EPM has a substantial workers' compensation practice and focuses on significant cases involving physical injury or occupational disease, including mental stress. The firm is known for its extensive knowledge of North Carolina workers' compensation law and procedure, and receives many of its cases through referrals from other law firms. Whether the case involves recovering benefits for a denied claim, obtaining necessary medical treatment, or negotiating a fair and equitable settlement of a claim, the lawyers are able to assist injured workers at all stages of their workers' compensation claims, including the hearing and appellate levels, if necessary. The various kinds of workers' compensation claims the firm handles include the following:

• Workplace Accidents
• Repetitive Motion Injuries
• Toxic Exposure to Chemicals

The North Carolina Workers' Compensation Act requires that employers pay benefits and reasonable medical expenses for on the job injuries or occupational diseases suffered by employees. If you have been injured or have contracted an occupational disease during the course of your employment, you may have a claim for workers' compensation benefits under the Act.

A workers'compensation action differs from a personal injury action, in that the injured person does not have to prove that the employer's negligence caused the injury in order to recover benefits. An injured worker does have to show that the injury arose out of and in the course of his employment. Types of injuries which are covered by the Act include injuries by accident such as back injuries and broken bones, crushed limbs, and head injuries, and occupational diseases such as exposure to chemicals, repetitive motion injuries and other diseases unique to a particular occupation.

Claims for workers' compensation benefits are filed with the North Carolina Industrial Commission (the "Commission") in Raleigh, North Carolina. The Commission is the state agency which oversees workers' compensation cases, including but not limited to, (a) holding trials in disputed claims, (b) approving settlements between the employer and employee, (c) answering questions from the public, (d) maintaining claim files and records of insurance coverage, and (e) enforcing the Workers' Compensation Act at the administrative level. The general contact information for the Commission is as follows:

North Carolina Industrial Commission 
4319 Mail Service Center 
Raleigh, NC 27699-4319 
(919) 807-2501 or (800) 688-8349 
Web Site: http://www.comp.state.nc.us/

The Commission can provide you with free claim forms, as well as its information pamphlet, The Bulletin. The Commission's Statistics Department can provide you with the name, address, and telephone number of your employer's insurance carrier or administrator. Claim forms, The Bulletin, and employer insurance information are also available through the Web site.

• Benefits recoverable by an injured worker may include the following:
• Weekly disability benefits for as long as the worker cannot earn wages due to the injury
• Payment of reasonable and necessary medical treatment
• Reimbursement for prescriptions and sick travel
• Compensation for permanent impairment to a body part
• Compensation for reduced earning capacity due to the injury

Unfortunately, the Act does not require employers or their insurance companies to pay injured workers for their mental anguish, or pain and suffering. However, if the injured worker has a personal injury claim against a third party (not the employer), arising out of the work injury, compensation for pain and suffering from the negligent third party may be recovered.

"Knowledge is Power"
Insurance companies and administrators for self-insured employers are knowledgeable about workers' compensation and often will use that knowledge to attempt to minimize their payment of workers' compensation benefits to injured workers. We recommend that injured employees consult with an attorney experienced in workers' compensation before negotiating with an insurance company or a self-insured employer.

WHAT SHOULD I DO IN THE EVENT OF AN INJURY AT WORK?

Should I Report the Injury?

Yes! The Workers Compensation Act requires that you report an injury within 30 days. If you sustain an injury during the course of your employment or experience physical symptoms which you feel may be related to your employment, you should immediately report the injury or symptoms to your supervisor. Your supervisor, or the individual in charge of handling injuries at your company, should immediately complete the employer's report of the accident, Form 19. Your employer is required to give you a copy of the completed Form 19, and required to file it with the Commission for injuries involving more than $2,000.00 in medical expenses or when more than one (1) day is missed from work. Your company may require the completion of additional internal forms.

You should also promptly file a written notice of your claim with the Commission, preferably on a Form 18. The employer's Form 19 is not an employee claim form, and clearly says so at the top of the form. You must file a written claim with the Industrial Commission within two (2) years from the date of your injury, or two (2) years from the date a doctor tells you that you have an occupational disease. You should not postpone filing your claim. You should file it immediately after becoming aware of your accident or occupational disease. Even if you believe your injury is minor, promptly and timely filing a written notice of your claim with the Commission will preserve your claim in the event that later your symptoms require medical treatment or you become disabled from work due to your injury. Failure to file your claim within two years will likely bar you from ever recovering under the Act.

Should I Request Medical Treatment?

