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If I File a Workers’ Compensation Claim, Am I Suing My Company?

Man in suit resting head on hands over a box of his belongingsProspective clients sometimes ask me whether, by going forward with their workers’ compensation claim, if they are bringing a lawsuit against their employer. The answer is NO!

Under North Carolina state law, employers are actually required to report certain workplace injuries to the North Carolina Industrial Commission, and a claim is then opened on behalf of the injured worker. The injured worker cannot voluntarily decide not to have the claim opened.

Workers’ Comp Insurance & the “No Fault” System

Further, employers are required by state law to have insurance for such claims (with some limited exceptions). State law sets forth not only the types of losses for which the injured worker may receive compensation, (such as medical bills and payment of partial income while out of work), but also limits the areas for which the insurance company is responsible.

Since workers’ comp is a “no-fault” system (meaning it does not need to be determined who caused the accident, and no one is liable), things work a little differently from other types of accident claims.

For instance, injured workers are not allowed to recover from the insurance company any money for pain and suffering experienced as a result of a work-related injury, no matter how painful the injury or how long such pain lasts. In addition, an injured worker is actually prohibited by law from bringing a separate lawsuit against the employer, or fellow employees, no matter how negligent the employer may have been in causing the worker’s injury.

Denials – Like a Lawsuit, But Not Quite

Certainly, there will be times when an insurance company will not agree to pay all or part of a workers’ compensation claim. When that happens, disputes are decided by the North Carolina Industrial Commission. Those disputes may involve hearings before a Deputy Commissioner, and take on some of the same aspects of a traditional lawsuit.

The primary differences, however, are that lawsuits are voluntarily brought in civil courts where juries make final decisions, whereas North Carolina workers’ compensation law requires employers to report injuries and any disputes may be resolved more promptly by Deputy Commissioners who usually have significant experience applying the very limited laws.

If You’ve Been Injured, You Need to Act Quickly

If you’ve been injured at work and you don’t think your claim has been reported to the Industrial Commission, you need to act quickly. There are time limits for reporting injuries and you could be barred from much-needed benefits.

For help, contact an attorney immediately.  Most NC workers’ compensation attorneys will work with you on a “contingency fee,” which means they won’t take an attorney’s fee until they get money for you first.

At the Law Offices of James Scott Farrin, our workers’ comp staff is comprised of several NC Board Certified Workers’ Compensation Specialists, a former North Carolina Industrial Commission Special Deputy Commissioner and a former Deputy Commissioner (one of whom was a former state senator), and people who used to work for workers’ compensation defense firms.

Contact us online for a free case evaluation or call us at 1-866-900-7078.


15 Things People Want to Know When Appealing a Denied Workers’ Comp Claim

A man and woman having a serious conversation behind a windowSo the workers’ compensation insurance company denied your claim for benefits for a work related injury.

The only way an insurance company can be made to pay benefits to an injured worker is to secure an order from the Industrial Commission requiring payments be made to you.


1. How can I get the Industrial Commission to make my insurance company pay?

Your attorney will need to request a hearing by filing a Form 33. Your attorney will then have to prove you should receive benefits at a hearing before the Industrial Commission.If the Industrial Commission agrees with your position, then it will issue an order requiring the insurance company to pay you benefits.

2. Do I have to hire an attorney in order to obtain a hearing before the Industrial Commission?

No, you do not necessarily have to hire an attorney. However, your employer and the insurance company will likely be represented by a highly-skilled attorney who will fight to prevent you from receiving benefits.

3. How long will it take to have my claim set for hearing?

Before a hearing is set for your case, the Industrial Commission will require you and your attorney to meet with representatives of the insurance company and their attorney in order to see if you and the insurance company can agree to settle this matter – usually for a lump sum cash settlement.This meeting or mediation takes place usually within 60 to 90 days after you have hired an attorney. If a settlement can’t be reached between you and the insurance company, then the Industrial Commission will set up a hearing/trial within two months of the mediation date.

4. Will my claim be heard by a judge or a jury?

Your claim will be heard and decided by 1 of 20 judges who hear cases across the state of North Carolina. There is no jury trial like you see on “Matlock” or “The Good Wife.”The judge will swear you in as a witness and your attorney will ask you questions about the circumstances that resulted in your injury, or any other matters that you have in dispute with regard to your claim. Your employer’s attorney will be able to cross-examine you at this hearing. Both you and your employer can present witnesses to support each side’s position in the case.

