Getting a denial on your workers’ comp claim can be devastating. You were hoping for benefits to help you through this difficult time while you’re out of work. Now, you’re facing an appeals process you wanted to avoid. How long do workers’ comp appeals take?

The wait time from filing your appeal to getting a decision from a judge is about 11-14 months. But there are some nuances you should be aware of.

What Is the Workers’ Comp Appeals Process?

If your claim is denied by your employer’s insurance company, you can file a hearing request with the North Carolina Industrial Commission (NCIC). The NCIC is the court system for workers’ comp appeals. There are three stages in appealing to the NCIC: mediation, a hearing before a judge, and appealing to the Full Commission.

Stage 1: Mediation

Before the NCIC will grant you a hearing, you’ll likely have to attend mediation. Mediation is a meeting between the two parties to the case under the guidance of a neutral third party.

The mediation should be completed within 120 days of when you filed your appeal and were notified to attend mediation. If a settlement can’t be reached at mediation, the next stage of your appeal is to go before an NCIC judge.

Stage 2: Hearing Before a Judge

At this hearing there will be one judge, the court reporter, both parties to the case, and potentially witnesses to testify for either side. Most NCIC hearings occur within about 60 days of an unsuccessful mediation.

You submit all documentation to the judge in advance of the hearing (medical records, bills, and other related documents). After the hearing, in which non-expert witness testimony may be given, the parties have a certain amount of time to ask the doctors to the case questions under oath. The doctors’ answers are vitally important, and it is crucial that you ask the right questions, bearing in mind specific legal standards. Then, you’ll submit a report to the judge laying out all your arguments and your evidence. The other side will do the same.

Next, the judge will decide who won the case. Most judges will take at least three months to make a ruling. Judges are allowed up to six months or more to reach their decision. Hopefully, your appeal ends here and you are awarded benefits.

Appealing to the Full Commission

If the judge rules against you, the next stage is an appeal to the Full Commission. The appeal must be made within 15 days. The hearing before the Full Commission will take place about three months after your appeal and supporting documentation are filed. For this hearing, there will be three judges instead of one. They’ll take a look at your case from scratch. They’ll review the record but won’t hear testimony.

The Full Commission is not required to make a decision by any particular deadline. Cases are often decided within six months, but it may take up to a year or more before the Commission reaches a decision on your case. Overall, the process may take about two years from when you file your appeal to resolution if you end up having to appeal to the full Commission.

Note: There are two more possible levels of appeal, but very few cases ever get past this point.

Can the Worker’s Comp Appeals Process Be Sped Up?

On one hand, no. As you can see from the timeline above, a good deal of the process is waiting for other people. You can try and schedule your mediation as quickly as possible, but your mediator may have a full schedule already. And you can’t control how long it will take for a decision at each hearing.

On the other hand, maybe. If you want to prioritize closing your case quickly over pushing for maximum compensation, you may be able to resolve your claim at mediation. About 70% of claims get resolved at that stage. If the insurance company is denying you any benefits, you may have no choice but to take your case as far as it needs to go. That of course means a longer wait time.

Controlling What You Can

There are also steps you can take to minimize delays on your end, such as making sure to show up to all doctors’ appointments and following your doctor’s orders in full. If you don’t follow your doctor’s orders, the insurance company may be motivated to push back harder on your case, delaying things further.

Missed deadlines and incomplete paperwork also cause unnecessary delays. To try and ensure nothing is missed and things move along as briskly as possible, consider hiring an attorney.

When Should I Contact an Attorney?

If you’ve applied and been denied, you may be feeling discouraged. Contact a worker’s compensation attorney as soon as you’ve been denied so you can decide on your strategy going forward. An attorney can be a source of support as you prepare yourself for the next leg in your battle for benefits. In fact, an attorney can take the entire legal burden off your plate – the sooner, the better for your peace of mind.

Have you received a denial? An attorney can help you move your appeal along and try to ensure the result at the end is worth the wait. For a free, no-obligation case evaluation from one of our attorneys, call us at 1-866-900-7078 or visit us online.

It’s not a secret that workers’ compensation claims get denied often. Reasons for those denials range from a poor case to a simple misfiled claim form or missed deadline. You can appeal your claim if it is denied.

The question is not necessarily, “How many times can you appeal a workers’ compensation case?” It’s not really about the number of appeals, but the increasing levels of judicial authority to which you can appeal. They are:

  • Hearing With a Deputy Commissioner of the North Carolina Industrial Commission (NCIC)
  • Hearing Before the Full Commission
  • The North Carolina Court of Appeals
  • The North Carolina Supreme Court

So what happens at each step?

Appeal #1: Deputy Commissioner of the North Carolina Industrial Commission

If your workers’ compensation claim is denied, you’ll get notification of that denial in writing, which will include a reason for the denial. If you disagree, you’ll have to submit a form (Form 33) to request a hearing with a deputy commissioner of the NCIC.

