Raleigh Estate Planning and Corporate Law Attorneys

Workers' Compensation

What Are the Workers’ Compensation Insurance Requirements for North Carolina Employers?

By

Workers’ compensation claims have a twofold purpose: to compensate employees who suffer work-related injuries and to protect employers from being sued by their injured employees. For this reason, North Carolina requires most businesses with three or more employees to obtain workers’ compensation insurance. Here, we discuss the general worker’s compensation requirements for North Carolina employers and how COVID-19 might impact employee claims.

General Requirements for Employers

The North Carolina Workers’ Compensation Act (North Carolina General Statutes §97-94) generally requires all businesses in the state (whether they operate as corporations, sole proprietorships, LLCs, or partnerships) with three or more employees to obtain worker’s compensation insurance. Certain exemptions apply, including for businesses that employ:

  • “casual” employees (those whose work is casual and not part of the regular trade or business);
  • domestic servants working in a household;
  • farm laborers when there are fewer than ten full-time, non-seasonal workers;
  • employees of certain railroads; and
  • North Carolina federal government employees.

Who Does NOT Count as an “Employee” for Workers’ Compensation Purposes?

Whether a business employs three or more employees is not as straightforward as it might sound. The following groups of individuals generally do not need to be covered by workers’ compensation insurance:

  • Business owners, such as partners in a partnership, do not necessarily count as employees.
  • Corporate officers may elect to be excluded from coverage (however, they will still be counted as employees when determining whether a business has three or more employees, even if they opt-out of coverage).
  • Finally, with some exceptions, independent contractors generally do not qualify as employees.

How Much Does Workers’ Compensation Coverage Cost Employers?

The cost of workers’ compensation insurance coverage will vary depending on the number of employees a business employs and the type of jobs its employees perform. The North Carolina Rate Bureau is a non-profit organization that sets “class codes” and “base premium rates” for workers’ compensation, which will determine the total cost of workers’ compensation for a business.

These figures vary and reflect how dangerous a job is compared to another type of job (with high-risk jobs carrying higher base rates than lower-risk jobs). Depending on an employee’s class code and base premium rate, the North Carolina Rate Bureau will set a rate for its workers’ compensation premiums, which businesses must follow.

North Carolina workers’ compensation insurers usually offer discounts to employers. These discounts will vary based on the insurer but can include discounts for a drug-free workplace; for businesses that are part of a professional, trade or industry group; and for businesses that implement certain safety or fall prevention programs. 

COVID-19 and Workers’ Compensation in North Carolina

For the foreseeable future, COVID-19 appears to be here to stay, and businesses across the State continue to be affected by it. While most businesses will undoubtedly be impacted by COVID-19 in one way or another, many business owners likely wonder how it will affect their workers’ compensation claims. Most notably: Will employees be able to file workers’ compensation claims for having contracted COVID-19?

Unfortunately, the short answer is that we simply do not know. It is unclear whether these claims will be compensable under North Carolina law. While it appears more likely that they will be denied, to understand why this issue is so complex, it helps to review the laws surrounding workers’ compensation claims.

Coverage for Workers’ Compensation Injuries

Coverage for workers’ compensation injuries is divided as follows:

  • Injuries that occurred because of an accident or specific trauma (e.g., a slip-and-fall at work); and
  • Injuries caused by an “occupational disease.”

Potential COVID-19 claims would likely have to be filed as “occupational disease” claims. The North Carolina statutes define an occupational disease as either one of the specific diseases enumerated in the Act (which does not include COVID-19), or any disease acquired while working at a job that placed the person more at risk for getting the disease than the general public.

Thus, if the general public is equally exposed to the disease outside of the place of employment, the disease is not considered an occupational disease and therefore would not be covered by workers’ compensation.

Establishing Eligibility for a COVID-19 Workers’ Compensation Claim

To be eligible for benefits, an employee must show that he or she contracted COVID-19 from exposure on the job and, because of the job, he or she was at a greater risk than the general public. It might be that some frontline workers, such as healthcare workers, would be able to show that they were at higher risk of exposure to the virus than the general public. Likewise, it is possible that others, such as grocery store clerks, could show the same.

What becomes more challenging to prove, however, is causation, that is, a link between the employee’s job and the resulting COVID-19 infection. Even if it were likely that the employee contracted the virus while on the job, (such as while working at a hospital or treating patients infected with COVID), it would be very hard to prove this, as the disease could have just as easily been contracted outside of work. In other words, proving causation is extremely difficult, if not virtually impossible.