5. Where will my hearing take place?

Your hearing will be set at one of five locations closest to where you and/or your employer is located. The hearing location could require up to a two hour drive for you and your witnesses to attend.

6. How long does a hearing last?

A hearing typically lasts less than 4 hours. If the hearing is estimated to last more than 4 hours, the Industrial Commission will specially set it before one of three judges designated to hear lengthy cases.

7. How long does it take the judge hearing my case to decide whether I win or lose?

Unlike “Judge Judy,” the judge who hears your case will not render a decision on the day you testify. It will usually be months before a decision is made by the judge.Usually you and your employer will want doctors who have examined you or reviewed your medical records to testify. To try to build a strong case, you will need a doctor who treated you to give an opinion that the injury was likely caused by the work-related accident or incident you reported. You may also need to have a doctor testify about your ability to return to work for your employer as well as what treatment you need.Doctors are not required to attend a hearing and neither are any other witnesses. The judge hearing your case will typically issue an order giving you and your employer 60 days after the hearing to go to each doctor’s office and record the doctor’s testimony. Both your attorney and your employer’s attorney will likely ask questions of the doctor who treated you. The doctor’s testimony is then transcribed and a copy is sent to the judge who will read the testimony of each doctor.

8. Who pays to have the testimony of each doctor recorded and transcribed?

The employer will be required to pay for the cost of recording and transcribing of up to two doctors solely selected by you. If you have seen multiple doctors, then you may be required to pay the costs of additional doctors you want to testify. The taking of the testimony of a doctor is called a deposition. Depositions can cost in excess of $1000.

9. How soon does the judge decide whether I win or lose after he or she receives copies of the doctors’ depositions?

The judge will issue an order giving your attorney and your employer’s attorney 30 days to send the judge a written copy of each side’s argument as to why the judge should rule for or against you.

10. I’ve waited a long time – how soon will the judge decide whether I win or lose after receiving the written arguments?

The judge has up to 3 months to decide the case after receiving the written arguments. The judge will write an Opinion and Award and will mail copies to your attorney and your employer’s attorney.

11. If I win, how soon can I expect to receive monetary benefits the judge ordered the insurance company to pay?

Typically, the insurance company will not pay the amount ordered by the judge if it loses the case. They will then appeal the judge’s decision to the Full Commission.

12. If I lose, do I have a right to appeal the decision?


13. What is the Full Commission?

They are six appellate judges appointed by the Governor. They sit in groups of three judges hearing the appeal of the cases that were heard by the 20 trial judges. If two of the judges disagree with the decision made by the judge that heard your case, then the decision is overturned.

14. Will I be able to testify before the three Full Commission judges who will decide whether the trial judge’s decision in my case should be upheld or overturned?

No. When you and other witnesses testify before the trial judge, a recording is made of the testimony. If your case is appealed, a written copy of that recorded testimony is made and sent to the Full Commission. The Full Commission judges read the testimony and decide whether you win or lose.Even if the judge who saw you face to face believes you, the Full Commission judges can reverse that judge’s decision because they don’t believe you based upon the written testimony they have read. Your attorney and the insurance company’s attorney will be given 20 minutes to argue in front of the 3 judges at the Full Commission as to whether the decision by the trial judge who heard your case should be upheld or overturned. This hearing takes place in Raleigh at the Industrial Commission.

15. How long afterwards will I know whether I have won or lost my case after it is appealed to the Full Commission?

It takes 2-3 months for the Full Commission to set the 40 minute hearing for your attorney and the insurance company’s attorney to attend. Both sides are given time to submit written arguments on their positions as to how the judges should decide the outcome of the case. The Full Commission takes between 3 and 6 months to render their decision after the 40 minute hearing.

Read this if you’ve been denied benefits:

If you’ve been denied benefits, you could be in for a long ride, and we highly recommend you do not try to present your case in front of the Industrial Commission on your own.

Most workers’ compensation attorneys work on a contingency fee basis – meaning they will only take an attorney’s fee out of your final settlement, so you have no upfront costs.