Understand that, before this hearing, you generally have to go through mediation with your employer and their insurer. A third-party mediator will work with all parties to find a resolution. If you and the other party cannot agree on a mediator, the NCIC will appoint one.

Only if the mediation fails will you proceed to a formal hearing. All sides will present evidence to support their case, including medical records and possibly witness testimony.

If the deputy commissioner rules in your favor, you can receive benefits (assuming your employer or their insurance company does not appeal the ruling). If they rule against you, you will have to press your appeal further.

Appeal #2: The Full Commission

If the deputy commissioner denies you, you must submit another form (an Application for Review) to the NCIC within 15 days. Your appeal needs to include all of your evidence and why you feel the deputy commissioner’s ruling was in error.

Three commissioners from the NCIC will hear evidence, review the prior appeal briefs, and may elect to hear oral arguments. It’s crucial that you have complete evidence to support your case. After this point, you will not generally be able to introduce new evidence.

If the commission rules in your favor, you can begin receiving benefits. Your employer or their insurance company can still appeal an unfavorable decision, as can you. However, the next level of appeal goes beyond the NCIC and into a courtroom.

Appeal #3: The North Carolina Court of Appeals

If the full commission denies you, you can escalate your case to the judicial branch. At this stage, your appeal takes place in an actual courtroom. It is very rare for a workers’ compensation claim to get this far, but when it does, a lawyer is a necessity. If you have not hired one and reached this point, you have a difficult road ahead.

Hiring a lawyer is now a must, but that lawyer must start at the beginning to fully understand your case and how to fight on your behalf. And because new evidence cannot be introduced – an appeal is generally heard based on the evidence available to the lower court only – that lawyer may find the going tough.

Your lawyer is going to be arguing points of law. You’ll need someone intimately familiar with workers’ compensation law, and even then, it’s going to be difficult if they’re “coming in cold.”

The Court of Appeals may rule in your favor, or they may remand the case back to the prior level with new guidance. If they rule against you, you’ve got one more possible chance in state court.

Appeal #4: The North Carolina Supreme Court

When all other attempts fail, you may appeal your workers’ compensation case to the North Carolina Supreme Court. To call this exceptional would, perhaps, be understating it. You should understand a few things about your case if it has gotten this far.

First, the North Carolina Supreme Court does not have to hear your appeal. It may decline to review the case, which would render the verdict of the Court of Appeals final.

Second, like the Court of Appeals, the North Carolina Supreme Court is not a trial court. It exclusively hears appeals on decisions rendered by lower courts.

The North Carolina Supreme Court’s ruling will determine whether you win or lose your appeal.

Can My Workers’ Compensation Case Go to the United States Supreme Court?

If going before the North Carolina Supreme Court is exceptionally rare, appearing before the United States Supreme Court is even more so. Many of the same rules apply, but there are a few more to note.

  • Your attorney must be admitted to argue before the United States Supreme Court.
  • The only way for a federal court of any kind, including the Supreme Court, to hear your workers’ comp case is if the case raises a question of federal law or jurisdiction.

In short, it’s a safe bet you won’t be headed to Washington, D.C. for your workers’ compensation case.

Closing Arguments on the Four Levels of Appeals for Workers’ Compensation Cases

The more you think about the process of a workers’ compensation case as a whole, the more it makes sense to hire representation at the outset of your case. Not only can they skillfully present your case at the initial stage, but they are experienced in negotiating and trying to reach a favorable outcome as soon as possible.

Appeals to the court system can take years to resolve. Many injured workers do not have that kind of time. One of the benefits of hiring a workers’ compensation attorney is to try to resolve your case as quickly as possible with the most favorable possible outcome.

If you’ve been hurt on the job and need help, don’t hesitate to contact us. We’ll evaluate your case for free.

When you sustain an injury on the job, it’s crucial to report your injury to a manager or supervisor right away. You should also file a Form 18 with the North Carolina Industrial Commission, which can be submitted electronically.

After you file your workers’ comp claim, the insurance company must follow an investigative process to determine if your case will be accepted or denied. They will review medical records regarding the injury and talk to your employer.

The first contact you have with the workers’ comp insurance adjuster will likely be in the form of a recorded statement. The adjuster will call you and ask your permission to interview you over the phone while they record the conversation.

The recorded statement should be approached with great caution, and it is prudent to consult with an attorney prior to providing one. The primary purpose of the questions the adjuster asks during the recorded statement is to gather facts and information about your workplace accident. The recorded statement is a key phone call for them – and for you. What you say can lead to acceptance of your claim or denial.

Is My Insurance Company on My Side?

Many people believe that the insurance company is working in their best interests. However, I often have to remind them of a basic fact about insurance companies. The majority of insurance companies are for-profit businesses.