Yes! If you are injured due to an accident at work or believe you are experiencing symptoms of an occupational disease, you should seek medical treatment from an appropriate doctor or hospital. If you have not already done so, you should notify your employer that you have been hurt and are seeking medical attention. If your employer or its insurance carrier have accepted liability for your injury, or agreed to pay benefits under the Act, they may choose the doctor you see. Refusal to comply with their recommendations for medical treatment could result in a termination of benefits or refusal to pay for additional medical treatment. If you disagree with your employer or its insurance carrier regarding the selection of a doctor or hospital or medical procedure, you may request approval from the Commission of medical treatment with the physician or hospital of your choice.

Should I Talk About the Injury?

You should limit your conversations concerning the facts of your injury or occupational disease to those individuals who are required to obtain such information, such as your supervisors, your company's human resources department, and your treating physicians. Additionally, you should file a written claim with the Industrial Commission.

In most cases, shortly after the accident or notification of an occupational disease, the injured worker will be contacted by a representative of the employer's workers' compensation carrier. The representative will ask to interview you, usually via telephone, and often will want to tape the conversation. Pursuant to Commission Rules, you are entitled to receive a copy of the transcript of your statement within thirty (30) days of your written request. The employer or its insurance company often use information obtained in recorded statements as a basis to deny claims. If you provide information to the insurance carrier, it should always be accurate and honest. Any statement or information provided by you concerning the facts of the accident or the injuries may be used in Court. Prior to providing any information, you may wish to consult with an attorney.

WHAT IF MY CLAIM IS DENIED?

In the event your employer or its insurance carrier deny your claim and refuse to pay benefits, it is required to file Form 61, Denial of Workers' Compensation Claim, within fourteen (14) days of its notification of your claim. The Form requires a detailed statement of the reasons your claim is denied. If you disagree with the denial, you may request a hearing by completing a Form 33, Request for Hearing. It can take several months for a claim to be scheduled to be heard by a Deputy Commissioner. Prior to the hearing, the Commission generally orders the parties to participate in a mediation conference. If the case does not settle at mediation, and the hearing is held, the Deputy Commissioner generally leaves the record open after the hearing for a period of 60 days to allow the parties to take doctors' depositions. After the record is closed, it will usually take the Deputy Commissioner several months to render a final decision called an Opinion and Award. If any party disagrees with the decision, an appeal to the Full Commission may be filed. If any party disagrees with the decision of the Full Commission, an appeal to the North Carolina Court of Appeals may be filed. Hotly disputed workers' compensation cases can often take years to be resolved through the court system. If your claim is denied, you may wish to consult with an attorney.

WHAT BENEFITS ARE AVAILABLE?

If your claim is voluntarily paid or the Commission issues an order that the employer is liable for your injury or occupational disease, you may be entitled to one or more of the following benefits:

Temporary Total Disability (TTD): This is a weekly disability payment which is usually 2/3 of your average weekly wages at the time of your injury or occupational disease. You are eligible to receive TTD during the period your treating physician indicates you cannot earn wages due to your injury. 
See N.C. Gen. Stat. § 97-29.

Temporary Partial Disability (TPD): This is a weekly disability payment which is usually 2/3 of the difference between your average weekly wages at the time of your injury or occupational disease, and your average weekly wages based on your reduced earning capacity due to your injury or occupational disease. You are only eligible to receive TPD during the 300-week period following the date of the injury or occupational disease. 
See N.C. Gen. Stat. § 97-30.

Permanent Total Disability (PTD): This is a weekly disability payment which is usually 2/3 of your average weekly wages at the time of your injury or occupational disease. If you are permanently disabled from working, based on the severity of your injury or occupational disease, you may be eligible for payment of PTD for the remainder of your life. 
See N.C. Gen. Stat. § 97-29.

Permanent Partial Disability (PPD): This is a weekly disability payment based on the percentage of permanent impairment to body members (or parts), including but not limited to: back, arm, leg, hand, foot, finger, toe, and organs. A physician determines the percentage of permanent impairment, or "rating", to the body part, and your payment is determined by multiplying the percentage of impairment by the number of weeks allowed for that body part under the Act by your weekly compensation rate. The schedule of body parts is set forth in N.C. Gen. Stat. § 97-31.

Medical Expenses: The employer or its insurance carrier must pay all of your reasonable and necessary medical expenses arising out of your injury or occupational disease. There is no co-pay. Keep your medical appointments, including physical therapy and diagnostic tests, as scheduled. If you cannot keep an appointment for a good reason, call the doctor's office in advance and reschedule your appointment. However, you should make every effort to attend medical appointments as scheduled, or the insurance company may accuse you of failure to cooperate in your medical rehabilitation. Do not make appointments with doctors not authorized by the insurance company, unless you have approval from the Commission. If you do see a doctor without prior approval from the insurance company or the Commission, you risk being responsible for payment of the medical expenses you incur for this treatment.

