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Application Process

How Your Case Moves Through the Industrial Commission

If you are injured on the job in North Carolina, you may be entitled to workers’ compensation benefits from your employer. By law, your employer is supposed to provide benefits for part of your lost wages and your medical bills.However, the reality is that many valid claims are denied and the criteria for a compensable claim can be complicated. Denied claims sometimes mean there was an error with the application – meaning you may not be communicating properly about injuries you experienced at work and how they’re impacting your life.

The reasons for denial can range from insufficient documentation about the injury to an incorrect application. In some cases, your employer may deny that your injuries were actually work-related or that you did not have a compensable accident.

On this page we’ll explain how the application process works.

Report Your Work-Related Injury or Illness to your Employer

An injured worker is required to report an injury or illness associated with work duties immediately to his or her employer. The employer directs the injured person to a designated doctor or clinic. The worker then gets the initial medical treatment from that physician. A claim form will be filed to recover compensation for the medical treatment, and to pay a percentage of wages during the period of recovery.

It is important that the injury or illness is reported to the physician as being work-related, so that this is clearly evident in medical records.

The medical treatment your doctor advises should be followed to the letter. A failure to follow medical advice can have a negative impact on your workers’ compensation case.

Ongoing Medical Treatment and Inability to Work

If your injury keeps you from working, your employer’s insurance carrier will continue providing for your medical care. In some cases, a worker has the right to seek a second opinion and the right to seek treatment from his or her own medical provider, subject to the approval of the insurance carrier or the Industrial Commission.

An attorney from our firm can assist you in obtaining care from the physician, surgeon or other medical provider that you trust, with approval from the employer’s insurance company or the Industrial Commission. Any disputes regarding medical treatment are addressed through the Commission, and it is advised you get a lawyer from our firm to help you.

The injured worker must accept appropriate medical treatment, and comply with the recommendations for treatment. Keep all appointments and write down the symptoms you are experiencing every day. Your written log can be valuable. Any failure to follow physician’s recommendations can hurt your claim for benefits, so make certain follow doctor’s orders carefully and fully. After medical treatment, bills are submitted to the employer and insurer for all services, as well as for mileage reimbursement.

If you are unable to work during your period of recovery or treatment, you are eligible to receive a percentage of your wages over that period of time (in most circumstances, you will receive approximately 66% of your pre-injury wages).

Continuing Period of Total Incapacity While Under Medical Care

If you are severely injured and still unable to work, your medical treatment will continue from the designated approved and authorized physician. At this point, you should start to receive TTD Benefits. Temporary Total Disability.

If any questions arise, you can call your employer, the workers’ comp insurance company, or the Workers’ Compensation Commission for help. An attorney from our firm can manage these details for you. It can be a complex matter to get TTD benefits. Rather than fighting with your employer or the Commission, let us do the heavy lifting while you focus on recovering your health.

Medical Status Improves & You are Capable of “Light Duty” or “Restricted Work”

After a period of recovery is complete, you may not be fully capable of performing your pre-injury duties, but your doctor may approve you for light duty or restricted work. You can request this work from your employer. If your employer is unable to provide you with lighter work duties, you can search for an appropriate job and request Temporary Partial Disability (TPD) benefits if you earn less than your previous wages.

If the attending physician indicates that your physical restrictions will be permanent, you can apply for help for job retraining , placement or educational expenses. It is important that you document a good faith job search.

Reaching Maximum Medical Improvement (MMI)

Once it is deemed you have reached MMI, you may contact the insurance company to reach an agreement on Permanent Partial Disability (PPD) benefits or a total settlement of the claim (clincher). These benefits are paid to workers who have suffered any permanent physical impairment due to the work-related injury as assigned by a Doctor. A voluntary agreement is signed for PPD benefits or for a compromise settlement of the entire claim. You generally have the right to a second opinion on the PPD ratings.

Employee Exhausts Period in which TTD Benefits are Paid over 500 Weeks

TTD Temporay Total benefits are paid for a limited period. However, in certain circumstances you can request a hearing with the Industrial Commission to extend the period that these benefits are paid.

Our firm can assist with this process, if you have received TTD benefits and the time of payment is going to run out.

Injury or Surgery Causes Disfigurement and/or Scarring

Some injuries leave you disfigured, or with permanent scars. Severe scarring or disfigurement may have a long-term effect on you emotionally and financially. Disfigurement may make it much more difficult to find a job, or lead a normal life.

If you have suffered a disfigurement or scar from the injury or from a surgery that left you disfigured or permanently scarred, you should contact the employer’s insurance company or the Industrial Commission to seek a scar/disfigurement evaluation.

Every case is evaluated individually, and compensation for this type of injury will vary, based upon the type of scar, location of scar, etc.

These issues should be managed by a legal professional who is very familiar with the process, so that it goes as efficiently and successfully as possible. There are statutory limitations on the amount of compensation payable for scarring or disfigurement.

Choose Riddle & Brantley for Your Workers’ Compensation Claim

At Riddle & Brantley in North Carolina, we have a talented team of workers’ comp attorneys that advocate for injured workers throughout the state. One of our founding attorneys, Chris Brantley, is a Board Certified Workers’ Compensation Specialist. He is one of only a small percentage of lawyers in the state who can call themselves specialists in workers’ compensation.

Our lawyers know how to best communicate the severity of the injuries that you experienced at work. We’re very familiar with the North Carolina application process. If you call us we can meet and give you a consultation on what steps you should take next.

Injured at work? Talk to our Raleigh workers’ compensation attorney before you do anything else, particularly if the injury is serious you cannot continue to work. You need help – the right kind. At Riddle & Brantley, justice counts, and we’re here to help you get it.

Verdicts and Settlements in Workers’ Comp Cases

We are proud of our accomplishments in workers’ compensation law. Some of our recent victories for our clients include:

  • $829,000 awarded in an accident involving a tree that fell on a cellular tower worker, leaving an 50-year-old man with severe head injuries that left him with cognitive impairments.
  • $786,000 awarded to a law enforcement officer who suffered a disabling injury to the spinal cord.
  • $725,000 awarded in settlement for an agricultural worker who injured his back carrying heavy objects, leading to back surgery and fusion, and ongoing pain. The award included a Medicare Set Aside valued at $525,000.
  • $700,000 settlement negotiated for an injured emergency services worker who suffered a back injury while on the job. The compensation included wage replacement, medical expenses, and pain management costs. After six years of ongoing payments, the case was settled in a partially structured settlement, allowing the client to get lifetime payments, as well as medical expenses.

Disclaimer: Please note that these results are intended to illustrate the type of matters handled by our firm, and not all the firm’s results are listed. These results do not guarantee a similar outcome, and they should not be construed to constitute a promise or guarantee of a particular result in any particular case. Every case is different, and the outcome of any case depends upon a variety of factors unique to that case. More information is available on our Case Results page.