Adjusters are typically highly-trained at finding ways to undermine your claim. If they see an opportunity to reduce the insurance company’s payment and don’t take it, they’re not doing their jobs. If they offer you more money for something than the bare minimum you would accept, they’re not doing their jobs.

An insurance company’s greatest expense is what it pays out in claims. If it pays out less in claims, it keeps more in profits. As such, even though an insurance company can be very pleasant to work with at times in a workers’ compensation matter, they are deeply interested in doing what is best for their company.

That’s why you must be careful when you explain what happened to cause your injury. And be careful how you answer seemingly harmless questions. You want to tell the truth, of course, but we have seen instances where the insurance adjuster spun the truth out of context in their efforts to deny a claim:

“Anything Unusual Happen?”

Let’s say, for example, after you describe your work accident, the adjuster asks you if anything unusual happened. Were you doing a task that is part of your regular job and were you doing it the way you normally would? The purpose of this question is not to judge whether or not you are a conscientious and careful employee. The answer you give might be directly related to the compensability of your case.

Injury by Accident

Generally, in order for an injury to be considered compensable, there must be an “injury by accident,” which means that something out of the ordinary or unusual must have happened.

“Unusual” to the insurance company might mean that one particular shelf you were stocking had been moved higher than usual and you lost your balance and fell while reaching. To you, reaching for a high shelf is all in a hard day’s work. Unusual to you might mean the electricity went out and you were stocking shelves in the dark. So you might reply that nothing unusual happened.

If you tell them you were doing your job as usual at the time of injury and omit any unusual circumstances, such as the shelf having been moved a bit higher than normal, your case may potentially be denied.

To the insurance company, this critical piece of information could be a key factor in accepting or denying your claim. Adjusters know you are not aware of this. (But they know we are!)

Why Do Some Adjusters Tell You Not to Hire an Attorney?

The insurance adjuster has a job to do. Usually, that job is to award you as little money as possible.

I have had clients tell me that an insurance adjuster told them that hiring an attorney will only hurt their case, and the attorney will only be seeking to take money out of their pocket. Why? Because they know we are potentially able to point out deficiencies in the way they are assisting in the claim or any additional benefits the injured worker may be entitled to that the insurance company is not providing in the claim.

When an injured worker has an attorney who can try to make sure they receive what they may be entitled to, then that can affect an insurance company’s bottom line – and not for the better. Insurance companies are keenly aware of this. Despite what they might otherwise say to an injured worker, many insurance adjusters are ultimately interested in what is best for the insurance company — and only the insurance company.

Should I Use My Private Insurance After an Injury at Work?

At this point, you may be wondering: Is it easier and less stressful to just use your own insurance, even for an injury suffered while at work?

No.

Do not use your personal health insurance if your injury should be covered under workers’ compensation.

Even if your employer asks you to do so and you don’t want to make waves, don’t do it. Don’t put yourself at risk so your employer can save on insurance premiums.

Your doctor likely won’t treat you under your insurance if you say you suffered a work-related injury. They know that workers’ compensation should be covering that and they might not get paid by your insurance. Will you lie to your doctor?

What if the injury is greater than expected and your insurance runs out? Any claim for workers’ compensation will likely be too late.

Can the Insurance Company Stop Sending Workers’ Comp Checks?

Congratulations! You recruited an experienced workers’ comp attorney and successfully avoided common insurance adjuster traps during your recorded statement. Your checks are coming regularly and for the proper amount. Can you relax, or can the insurance company suddenly stop sending you your check?

The concern about continuing to receive a weekly check is something we see often, and understandably so. When you are out of work due to a work injury, your only source of income is often that weekly benefits check, and it’s important to protect it while you’re recovering from your work injury.

Here’s the deal. If you go back to work, even for a day, the insurance company can stop your weekly workers’ compensation check immediately, without going before a judge. If you are, for any reason, unable to continue working after you’ve returned to work, it is very difficult to get that weekly check re-started.

If the insurance company is asking you to go back to work and you do not feel ready or able to perform the job they are asking of you, the only way the insurance company can stop your weekly check is to go before the Industrial Commission and obtain an order allowing them to stop it.

If the insurance company goes before the Industrial Commission, you or your attorney will have an opportunity to explain why you do not feel able to return to work. After that time, the Industrial Commission will make a ruling. Only if they side with the insurance company is the check stopped. This process can take several weeks.

Tip: In North Carolina, your doctor must review and approve a written job description before you go back to work.

Why You Want an Attorney to Deal with the Insurance Company for You

There are many nuances to workers’ compensation law, like the “injury by accident” rule. That is why we urge anyone who is faced with giving a statement to an insurance representative to consult with a workers’ compensation attorney first. An attorney can help you understand the types of questions you may be asked and possible pitfalls and nuances in language to heed. Your attorney can also be part of the conversation during your recorded statement. If inappropriate questions are asked, they can object.

Two Clients, Two Very Different Outcomes

We had two clients recently who had to deal with the insurance company, and they had very different outcomes based on their actions.