Currently, unless legislation is passed that defines COVID-19 as an occupational disease, it appears likely that an employer will be in the position to deny such claims in North Carolina. However, this is an unfamiliar terrain, and the coming months are likely to bring more clarity.

Workers’ Compensation Claims During Uncertain Times

While the costs associated with a workers’ compensation policy will vary depending on the size and nature of your business, owners of small, medium-sized, or large businesses should be aware of their obligations. At this time, it remains unclear whether COVID-19 claims will be covered under workers’ compensation insurance, but business owners should make sure they are fully in compliance with the laws regardless of what changes may be on the horizon.

4 Steps To Take After Being Injured At Work

By

injured at work

No one plans on getting injured at work. But when an injury occurs, all of a sudden, you need to know what to do. The steps that you take after a work injury are very important to not only your physical recovery, but also to making sure that you get the financial relief that you need to get your life back in order. Here are four steps to take after being injured at work:

1. Make an accident report

Your ability to recover after an accident may depend on making a report as soon as you can after an accident. If your case falls under workers compensation laws in your state, you may need to make an accident report within a very short time after the accident occurs in order to state your claim. You make your report directly to your employer. Your employer should have a form, and they should be able to help you with the procedures for how to file your report.

It’s not enough to make an oral report to a co-worker or a supervisor. A written report is what’s required in order to start the ball rolling with your claim. When you make the report, you should include the basics of your accident. You should include when, where and how the injury occurred. Don’t worry too much about getting every last bit of punctuation perfect and don’t stress too much over details. You just need to document that the accident occurred and give the basic information.

The time window for filing your report may be very short. The sooner you can get a report filed, the better. It’s important to be skeptical of any attempts to dissuade you or otherwise stop you from filing a written report. Your employer should be able to guide you through the process, and it should be quite simple to file your report. When you get your report filed, you’ve taken the first important step in ensuring that you get the compensation that you deserve for your injuries.

2. Get appropriate medical care

The next step to take after being injured at work is to get immediate medical care. You might need to call emergency services to take you to the hospital. If your injuries are severe, you may be incapacitated and rely on others to summon the care that you need. Whether you leave the scene in an ambulance or you’re able to travel to the doctor on your own, you need to seek medical care immediately.

There are several reasons that it’s critical to seek medical attention as soon as you can after you’re injured at work. First, seeking medical care may be critical to your health. You want to address your injuries so they don’t get worse. Knowing what you need to do in order to care for your injuries is critical to making sure that you begin to heal as soon as possible.

It’s important to follow your medical treatment plan. You don’t want your employer claiming that your injuries aren’t serious because you aren’t following your doctor’s recommendations. You also don’t want your employer to claim that the costs of your injury may have been lower if only you had followed your medical care plan. Following your treatment plan is critical to preserving your right to fair compensation for your work injury.

There’s another reason that it’s crucial to seek medical attention right away. A significant part of getting fair, financial compensation after a work injury is documenting exactly what your injuries are. Your injuries may be far more serious than you realize. You may not be able to appreciate exactly what your prognosis is without a full medical evaluation. Your medical treatment team can not only get to the bottom of your diagnosis, but they can also verify and document your injuries in case there are any disputes about them later on.

3. Take photos of the scene of the injury

Even though you’re not a professional investigator, there are things that you can do to gather the evidence that’s available at the scene of your injury. The more evidence you can gather, the stronger your claim is going to be right off the bat. One of the things that can help you get off to a great start when it comes to building your case after being injured at work is taking photos of the accident scene.

You don’t need to be a photographer to get helpful photos of the accident scene. Snapping photos up close and also of the overall scene can show machinery, slippery surfaces and other things that may have contributed to the accident. It’s always better to over-document than under-document, so don’t be shy about taking a lot of photos.

Even if you don’t know what’s the most important, having photographs of the scene can help you establish facts that are critical later on. Witnesses may not be honest, and they can be mistaken. If you have photographs, you have helpful proof of facts that may be critical to proving your claim.