At our firm, we have several NC Board Certified Workers’ Compensation Specialists and two former Industrial Commissioners.  Tell us about your case and get a free case evaluation. Or call us at 1-866-900-7078.


How Can I Negotiate With the Insurance Company for a Better Offer for My Car?

Car accident victim holds head in hands with his smashed car in the backgroundIn a car accident, the at-fault insurance company may accept responsibility for the damage to your vehicle and make an offer to settle the property damage claim. You will almost always deal with the at-fault driver’s insurance company through its adjuster. An adjuster is the person the insurance company hired to review and negotiate your claim. Typically, part of the adjuster’s job is to try to minimize your claim in order to control costs for the company. When the insurance company accepts fault, and makes an offer, this will either result in repair of your vehicle, or they will decide the vehicle was a total loss and pay you for the vehicle’s value.

If you are satisfied with the insurance company’s first offer, then it is fine to accept it. However, what should you do if you do not believe the offer is fair? If you are not satisfied with the insurance company’s offer, then you should arm yourself with information to negotiate with the insurance adjuster.

Offers to Repair

An insurance company will often offer to repair a vehicle if the cost of repairs plus supplemental claims equal less than 75% of the vehicle’s pre-accident cash value. “Supplemental claims” include things like the projected rental vehicle costs during the repair period.

The pre-accident cash value is sometimes called the “fair market value.” Fair market value is the price a willing buyer would pay a willing seller, when neither is being compelled to buy and/or sell, and both have reasonable knowledge about the relevant facts. When calculating repair costs versus value, insurance adjusters may use the National Automobile Dealers Association (NADA) publication, the “Official Used Car Guide,” to determine the fair market value. The NADA is published monthly. It is available online at www.nadaguides.com.

While the insurance company may use the NADA book value to determine fair market value, the book is only a guide. There is more room to negotiate based on the actual condition of your vehicle.

You should get estimates for the amount of repairs your vehicle will need. After you get the estimates, and provide them to the insurance company, the insurance adjuster may make an offer over the telephone. If you do not agree with the telephone offer and the adjuster has never seen the damaged vehicle, then you can require the adjuster or the insurance company’s appraiser to personally inspect your damaged vehicle.

If you do not agree with the settlement offered by the adjuster, you have the right to request that the adjuster send to you in writing the amount of the offer along with the specific policy provisions or legal basis the adjuster is relying on in support of the offer.

An adjuster may tell you they want you to take your car to a particular garage – typically, a garage with which they get a volume discount. However, you have the right to take your vehicle to any repair shop of your choosing.

Offers to Pay Cash Value for a Total Loss

Insurance agent working during on site car accident claim processA vehicle is legally considered a total loss if the cost of repairs and supplemental claims equal or exceed 75% of the fair market value. If this is the case, the liability insurance carrier is required to pay fair market value for the vehicle.

Fair market value is often determined via a local market survey. Local fair market value must be determined by using either the local market price of comparable vehicles or, if no comparable vehicles can be found, quotes from at least two qualified dealers within the local market area. If your vehicle was in better-than-average condition prior to the collision, the adjuster is required to give due consideration to this fact when determining value.

It is also important to note that the insurance company is not necessarily obligated to pay the full balance of an existing lien on the vehicle. If you owe more on the car than it is worth at the time of loss, all the insurance company has to pay is still fair market value, not the payoff amount.

You should require the adjuster to give you a written statement, along with the total loss payment. This statement should include estimates, evaluations and deductions used in calculating the payment, as well as stating the source of these values.

Complaints About the Insurance Company

Insurance agent working on car accident claim process with accident victimIf you have a complaint about an insurance company and the way they are handling your claim, you may call or write the Consumer Insurance Information Division of the North Carolina Department of Insurance. The toll-free telephone number is 855-408-1212. The mailing address is: North Carolina Department of Insurance, Consumers Services Division, 1201 Mail Service Center, Raleigh, NC 27699.

The Consumer Services Division will take information from you and then an analyst from the Division will request information from the insurance company, agent or adjuster. If the analyst finds that there is just cause for the complaint then a recommendation will be made to both sides as to how to settle the situation. If this does not resolve the problem, a deputy commissioner may arrange a conference with the insurance company involved to resolve the problem. If the conference does not resolve the disputed issue, then the deputy commissioner may recommend to the commissioner that appropriate legal action be taken including a public hearing (filing a lawsuit).