One client was contacted by the insurance company and told to return to work. He had been assigned work restrictions and was unable to perform his pre-injury job due to the injury. He felt he had a good relationship with his boss, and thought his employer would work with him. He did not know that the insurance company was required to have a doctor-approved job description.

So he went back to work. His employer, however, made him do more than he was physically capable of doing, and he was unable to continue working. Yet, because he returned to work, the insurance company was able to cut off his check, and he eventually had to seek relief by going before a judge.

Returning to work after a WC injury may mean demanding activity and less money from insurance.

Another client was rightfully hesitant about returning to work when the insurance company asked him to. He contacted us and we told him to wait until he had a doctor-approved job description. As it turns out, his employer was never able to put together a job description because they didn’t really have “light duty” work available. He remained out of work and focused on healing from his injury.

Sadly, you simply cannot trust some insurance companies to act in your best interest. Too much money is at stake.

Need Advice? Get a Free Case Evaluation

We have several North Carolina State Bar Board Certified specialists in workers’ compensation law on our team. Several of our staff used to work for the insurance companies – and two even worked at the North Carolina Industrial Commission.

Before you talk to any insurance representative, especially on a recorded statement, contact us or call 1-866-900-7078. We’re available to take your call 24/7.

Many people wonder how filing a workers’ compensation claim might affect their employment status and their benefits – especially their health insurance.

It’s important to understand that your employment relationship with your employer should remain the same even though you have filed a workers’ compensation claim for an on-the-job injury. Although you are pursuing a claim, you are still an employee of this employer and you should continue to receive benefits just as you always have. You should pay the same health insurance premiums, if any, that you are normally required to. Your employer should continue to pay their portion of your health insurance as they have been doing.

While you are out on disability, talk to your employer about how to maintain your health insurance.

What Happens to My Health Insurance if I Go Out of Work While On Workers’ Compensation?

If your authorized treating provider writes you entirely out of work or your employer is unable to accommodate your work restrictions, you will be placed out of work. You will stop receiving your regular paycheck and you should begin receiving weekly workers’ compensation checks from the workers’ compensation insurance company that services your employer.

This is called temporary total disability or TTD. While you are out on TTD it is important to talk to your employer about how workers’ compensation and health insurance coverage interact.

Who Pays My Health Insurance While I am Out on Workers’ Comp?

Great question, and one you need to be clear on. Talk to your employer as soon as the decision has been made for you to go on temporary total disability (TTD).

If you usually contribute to your health insurance premium through payroll deduction, your employer may not automatically notify you that you need to continue making these contributions to maintain your health insurance. Ask your employer if and how you should make these contributions, and verify the answer with the insurance company. And keep a record of these communications!

Do not assume your regular health insurance contributions are coming out of your TTD check!

If your employer continues to make health insurance payments for you, but you are not paying your usual health insurance premiums while on workers’ comp, your health insurance may end up being canceled before you ever realize you owe anything. Talk to your employer, and find out if you need to send in a check each pay period to keep your health insurance coverage current.

What Happens to My Health Insurance if I’m Fired After Filing For Workers’ Comp?

Unfortunately, it is still possible for you to be fired by your employer even if you have an open workers’ compensation case. If you are terminated, you can expect your health insurance benefits to end the same way that they would for any terminated employee.

You have the option of temporarily continuing your health insurance under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Your health plan administrator must give you a notice stating your right to choose to continue benefits provided by the plan. You then have 60 days to accept coverage or lose all rights to those benefits.

If you elect to continue coverage through COBRA you will have to pay the full cost of the coverage plus a 2% administrative charge. If your employer was paying the bulk of your health insurance expense before your termination, you can expect that health insurance through COBRA will likely be much more expensive than you are used to.

COBRA generally applies to all group health plans maintained by private-sector employers (with at least 20 full-time employees) or by state and local governments. Check with your state to see what kind of state continuation program is in place. Either way, you may want to shop around and consider other insurance companies to find your best options for obtaining private insurance.

Get a FREE Case Evaluation from Workers’ Comp Attorneys

If you are concerned that your employment status or your right to health insurance benefits may have been unduly affected by your workers’ compensation case, contact one of our workers’ compensation lawyers right away. There is a lot at stake, and if you are trying to negotiate on your own against a big powerful insurance company, you are likely at a huge disadvantage.

There is no charge to call us for an initial case evaluation. It is completely FREE to you.

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

There are about 29,000 North Carolina licensed attorneys.3

Less than 4% are North Carolina Board Certified Specialists, and ten of them practice right here at our firm.3

Out of 29,000 NC attorneys, less than 4% are North Carolina Board Certified Specialists, Farrin has 10 of them.

While N.C. board certification isn’t offered for personal injury/car accident practice areas (or many other types of practice areas), it is offered for workers’ compensation and Social Security disability law.