4. Learn about workers compensation and negligence laws

The best way to ensure that you get the recovery that you deserve and find satisfaction in the recovery process is to educate yourself about the laws that apply to your case. Many work injuries fall under workers compensation law. Even though workers compensation laws generally compensate injured employees for their out of pocket losses after an accident at work, there are still steps to take in order to assert your claim and get a recovery that you deserve. The more that you know about the laws that apply, the more confidence that you can have that your case is moving in the right direction.

Wilson Ratledge can help you understand the law that applies to the case. Workers compensation laws may apply, but traditional negligence laws may also apply in some cases. We can advocate on your behalf, and can empower you to understand the law and know that it’s working on your behalf to arrive at the right result after an injury at work.

Taking the right steps after a work accident

An injury at work is a serious matter. You may not be able to return to work immediately, and you may have medical bills and other losses. When you know what to do after a work injury, you can take the right steps to get the compensation that you deserve. Seeking medical care, making the right reports, taking photographs of the scene and empowering yourself to learn about the law can help you recover physically and financially as you move forward after an injury at work.

North Carolina’s Response to the Opioid Crisis Continues to Build Steam

By

As the nation struggles to deal with the staggering human and economic costs associated with the crises of opioid addiction and misuse, North Carolina is on the vanguard of the response.

The centerpiece of this effort is the Strengthen Opioid Misuse Prevention Act, more commonly referred to as the STOP Act.  Passed unanimously by both houses of the General Assembly on June 28, 2017 and signed into law by Governor Cooper on June 29, 2017, the STOP Act limits first time prescriptions for most opioids to no more than 5 days for acute pain, and 7 days for post-surgical pain.  It will require medical providers to check North Carolina’s Controlled Substance Reporting System database (CSRS) to confirm that the patient is not receiving inappropriate medications from other sources, and will require electronic prescriptions for such drugs by 2020.  The STOP Act also strengthens the CSRS, including provisions requiring pharmacies to report opioid transactions more quickly, and expands the availability of the opioid antagonist naloxone, in an effort to reduce the harm from opioid overdose.  But, recognizing the value of opioids in the correct settings, the STOP Act does not apply to medications administered in an inpatient setting, nor does it prevent follow up prescriptions for longer terms when medically appropriate.

In concert with the STOP Act, other efforts to confront the opioid crisis include the North Carolina Department of Health and Human Services’ Prescription Drug Abuse Advisory Committee, and the North Carolina Industrial Commission’s Opioid Task Force, which seeks to recommend rules and guidelines addressing the use of opioids in the context of workers’ compensation claims.

For more information on how North Carolina is addressing the opioid crisis, you may want to review the state’s Opioid Action Plan:  https://www.ncdhhs.gov/opioids

Select NC Industrial Commission Filings Now Require An Attorney

By

As of Monday, September 18, 2017 the North Carolina Industrial Commission will no longer allow adjusters to file or respond to the below documents, as the North Carolina State Bar has determined that it constitutes the unlicensed practice of law.  Therefore, if you wish to file or respond to any of the below documents, an attorney will have to be retained in order to do so:

  • Form 24 Application to Terminate or Suspend Benefits
  • Motion to Compel Cooperation with Medical Treatment or Vocational Rehabilitation
  • Response to Form 23 Application to Reinstate Benefits
  • Response to Form 18M, Form 28U
  • Response to any Motions filed by Plaintiff or Plaintiff’s Attorney, including a Motion to Compel Medical Treatment, Motion to Compel Rule 607 or Discovery Responses, Motion to Compel Second Opinion.

Please contact any of our workers’ compensation attorneys if you have any questions.

NC Supreme Court Reaches Verdict In Wilkes v. City of Greenville

By

On Friday, June 9, 2017, the North Carolina Supreme Court reached its decision in the Wilkes v. City of Greenville case, and the ramifications of the decision will have the most impact on workers’ compensation claims since the Reform Act of June 24, 2011.

At issue in the Wilkes case was the causation presumption. It has long been Defendants’ position that only the body parts specifically identified on a Form 60 or 63 are compensable, and it is Plaintiff’s burden of proving that other symptoms, conditions and/or injuries to other body parts are related to the original accident. The North Carolina Supreme Court in the Wilkes decision has struck down such an argument, holding that in admittedly compensable accidents, Plaintiffs are entitled to a rebuttable presumption that additional medical treatment for any symptoms, conditions or injuries is related to the work accident.

We encourage you to contact one of our attorneys to schedule a meeting or seminar to discuss the impact of the Wilkes decision on your current claims and your handling of future claims.