Our Recommendation:  No Need For an Attorney Unless You Were Hurt

At our firm, we recommend you handle most property damage claims yourself. This can save you both time and money-you do not want to unnecessarily delay the property damage aspect of your claim, and it is often not cost effective to hire an attorney to pursue property damage.

However, if we represent you on a bodily injury claim related to the accident,

Whatever the size of your case, we believe you deserve the best representation and service we can provide. If you have questions, or want to see if we can help, give us a call at 1-866-900-7078 or contact us online.

Three Things You Need to Do Immediately If You’re Hurt on the Job (+ Bonus Tip)

Closeup view of man's hand with plaster castWorkers’ compensation law provides two important benefits if you get hurt on the job:

  • Medical treatments to help you recover from your injuries
  • Payments if you are not able to work because of your injury

These benefits help keep injured workers from financial ruin due to unpaid bills because of their injuries, but if you’re not careful, you could end up losing out on any benefits at all.

If you’ve been hurt, the following are three important tips to help you try to protect your workers’ compensation claim:

Tip No. 1: Report your injury to your employer.

One frequent mistake I see workers make is they fail to report when they get injured on the job. Maybe they felt like the injury was not serious at the time the accident occurred or thought it would get better over time.

I have often had clients tell me, “well, everyone knew about it so I did not think I needed to make a written report.” But not reporting your injury can be a fatal mistake in a claim. It is often used as a reason for insurance companies to deny a claim – even if there are multiple witnesses to the event.

So if you are hurt, you must make your employer aware of your injury as soon as possible. You should also provide a written report. Most employers will have a form for you to complete. Even if they do not have a form, you can send your employer an email, text or written note telling them you were hurt on the job (just be sure to save a copy). This documentation is very important to try to ensure you’re building the strongest case possible for the benefits you need.


Medical physician doctor filing patient's formTip No. 2: Go to the doctor.

If you are injured on the job, seeking prompt medical care is the best way to obtain a full recovery. Even what seems like a minor sprain or strain could actually develop into a condition that will require surgical intervention. If you do not seek medical treatment right after you are injured, an insurance carrier may deny your claim for benefits.

I have had many clients who thought they could “tough out” an injury and continued to work, only to realize later they would not recover without getting medical treatment. Because they waited several days or weeks to go to the doctor, the insurance company denied their claim. Now this cannot always be avoided. Some employers do not always treat their employees fairly. And insurance companies have their own interests at heart. If you are hurt, ask your employer to go to the doctor. Seeking medical attention promptly will not only help you recover from the injuries, but it helps ensure that you’re protecting your workers’ comp claim.

Employee filing claim at the Industrial CommissionTip No. 3: File your claim at the Industrial Commission.

A workers’ compensation claim is not a lawsuit against your employer. The Industrial Commission is the government agency that has what is called “jurisdiction” over all workers’ compensation claims covered by North Carolina law.

If you do not file a claim for benefits, you may lose any right you have to receive benefits in your case – even if your employer has paid for medical care and no one disputes that you were injured on the job.

I have had to tell injured workers that because their claim was not timely filed, we could not help them with their case. The Industrial Commission has a specific form with instructions that can be found at www.ic.nc.gov/forms/form18a.pdf. This form may seem complex but it is really meant as a simple form for injured workers.

Filing the claim allows your employer’s insurance carrier to appropriately respond to the claim. It provides documentation for your injuries. It can also help medical providers who have not been appropriately paid to have a form to seek reimbursement for medical care they may have provided you. The Industrial Commission has a help line of information specialists that you can reach at 1-800-688-8349 or (919) 807-2501.

Bonus Tip:

Of course, the Industrial Commission does not provide legal advice, which you may need (especially if you’ve skipped any of the steps above).

At the Law Offices of James Scott Farrin you can get a free case evaluation on any workers’ compensation issue you may have. Even if we cannot represent you or you decide you don’t ultimately want representation, we’re willing to review your situation and see if we can help you understand your rights and benefits under the law.

Just call us at 1-866-900-7078.