N.C. State Bar Board Certification Explained

So what exactly does it mean to be board certified? It means you have an attorney who shows special knowledge and proficiency in their specific area of law, having undergone additional training (and other intense analysis) to become certified as a specialist.

It’s a little like commercial pilot training. Certain airports with particularly dangerous runways or topography require specialized pilot training and certification to fly into. Think Princess Juliana International Airport in St. Martin in the Caribbean.

Would you want a pilot without certified experience and specialized skill landing this plane?

a plane just over a beach about to landNow unlike pilot certifications, a lack of specialization does not prevent an attorney from practicing, but it does indicate a certain level of expertise and accomplishment.

The North Carolina State Bar puts it another way: “Certification of lawyers as specialists by an objective entity and according to objective criteria fulfills the mission of the State Bar to protect the public by providing relevant, truthful, and reliable information to consumers of legal services. Certification helps consumers to identify lawyers who have experience and skill in a certain area of practice. Certification also helps lawyers by encouraging them to improve their expertise in particular areas of practice and providing them with a legitimate way of informing the public and other lawyers of this expertise.”

North Carolina State Board Certification Requirements

North Carolina is one of only 18 states that offer a legal certification program. Although requirements vary from one specialty area to the next, to meet the minimum requirements, the applicant must:

  • Be licensed and in good standing to practice law in North Carolina
  • Be substantially involved in the practice area, usually for a minimum of five years
  • Take a certain number of continuing legal education credits in the specialty area during the three years prior to application
  • Be reviewed satisfactorily by their peers
  • Achieve a satisfactory score on a written examination in the practice area

Several N.C. Board Certified Specialists at James Scott Farrin

If you are looking for an attorney who is a NC Board Certified specialist in workers’ compensation law or Social Security disability law, you won’t find many. Less than 1% of all North Carolina licensed attorneys are Board Certified Specialists in workers’ compensation law.3 There are even fewer in Social Security disability law – about 0.1%, in fact.3 We have ten of those specialists here at our firm. Contact us or call us toll free at 1-866-900-7078 to speak to one of them for FREE.

Workers’ Compensation Specialists

Doug Berger joined us in 2005 and is a Partner of the firm. Doug is a former North Carolina Senator and also served as a Deputy Commissioner at the North Carolina Industrial Commission (NCIC) for 10 years.

Ryan Bliss joined the firm in 2012 after having been a worker’s compensation defense attorney representing insurance companies. This experience allowed him to see how workers’ compensation law is practiced from both sides. Super Lawyers magazine listed Ryan as a “Rising Star” in workers’ compensation law in 2018.5

Matt Harbin joined the firm in 2003 and became a Partner in 2008. Matt was appointed by (former) North Carolina Governor Bev Perdue to a two-and-a-half-year term on the North Carolina Commission for Mental Health, Developmental Disabilities and Substance Abuse Services, which he recently completed.

Matthew Healey ran a workers’ compensation department at another N.C. firm prior to joining our firm. He has been selected to Best Lawyers in America’s annual list of workers’ compensation lawyers every year since 2013.4 North Carolina Super Lawyers listed him as a “Rising Star” from 2010–2013 and a “Super Lawyer” from 2014–2016.5,6 Best Lawyers went a step further and named Matthew as a workers’ compensation “Lawyer of the Year” for Raleigh in 2015 and 2017.7

Barry Jennings joined us in 2006 and is a Partner of the firm. Barry has earned the designation of “Rising Star” by North Carolina Super Lawyers in 2011, 2012, and 2013.5 He was selected to Best Lawyers in America’s annual list of workers’ compensation lawyers every year since 2015.4 Additionally, he received the 2015 Martindale-Hubbell® Peer Review Ratings™ designation — the gold standard in attorney ratings.8

Daniel Lehrer joined the firm in 2019 handling workers’ compensation and personal injury cases. Daniel’s background also includes Social Security disability law.

Michael Roessler joined the firm in 2015, after having represented personal injury and workers’ compensation clients for more than five years. He is passionate about representing marginalized members of the community and is an advocate of individuals’ rights.

Susan Vanderweert represented insurance companies and employers for more than 12 years before joining our firm. Susan has received the 2016 Martindale-Hubbell® Peer Review Ratings™ designation — the gold standard in attorney ratings.8

Social Security Disability Specialist at James Scott Farrin

Rick Fleming joined the firm in 2002 and is a Partner and head of the firm’s Social Security disability department. He is admitted to practice before the Supreme Court of the United States. Rick is also the Fourth and DC Circuits representative for the National Organization of Social Security Claimants’ Representatives (NOSSCR) Board of Directors, and serves on the Nominations and Elections Committee for the NOSSCR. Additionally, he is vice chair of the N.C. State Bar’s Social Security Disability Law Specialty Committee.

