Protecting the Rights of Injured Clients
Durham Workers’ Compensation Attorneys
Representing the Rights of Injured Workers Throughout Durham County
If you were injured on the job or suffered a work-related injury, illness, or medical condition, you are likely entitled to workers’ compensation benefits. In North Carolina, any employer in the private sector with three or more employees must carry workers’ compensation insurance. This insurance covers nearly all employees and provides benefits to those who cannot work, either temporarily or permanently, as a result of their work-related injuries.
At Hyland + Padilla, PLLC, we help clients with all aspects of workers’ compensation, from understanding their rights and eligibility for benefits to filing claims and navigating the appeals process. We have a long history of success helping injured workers recover the benefits they were owed under North Carolina’s workers’ compensation system; learn how our firm can assist you with your claim today.
Request a free consultation with our team today by calling (919) 891-8361 or by contacting us online using our secure submission form. Hablamos español.
What Is Workers’ Compensation?
Workers' compensation is a no-fault system of insurance developed to provide benefits to injured workers or their families in the event of job-related injury, illness, or death. Under this system, employees are entitled to receive medical care and wage replacement while they are unable to work due to a workplace injury or illness. At the same time, employers are protected from being sued by their employees for a job-related illness or injury.
Workers' compensation is an important benefit that provides financial security for individuals who have been affected by a workplace accident or occupational disease. If you work for a North Carolina employer with at least three employees, you are covered by workers’ compensation and can seek benefits when you suffer a job-related injury, illness, or medical condition.
What Types of Work-Related Injuries Are Covered by Workers’ Compensation?
Workers’ compensation covers all work-related injuries and occupational illnesses, including some mental health conditions. If you can prove that your injury or medical condition occurred at work or in some way related to your work, you are likely entitled to workers’ compensation benefits.
Some examples of common work-related injuries and illnesses that are usually covered by workers’ compensation include:
- Back injuries
- Head and neck injuries
- Traumatic brain injuries
- Spinal cord injuries
- Broken bones
- Traumatic amputation/loss of limb
- Burn injuries
- Sprains and strains
- Repetitive strain injuries
- Overuse/overexertion injuries
- Respiratory illnesses
- Hearing damage/loss
- Infectious diseases
- Stress and certain other mental health disorders
If you sustained a work-related injury or occupational illness and need help with your workers’ compensation claim, reach out to Hyland + Padilla, PLLC for a free consultation. We can discuss your legal rights and options at no cost and with no obligation to you.
Workers’ Compensation Benefits in North Carolina
The North Carolina workers’ compensation system provides several different types of benefits to qualifying claimants.
These benefits include:
- Medical Care: Workers’ compensation pays for all reasonable and necessary medical expenses related to your workplace injury or occupational disease.
- Temporary Partial Disability: Temporary partial disability (TPD) is paid to workers who can only return to work in a partial capacity due to their qualifying injuries.
- Temporary Total Disability: Temporary total disability (TTD) benefits are paid when a worker cannot return to work temporarily due to their qualifying injury.
- Permanent Partial Disability: If you suffer a permanent partial disability that prevents you from ever returning to work at full capacity, you could qualify for permanent partial disability (PPD).
- Permanent Total Disability: Permanent total disability (PTD) is awarded to workers whose injuries are so severe, they are completely disabled and unable to return to any form of work.
- Vocational Rehabilitation: Vocational rehabilitation benefits help cover certain expenses associated with job retraining and reentry into the workforce.
- Death Benefits: When a worker dies in a workplace accident or as a result of an occupational disease, certain family members may be entitled to workers’ compensation death benefits.
Our Durham workers’ compensation attorneys can help you understand what types of benefits you may be entitled to receive, as well as the amount you can expect in workers’ compensation.
How to File a Workers' Compensation Claim in North Carolina
Filing a workers' compensation claim in North Carolina involves several steps. Workers' compensation is a system designed to provide benefits to employees who are injured on the job.
Here's a general overview of the process:
- Report the Injury to Your Employer: As soon as you are injured at work, report the injury to your employer or supervisor. This is a critical step, and you should do it as soon as possible, ideally within 30 days of the accident. Failure to report the injury promptly could jeopardize your claim.
- Seek Medical Attention: If your injury is severe, seek immediate medical attention. Your employer may have a designated healthcare provider for workers' compensation cases. Follow their instructions or go to a medical provider of your choice. Make sure to inform the healthcare provider that your injury is work-related.
- Notify Your Employer in Writing: It's a good practice to provide written notification of your injury to your employer. This could be a simple letter or email detailing the injury, when and where it happened, and any other relevant information.
- Complete a Form 18: In North Carolina, you may need to complete a Form 18 to officially file a workers' compensation claim. This form can be obtained from the North Carolina Industrial Commission (NCIC) website or your employer. Complete the form and provide a copy to your employer and the NCIC.
- Employer's Responsibilities: Your employer is required to file a Form 19, which is their report on the injury. This should be filed with the NCIC within five days of your report. Your employer's insurance carrier should also be notified.
- Investigation by the Insurance Carrier: After the claim is filed, the workers' compensation insurance carrier will investigate your case. They will determine whether your claim is valid, and if so, what benefits you are entitled to.
