also be paid for "occupational diseases" such as asbestosis, chemical exposure, bursitis, carpal tunnel syndrome, and hearing loss.

You Must Show that You Sustained an "Injury by Accident". The North Carolina Workers’ Compensation Act defines an "injury by accident" as an unlooked for or untoward event such as a slip, trip, fall or other unexpected event that interrupts your usual work routine. 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 that the claim is not going to be compensable.
 

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 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 employers business.

"Occupational Diseases" are specific conditions which are listed in the North Carolina Workers Compensation Act. These conditions include, asbestosis, silicosis, synovitis, tenosynovitis, bursitis, and chemical exposure.
 

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. A common "occupational disease" that is included under this provision is carpal tunnel syndrome.

Generally, you cannot sue your employer in the North Carolina Courts for a work-related injury.
 

However, there are two (2) exceptions to this rule: First, if the employer intentionally engages is misconduct knowing with substantial certainty that serious bodily injury or death would result from the misconduct, a direct civil action can be pursued; second, you can sue your employer if he or she intentionally harms you.

A third party claim results from your having an injury at work but the responsible party who causes the accident is a person who is outside of your company. For example, you are making a delivery for your employer and you are involved in a motor vehicle accident. If the party who causes the accident is not a co-worker and they are at fault, you can sue this person in the North Carolina Courts for their negligence in addition to filing a workers’ compensation claim.

It is extraordinarily important that you pursue such a claim as you may be entitled to additional compensation beyond what you would receive under the North Carolina Workers’ Compensation Act.

Immediately Report the Injury to Your Supervisor. Under North Carolina law and the North Carolina Workers’ Compensation Act, you are required to report your injury to your employer within thirty (30) days of the accident. However, it is recommended that you report the injury as soon as possible.
 

Notify your supervisor of the injury and document the report in writing. Many employers have a form for this purpose and you should request the form and complete it. If possible, have your supervisor sign the written report and request a copy of the report for your own records. In addition, if there are witnesses to the accident, bring them along, have them make a written statement and get a copy for your records.
 

If a written report is not made, the door is left open for the employer and insurance company to deny that you ever gave them notice of the injury.
 

Seek medical attention. Workers are strong, tough people who believe the pain they feel from an injury will go away after just a couple of days. However, if the pain does not go away and you wait a long time before you go to the doctor, you may have armed the insurance company with "evidence" they can use to deny your claim. If you wait to go to the doctor, the insurance company may doubt that your injury occurred at work and contend that your injury occurred outside the workplace at a time later than what you have claimed. A timely report from a doctor that outlines the time, place and circumstances surrounding your injury can go a long way in helping you prove your case.
 

Make your own file and journal. Every time the insurance company contacts you, they make an entry in their records. You should do the same thing. Keep a journal or diary and write down the date and time of all calls concerning your case. Write down who you spoke to and the subject of the conversation. Keep copies of all Industrial Commission Forms that have been filed, all letters about your case and all medical records in your own file.
 

Make sure your claim is filed properly. The North Carolina Industrial Commission in Raleigh is is the state agency which regulates and oversees workers’ compensation claims. All claims must be filed with the North Carolina Industrial Commission before the Commission can take jurisdiction over your case.
 

A claim is filed with the North Carolina Industrial Commission by completing and submitting an Industrial Commission Form 18. Failure to file a claim within this two year period will result in a time bar to your claim unless you can show that your employer and/or the insurance company intentionally engaged in conduct intended to deliberately mislead you about your right to seek workers’ compensation benefits.
 

In "occupational disease" claims, you must file an Industrial Commission Form 18 or Form 18B within two (2) years of being advised by a doctor that you have a work related "occupational disease".
 

You should also make sure that your employer files a notice of injury with the Industrial Commission. The form that an employer is required to complete is an Industrial Commission Form 19.

Your employer cannot fire you because you have filed a workers’ compensation claim. If you believe that your employer has engaged in such conduct, you should immediately contact the North Carolina Department of Labor at (800) 552-6762. You must take action within 180 days of the termination or your claim may be lost.

Chances are that the insurance adjuster handling your case will, at least, consult an attorney. You should do the same thing. Workers’ Compensation law in North Carolina is a very complicated and specialized area of the law and an experienced attorney can help preserve evidence, obtain photographs of the accident scene and find experts to assist you in the prosecution of your case. A person who is injured on the job in North Carolina has the right to enforce his employer’s liability under the North Carolina Workers Compensation Act through appropriate proceedings, motions and hearings against the insurance company. The Arthur M. Blue Law Office, P.A. has the attorneys and staff to assist you with this process.
 

We can assist you if your claim is denied. An employee who files a written notice of claim (Form 18) with the Industrial Commission is entitled to a detailed statement from the employer or insurance company within fourteen (14) days that explains the Defendants’ position on acceptance or denial of your claim. On occasion, the insurance company may not admit or deny your claim in this time period. If this happens, we can assist by filing a "Motion to Compel" the insurance company to promptly admit or deny your right to benefits under the North Carolina Workers’ Compensation Act.
 

If the claim is denied, you are entitled to request a specific statement from the insurance company which details the reasons for the denial of your claim. If the claim is denied, you have the right to request a hearing before a Deputy Commissioner of the North Carolina Industrial Commission. Deputy Commissioners essentially act as judges and preside over the hearings of workers’ compensation cases. A hearing is requested by filing an Industrial Commission Form 33 with the Industrial Commission. When a hearing has been requested, the Industrial Commission will, in most cases, order that the parties attend a mediation and attempt to settle the claim prior to a hearing.
 

We can advise you through the investigation process. Before the insurance companies pay workers’ compensation benefits, they will want to make sure that your injury actually happened at work. For you to be entitled to benefits the injury must have been one "by accident" and it must have occurred "in the course and scope of employment". An insurance adjuster may contact you and ask to take a recorded statement. The adjuster will ask you questions that are designed to obtain an answer which gives them the ability to deny your case. We can help you through this process and our attorneys will be present for the recorded statement to make sure that your rights are being protected.
 

We can assist in making sure that you are getting the correct medical treatment. You must cooperate with your medical care providers. You should be dressed cleanly and neatly for all appointments with your medical providers. Listen carefully to all instructions given to you by your treating physician and follow those instructions carefully. If you cannot make an appointment, notify the doctor’s office. If you fail to show up, a notation will be made in your medical chart that the insurance company will claim shows that you have not cooperated in your medical care.
 

If your treating physician is not cooperative or you feel that you are not getting the treatment you need or if the doctor seems to be in your employer’s corner, we can assist you in changing physicians and ensuring that you are getting proper medical attention. Sometimes, a motion must be filed with the North Carolina Industrial Commission and an attorney can assist with this process. It is the North Carolina Industrial Commission, not the insurance company, that has the final word on medical care.
 

All attorneys fees must be approved by the North Carolina Industrial Commission. An injured worker should not be making any payment to an attorney for his or her workers’ compensation claim without that approval.