Sick Travel and Prescriptions: The employer or its insurance company reimburses you for mileage to and from doctors and hospitals, provided the trip is more than ten (10) miles one way or twenty (20) miles round-trip. They also reimburse you for your prescriptions prescribed by approved treating physicians. Use Forms 25P and 25T to claim reimbursement for these expenses. In cases of hardship, the employer or insurance carrier will sometimes authorize direct billing of prescription medication by an approved pharmacy.

In some cases, injured workers are entitled to more than one of the above weekly benefits, but the choice or "election" of one type of benefit may prohibit the election of a more valuable benefit. Before choosing between benefits or signing a settlement agreement, you should consult an attorney.

WILL I BE UNDER SURVEILLANCE?

It is common for insurance companies to hire private investigators to observe injured workers periodically, especially in cases of serious injury. Please be aware that you may be under surveillance at any time. Normally, if you are not doing anything you are not supposed to be doing, the surveillance is only for a short period. The insurance company uses private investigators to seek evidence that you are not as hurt as you have indicated to your doctors, or that you are receiving temporary total disability benefits at the same time you are earning wages.

You should always be accurate and honest in what you tell your medical providers and the insurance agents. Tell your doctor you cannot perform certain activities, such as yard work, sports, shopping, housework, lifting children, only if you actually cannot perform these activities. If your doctor has written you out of work, then do not work "on the side" or "under the table." If the insurance company obtains evidence that you are not as hurt as you have indicated to your doctors, or that you are receiving weekly benefits at the same time you are earning wages, this could have an adverse impact on workers' compensation benefits to which you are entitled, including immediate termination of benefits you are receiving. The insurance company may accuse you of insurance fraud. Proof of insurance fraud can result in criminal prosecution.

WILL I HAVE TO WORK WITH A REHABILITATION SPECIALIST?

The insurance company may hire a medical consultant to manage your medical care or a vocational consultant to help you return to work. Please be aware that one of these consultants' goals is to help you but they have been hired by the employer or insurance company. They write regular reports about their contacts with you. Please do not discuss anything with them which you do not wish to appear in a report to the insurance company.

SHOULD I GET AN ATTORNEY?

Whenever an attorney is asked whether a seriously injured worker should have legal representation it is almost certain that the attorney will answer "yes". Although this answer may seem to be self-serving, it is appropriate advice. It recognizes the complexity of the legal system and that it takes a trained professional to protect your best interests.

An injured worker's rights are determined by the Workers' Compensation Act. The Act was first passed in 1929. It has since been amended many times and is constantly being interpreted by court and Industrial Commission decisions. The Commission has its own Rules regarding procedures, working with rehabilitation specialists, discovery and time limits. The law also addresses the admissibility of evidence, legal procedures necessary to assert your claim, and the time period during which you must institute the procedure or be forever barred from asserting your claim. As such, the law can present a complex web that may trap the unwary.

Insurance companies recognize the soundness of the advice of retaining counsel and they employ many attorneys. Many companies have "in house" attorneys who work solely for the company. Depending on the circumstances of your accident, the employer or insurance carrier may have discussed the matter with their attorney within a few hours after the incident. Obviously, employers and insurance companies think it is important to have an attorney protecting them.

What Should I Look for in Selecting a Lawyer to Represent Me?

Before hiring a lawyer, a prospective client should research the firm he or she is considering hiring. Ask for information about the lawyer's education, training and experience. Find out if the lawyer has been Board Certified as a specialist in workers' compensation in North Carolina. Ask the lawyer to tell you about his or her experience dealing with cases similar to yours. Ask the lawyer to go over the fee contract with you in detail, and be sure you understand how you will pay the lawyer's fee and costs at the end of the case. Ask about the possible adverse consequences if your case is lost. Ask if your lawyer intends to handle your case alone, and if you are told that other lawyers outside the law firm will be asked to assist, find out what the fee arrangements will be.

The law office of Elliot, Pishko Morgan is available to serve your needs with regard to workers' compensation claims. If you have been injured or have sustained an occupational disease during the course of your employment, we can advise you regarding the laws that affect your case, represent you in the pursuit of your claim(s), and obtain the workers' compensation benefits to which you are entitled.

At Elliot Pishko Morgan, your initial consultation is free. You will speak with an attorney, rather than a paralegal or an investigator, about your case. Following the conference, the attorney will provide you an evaluation of your case. Both you and the firm will then decide whether to enter into an attorney-client relationship. If an agreement is reached with Elliot Pishko Morgan to represent you, you will not be required to pay any money for the time the attorneys work on your case unless and until you have been compensated for your injury. If we do recover benefits for you, the Commission must approve our attorney fee to insure it is fair.

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