- Receive a Notice of Acceptance or Denial: The insurance company will send you a notice of acceptance or denial of your claim. If they accept your claim, it will detail the benefits you will receive. If your claim is denied, the notice will explain the reasons for denial.
- File a Request for Hearing (If Necessary): If your claim is denied, and you believe it should be approved, you can request a hearing before the North Carolina Industrial Commission. This is a formal process where an administrative law judge will review your case.
- Mediation or Settlement Negotiation (If Applicable): In some cases, you and the insurance company may engage in mediation or negotiate a settlement before a hearing. This is a way to potentially resolve the dispute without going to court.
- Appeal (If Necessary): If the decision at the hearing is not in your favor, you have the right to appeal the decision to the Full Commission and, ultimately, to the North Carolina Court of Appeals.
Common Reasons a Workers' Comp Claim Is Denied
Workers' compensation claims can be denied for various reasons.
Some common factors that often lead to the denial of workers' compensation claims include:
- Late Reporting of the Injury: Failing to report the injury promptly to your employer is a common reason for denial. Most states require employees to report work-related injuries within a specific timeframe (usually 30 days or less). Delaying the report can raise suspicion and make it harder to establish the injury's connection to the workplace.
- Lack of Medical Evidence: Insufficient or conflicting medical evidence can lead to claim denials. The injury's severity, its connection to the workplace, and the need for medical treatment must be well-documented by healthcare providers. If the medical records or doctor's assessment do not support the claim, it may be denied.
- Injury Not Arising Out of Employment: Workers' compensation generally covers injuries that arise out of and in the course of employment. If it's unclear whether the injury occurred at work or while performing work-related duties, the claim might be denied.
- Pre-existing Conditions: If the insurance carrier believes the injury is related to a pre-existing condition and not primarily caused by a workplace incident, they may deny the claim. However, if the work injury exacerbates a pre-existing condition, you may still be entitled to benefits.
- Failure to Follow Medical Advice: If you do not follow the prescribed medical treatment or do not attend necessary medical appointments, the insurance company may use this as a reason to deny your claim. They may argue that your non-compliance worsened your condition.
- Disputes About the Injury: Disagreements between you, your employer, or the insurance company about the nature and extent of your injury can lead to denials. They may claim that your injury is not as severe as you say or that it is unrelated to your work.
- Injury Outside the Scope of Employment: Injuries that occur while you are engaged in personal activities unrelated to work are typically not covered by workers' compensation. If the insurance carrier believes your injury falls into this category, they may deny your claim.
- Intoxication or Misconduct: If your injury resulted from being intoxicated or engaging in serious misconduct at work, your claim may be denied. These actions are often considered a violation of workplace safety rules.
- Missed Deadlines: Failing to meet the deadlines for filing a claim or responding to requests for information can result in a denial. Adherence to administrative and legal deadlines is crucial in the workers' compensation process.
- Employer's Dispute: Your employer or their insurance carrier may dispute your claim for various reasons, such as believing it's fraudulent, that the injury didn't occur at work, or that it wasn't properly reported.
- Administrative Errors: Sometimes, claims are denied due to administrative errors, such as incomplete forms, missing information, or clerical mistakes.
What to Do If Your Workers’ Compensation Claim Is Denied
Unfortunately, many workers’ compensation claims are denied. If this happens to you, you have the right to appeal. We strongly recommend that you work with an experienced workers’ compensation appeals attorney, like those at Hyland + Padilla, PLLC, as the appeals process can be lengthy, complex, and confusing. An attorney at our firm can help you file your appeal and navigate the ensuing process, including preparing for and attending appeals hearings.
We are committed to securing maximum compensation for hard-working people who suffer devastating job-related injuries and illnesses. We are prepared to be your advocate and guide, helping you protect your rights and seeking the full amount in benefits you are owed.
Contact Our Workers’ Compensation Lawyers for a Free Consultation
At Hyland + Padilla, PLLC, we offer our legal services on a contingency fee basis. This means that we do not collect any upfront or out-of-pocket legal fees. Instead, our attorneys only get paid if/when they recover a settlement or verdict for you. Once we have successfully secured compensation on your behalf, our fees are paid via a percentage of your total recovery.
We are here to answer your questions and address any concerns you may have. Our Durham workers’ compensation lawyers have extensive experience navigating workers’ compensation claims and appeals, and we are ready to help you fight for the benefits you are owed.
Call us at (919) 891-8361 or contact us online to schedule a complimentary case evaluation.
Over $40,000,000 Recovered We have won over 40 million dollars for our clients since 2012 and counting.
Over 7000 Cases Handled We have represented thousands of personal injury clients since 1999.
“Llegué a Hyland y Padilla después de un accidente automovilístico. El Sr. Padilla trabajó muy duro en mi caso. Su principal preocupación es el bienestar de sus clientes. Fue cariñoso, profesional, honesto y p” - Toni B.
“Muy contenta y genial con los resultados. Gracias por ayudar a la comunidad hispana muy feliz con los resultados bendiciones. Andrea y Stefani hicieron un gran trabajo.” - Jazmin B.