North Carolina Worker’s Comp and Social Security Disability Specialists

two pilots in the cockpit of a planeWhile you probably would not want these attorneys piloting your Airbus A340 as it approaches the St. Martin runway, these board certified specialists have been highly trained and vetted to try to guide clients through what can sometimes be a turbulent battle for just compensation.

Get a FREE Case Evaluation from NC Lawyers

If you think you can’t afford them (or any of our attorneys), think again. All of our attorneys work on a contingency fee basis to try to help our clients navigate the best course of action for their specific situation.2

Feel free to contact us or call us toll free at 1-866-900-7078. We’ll have an attorney evaluate your case for FREE.

 

3Figures and percentages provided by the N.C. State Bar as of December 31, 2018.

4Since it was first published in 1983, Best Lawyers® has become universally regarded as the definitive guide to legal excellence. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation. Almost 87,000 industry leading lawyers are eligible to vote (from around the world), and Best Lawyers has received almost 10 million evaluations on the legal abilities of other lawyers based on their specific practice areas around the world. For the 2019 Edition of The Best Lawyers in America©, 7.8 million votes were analyzed, which resulted in almost 60,000 leading lawyers being included in the new edition. Lawyers are not required or allowed to pay a fee to be listed; therefore inclusion in Best Lawyers is considered a singular honor. Corporate Counsel magazine has called Best Lawyers “the most respected referral list of attorneys in practice.” For more information regarding the standards for inclusion, visit www.bestlawyers.com.

5To be eligible for inclusion in Rising Stars, a candidate must be either 40 years old or younger or in practice for 10 years or less. Rising Stars undergo a rigorous, multiphase process which combines peer nominations with third-party research. Each candidate is evaluated on 12 indicators of peer recognition and professional achievement. Selections are made annually on a state by state basis. While up to 5% of the lawyers in any state are named “Super Lawyers,” by Super Lawyers magazine, no more than 2.5% are named to the Rising Stars list. For more information regarding the standards for inclusion, visit www.superlawyers.com.

6Super Lawyers undergo a rigorous, multiphase process which combines peer nominations with third-party research. Each candidate is evaluated on 12 indicators of peer recognition and professional achievement. Selections are made annually on a state-by-state basis. For more information regarding the standards for inclusion, visit www.superlawyers.com.

7 Only a single lawyer in each practice area and designated metropolitan area is honored as the “Lawyer of the Year,” making this accolade particularly significant. Lawyers being honored as “Lawyer of the Year” are selected based on particularly impressive voting averages received during the exhaustive peer-review assessments conducted with thousands of leading lawyers each year. Receiving this designation reflects the high level of respect a lawyer has earned among other leading lawyers in the same communities and the same practice areas for their abilities, their professionalism, and their integrity. For more information regarding the standards for inclusion, visit www.bestlawyers.com.

8For more information regarding the standards for peer review ratings, visit www.martindale.com.

What Is My Workers’ Comp Case Worth?

Many people considering a workers’ compensation claim want to know “How much is my case worth?”

It’s a complex question, and can sometimes depend on who’s holding the calculator. Here are three primary factors that will affect how much you’re paid.

Get a free professional opinion on how much your workers’ comp case may be worth. No strings attached.

3 Factors That Can Determine Your Workers’ Comp Benefits

Three key elements go into determining the value of a workers’ comp case:

  1. Impairment Rating

    Once you have reached what is known as Maximum Medical Improvement (when you’ve healed as much as possible) but you’re still not the same as you were before your injury, your doctor should assign an impairment rating to the part of the body that was injured.

    An impairment rating is worth a certain amount depending on your compensation rate at your job and the part of the body that was injured. Your compensation rate is 2/3 of your average weekly wage for the 52 weeks prior to your injury. The part of the body that was injured and the rating is significant in this formula because the North Carolina Industrial Commission has determined that specific body parts are worth a certain number of weeks of your compensation rate.

    For example:

    Spine = 300 weeks
    Leg = 200 weeks
    Arm = 240 weeks

    Let’s say you injured your left arm at work and your authorized treating physician has assigned a 10% impairment rating to that left arm. Your compensation rate is $350, based on the following formula:

    10% of 240 weeks = 24 weeks
    24 weeks x $350 salary = $8,400
    You would be entitled to $8,400 for that rating

    Unfortunately, that means if you have low wages, and therefore a low compensation rate, your impairment rating will not be worth as much as another employee with a large compensation rate. Based on the above scenario, if your compensation rate is $100, that same 10% rating would only equal $2,400.

    That’s why making sure your compensation rate is calculated accurately is extremely important. We’ve found additional money for lots of clients by looking more closely at their compensation rate and sometimes finding that overtime pay or additional work days had not been factored into their compensation rate.1

    We can help you try to get a second opinion on your impairment rating.

  2. Indemnity Benefits – or Temporary Total Disability (TTD)

    Another factor taken into consideration when determining the value of your workers’ comp case is how much the insurance company may have to end up paying in indemnity benefits (disability benefits). Indemnity benefits are the weekly payments the workers’ comp insurance company makes to you when your authorized treating physician has written you out of work or has assigned work restrictions your employer cannot accommodate. This is also known as Temporary Total Disability (TTD) benefits.

    Our firm has been representing injured workers for a long time. And one of the many things we’ve seen is that insurance companies don’t want to have to write these checks to you for any longer than they have to.

    Many factors affect how long you may be entitled to these checks. Whether they continue to pay you TTD or try to settle your case is a numbers game to them to try to ensure they pay you as little as possible. Here are some of the factors they consider when deciding how much and how long to pay you.

    Date of Your Work Injury Affects TTD Benefits

    • If you were injured on or after 6/24/11, you can receive a maximum of 500 weeks of TTD.
    • If you were injured prior to 6/24/11, you could potentially receive TTD for the rest of your life.

    Work Restrictions a Factor in Workers’ Comp Settlement Amount

    We may be able to help you maximize your indemnity benefits by working to prevent you from returning to work in a job that is outside of your work restrictions.

    If you have temporary light duty restrictions with minimal medical treatment, and are expected to be able to go back to your regular job performing the same duties as before your injury, the insurance company may be less likely to pay a large sum to settle your case. However, if you have permanent restrictions that prevent you from returning to your pre-injury employment or other work, the insurance company may have more incentive to settle your case as soon as possible, rather than potentially paying you years of TTD.

    While we cannot tell your treating physician what restrictions to assign you, we can try to make sure your doctors are aware of what your job entails and fight on your behalf to get reasonable restrictions – or a second opinion from another doctor.

    As is the case with impairment ratings, your compensation rate plays a big factor in determining how much money the insurance company may have to pay you for being out of work.

    Salary a Factor in Workers’ Comp Settlement Amount

    If you have a compensation rate of $350, the insurance company knows that if they have to pay you for being out of work for a year they’ll spend $18,200. However, if your compensation rate is only $100, even if you are out of work for a year, the insurance company only has to pay you $5,200. They may be more likely to settle earlier on if it they believe it might cost them more to continue paying you TTD.

    Pain and Suffering NOT a Factor in Workers’ Comp Cases

    Many of our workers’ comp clients are surprised to find out that pain and suffering are not taken into account in workers’ comp. No matter how much frustration and suffering your work injury has caused.

  3. Future Medical Treatment

    Your claim will also be more valuable if your authorized medical physician recommends significant medical treatment for your workers’ comp injury than if there are few or no medical recommendations.

    If you have a shoulder injury, for example, and your physician recommends a rotator cuff repair surgery, the insurance company may be more inclined to pay you more to settle your claim quickly so they don’t have to pay for that surgery. On the other hand, if you have a shoulder injury and your physician says you only need some physical therapy, the insurance company may likely be more motivated to simply pay for your physical therapy instead of paying you more to settle your claim.

    As you can see, there are many nuances in workers’ compensation law. Thousands and thousands of legal pages have been written to explain these nuances. It can take an experienced workers’ comp attorney to understand and interpret these laws to help you try to maximize these factors to your advantage.

    We can help you try to ensure your physician knows the full extent of your injuries. And we can help monitor your progress with the doctor and the insurance company. 

    A good workers’ comp attorney can do more than that! They can help you try to get a second opinion on your impairment rating if the first rating is too low, based on your injury. They may be able to help you maximize your indemnity benefits by working to prevent you from returning to work in a job that is outside of your work restrictions. And while they cannot tell your treating physician what restrictions to assign you, they can make sure your doctors are aware of what your job entails and fight on your behalf to get reasonable restrictions – or a second opinion from another doctor.

Choosing a Workers’ Comp Lawyer

You’re reading this blog for a reason. Are you getting the run-around from your insurance company? Are you confused by the rating and compensation process (you’re not alone)? Is your insurance company trying to force you to settle? Are they withholding checks?

If you’re struggling with your workers’ comp situation and you think you may need an attorney, download this booklet: How to Choose a Lawyer for Your Workers’ Compensation Claim.

If you follow the tips in this booklet, we believe you’ll find a good attorney for your case. Of course, we believe our attorneys embody the qualifications and ideals you should seek when looking for a workers’ compensation attorney. Several of our attorneys are North Carolina Board Certified Specialists in Workers’ Compensation Law. (Very few attorneys in in North Carolina can make that claim.) We’re committed to helping you understand your options and arming you with the knowledge you need to make an informed decision that’s right for you.

Get a FREE Case Evaluation From Our North Carolina Workers’ Comp Attorneys

Contact us anytime or give us a call at 1-866-900-7078 if you have questions or concerns about your workers’ comp case. We’re available to you 24/7.

 

Employee leaves office with belongings wondering if she can get unemployment and workers' comp.If you’ve been injured on the job and are now out of work, you may be struggling financially. It’s often difficult to find information about the smartest route to take – applying for unemployment or for workers’ comp.

Workers’ comp is the obvious choice, particularly if your employer wants to keep you on as an employee after you’ve healed.

However, you may have heard that workers’ comp claims can take a long time to process, and are sometimes, after a long deliberation process, outright denied. That means you could wait for weeks for a verdict on your claim – only to find out no checks are forthcoming.

On the other hand, filing for unemployment, while it can be processed much more quickly, generally nets you far less money to pay your bills. And you may not even be eligible for unemployment. In North Carolina, you are only eligible for unemployment if you worked 12 out of the last 16 months.

What Is the Monetary Difference Between Unemployment and Workers’ Comp?

(Please note that all figures in this article are for the purposes of illustration. They are not a guarantee of the actual monetary amount you will receive if you apply for either unemployment or workers’ compensation).

Unemployment Benefits

In North Carolina, your weekly unemployment benefits are calculated by adding up your wages in the last two quarters of the base period and dividing that amount by 52. That figure determines what your weekly unemployment check will be. (Currently, the most you can receive each week is $350 per week.)

For example, if you earn an annual salary of $40,000, your last two quarters would be approximately $20,000. Dividing that by 52 you get approximately $384.61, so you’d receive the maximum weekly unemployment check of $350 a week – less than half the salary you’d formerly been relying on.

Workers’ Comp Benefits

By contrast, a successful workers’ comp claim is two-thirds of your average weekly wage for the year prior to your injury. If you’ve worked for the employer for less than a year, they would use your earnings up until the date of injury.  In our scenario where your salary is $40,000/year, the amount of your weekly checks would be about $513 – much better than the $350 from unemployment.

Can You Apply for Both Unemployment and Workers’ Comp?

Are you allowed to apply for both unemployment and workers’ comp – as a sort of safeguard in case one doesn’t come through?

The short answer is yes, you can. The long answer is: yes, you can, but you really shouldn’t without solid legal representation, because if you don’t handle the situation exactly right, you could find yourself being denied for both!

What Makes Applying For Both Such a Tricky Scenario?

Unemployment benefits are designed to help you pay your bills when you lose your job. Workers’ compensation replaces your wages at your existing job when you can no longer work because of an on-the-job injury.

Collecting workers’ comp and unemployment is not legal for one simple reason: workers’ comp implies that you still have a job, even though you’re not currently performing your duties because of an injury. In the eyes of the state you do not qualify for unemployment since, technically, you are still employed.

That said, workers’ comp claims can take some time to process, and you don’t know whether your claim will be granted or denied. During that time, when you’re waiting for your workers’ comp claim, you may be able to collect unemployment to cover your bills – with some serious caveats.

You can apply for unemployment in North Carolina while your claim for workers’ comp is being processed and you may receive benefits up until the point that your workers’ comp claim is granted. This can be the best option for many people, since workers’ comp claims can take some time to process, and in the meantime, of course, you need to keep a roof over your head.

We strongly recommend that you have a qualified workers’ compensation lawyer handle this scenario for you.

How Can a Workers’ Compensation Lawyer Help Maximize Your Unemployment Benefits?

A lawyer can help make sure you’re not accidentally setting off alarm bells at the various agencies processing these claims. In many cases, employees who apply for both workers’ comp and unemployment are seen as attempting to defraud the system, and you want to avoid that at all costs. We’ve seen a lot of people who applied for both without representation, and were denied because the agencies may have assumed they were trying to double dip.

When attempting to collect unemployment while waiting for workers’ comp results correctly and legally, you won’t actually be receiving double benefits. And with the aid of a lawyer, the state of North Carolina will have no reason to think you’re attempting to do so.

If your workers’ comp claim is accepted, you will be entitled to disability checks dating from one week after the date your injury – which is to say, checks that cover a period of time that has already passed while the claim was being processed.

If you’ve been collecting unemployment during this time (which is legal), you would effectively be in the position where you were collecting unemployment and workers’ comp checks during the same period of time (which is not legal). To ward off any likelihood of double dipping, your workers’ comp insurance carrier is typically given credit for the amount of unemployment benefits you’ve already received.

Once again, this is a situation where a lawyer can be extremely beneficial. The deduction for credit against your workers’ comp benefits is not absolute and has to be approved by the North Carolina Industrial Commission. You’ll want a solid legal team behind you to be sure the final accounting comes out properly.

NC Workers Comp Attorneys Can Evaluate Your Claim – FREE

If you’ve recently been injured on the job and aren’t sure whether filing for unemployment or workers’ comp – or both (with legal support) – is best for you, please contact us online or give us a call toll free at 1-866-900-7078.

We work on a contingency fee basis to help our clients figure out the best options for their situation, and we may be able to help you determine what course of action is most likely to keep food on the table and lights on overhead while you recover from your injury.