Whenever a workplace injury happens, the injured victim is likely covered by their employer’s workers’ compensation insurance. Virtually every employer in North Carolina is required to have this insurance, and it is meant to pay for the medical treatment the victim requires and can help offset their inability to work with disability benefits. A Charlotte lawyer can help you secure the benefits you need for a serious injury for injuries requiring surgery.
The team at The Sumwalt Group Workers’ Compensation and Trial Lawyers offers compassionate and responsive legal counsel to injured workers who need help filing their workers’ compensation claims and resolving the various legal issues that commonly arise following workplace injuries. If you suffered an injury requiring surgery, it’s understandable to have concerns about your medical expenses and what workers’ compensation insurance can cover.
While the claim filing process often appears straightforward at first, many injured workers encounter unexpected complications with these claims. It’s possible for employers to interfere with the process, and insurance companies do not always process claims for compensation in good faith. With our team’s assistance, you can approach this difficult process with confidence and peace of mind.
We have helped many workers file their workers’ compensation claims, and when those clients have required extensive medical expense coverage for injuries requiring surgery, we have helped them resolve billing disputes and ensured maximum benefits for their injuries. In some cases, injured workers have additional avenues of legal recourse available to them, and if this applies to your situation, we can help you maximize your recovery.
It’s possible for work injuries to happen in any workplace, and they may result from traumatic injuries or they may develop gradually over time. The purpose of workers’ compensation insurance is to cover the injured worker’s medical expenses and provide disability benefits while they are unable to work. When injuries require surgery, ensuring complete medical expense coverage is crucial.
Some of the most common types of work injuries that require surgery include:
These are only a few possibilities for work injuries that will require surgery. If you or a family member has suffered any such injury at work, you need to know your rights and how to secure workers’ compensation benefits through your employer’s insurance. It is also vital to understand the value of having an experienced attorney centrally located in Charlotte helping with your case. A Charlotte lawyer for injuries and surgery can ensure you receive a fair determination of benefits.
In North Carolina, almost every employer is required to have workers’ compensation insurance, and almost all regular employees are covered. Some types of workers in specific industries are exempt from this. For example, employers are usually not required to cover independent contractors, and federal employees are covered by a different workers’ compensation system. Most other employees will have the right to file claims for workers’ compensation insurance if they sustain injuries on the job.
Workers’ compensation insurance in North Carolina functions on a no-fault basis, and it is considered a sole remedy for an injured worker to recoup compensation for their damages through their employer. This means that it is not necessary to prove fault for a workplace injury in most cases. It is even possible for a worker to have caused their own injury and still qualify for workers’ compensation benefits. However, there are some exceptions.
You can still claim workers’ compensation benefits if you caused your own injury as long as the injury happened while you were performing your job duties and happened because of an honest mistake or simple negligence. However, if you intentionally violated workplace safety rules or you were working while under the influence of drugs or alcohol and this use contributed to the injury, it could disqualify you from workers’ compensation benefits.
If you meet the eligibility criteria for a workers’ compensation claim, you must also notify your employer about your injury within 30 days of its occurrence unless your employer has actual knowledge of it; otherwise, your employer can deny the claim. It is advisable to report any workplace injury immediately to ensure you meet this reporting requirement, but most work injuries requiring surgery are medical emergencies, so employers typically learn of these incidents as soon as they happen.
In addition to meeting the 30-day reporting requirement, you will need to meet the limitations period for filing your claim. In North Carolina, you have two years from the date of your injury to file your workers’ compensation claim or, for a “wear and tear” type claim or an occupational disease, two years from the date on which both of these occur: (1) diagnosis of your medical condition as being related to work by a competent medical authority and (2) disability from the medical condition. An experienced lawyer centrally located in Charlotte can assist you with the claim filing process and resolve any disputes that arise regarding your eligibility to file a claim, particularly if your injury involves surgery.
Filing a claim for workers’ compensation benefits is similar to filing most other types of insurance claims. However, your employer plays an important role in this process, and most workers’ compensation insurance carriers in North Carolina will require you to complete specific steps before they will review your claim for benefits. Once you receive your claim forms from your employer, you will need to prepare for a medical evaluation.
You can see any available doctor in an emergency after a workplace injury, but you must have a workers’ compensation doctor conduct a functional capacity evaluation after your work injury to qualify for benefits. This doctor will review the severity of your injury and assign you a disability rating, which is a numerical indicator of the overall seriousness of your injury and your remaining functional capacity to work.
The higher your disability rating, the more serious the injury, and the more you can expect in workers’ compensation benefits. If any disputes arise pertaining to your disability rating or your employer’s handling of your claim, a lawyer centrally located in Charlotte can assist you with any claims, particularly for injuries requiring surgery. They will guide you through the claim filing process and ensure that all involved parties handle the situation in good faith.
A successful workers’ compensation claim in North Carolina typically yields compensation for all medical expenses related to the injury. This means that your employer’s insurance is supposed to cover all immediate and future medical care you need to recover as much as possible from your workplace injury. For work injuries requiring surgery, your employer’s insurance should cover the cost of all surgical fees resulting from the injury.
When an injured worker requires ongoing treatment, it often requires coordinating billing through their medical treatment centers to the employer’s insurance carrier. Workers’ compensation insurance is quite broad in what treatments it will cover, but it is possible for conflicts to arise, and some claimants will need to follow specific terms and conditions in order to get the exact care they need.
Surgery also typically requires preauthorization, follow-up care, ongoing rehabilitation, and other long-term treatments in order for workers to reach maximum medical improvement from their injuries. It is possible not only to have your immediate emergency treatment costs covered by your employer but also the cost of surgery, prescription medications, necessary medical devices, and all other healthcare expenses related to your injury.
In addition to covering your medical expenses, your employer’s workers’ compensation insurance policy can also provide disability benefits when you are unable to work during your recovery and even if you have work restrictions that your employer cannot accommodate. These benefits are meant to offset the financial impact of your inability to work following your injury. The amount you will receive each week will depend on how much you typically earn on average each week at work before your injury.
Disability benefits from workers’ compensation insurance are usually assigned in partial or total disability designations based on the severity of claimants’ injuries. When the victim is still able to work but they are unable to earn their usual income due to their injury, they are likely to receive partial disability benefits. They report their earnings to the insurance company each week, and each payment helps make up the difference in their earning power.
When an injured worker is unable to work at all due to their injury, they can receive total disability benefits. Each week, the injured worker should receive about two-thirds of their average weekly pay based on their prior year of work for their employer (or shorter period if you worked less than a year before the injury). These payments will continue for as long as it takes for the victim to recover enough to return to work. It is also possible for them to transition to partial disability benefits if they can resume light duty after some time.
While workers’ compensation insurance is meant to provide financial relief to injured employees, it also provides civil liability protection for covered employers. This means you cannot sue your employer for a work-related injury except under specific conditions. However, if a third party outside of your work caused your injury, you could not only file your workers’ compensation claim against your employer but also a third-party personal injury suit against the responsible third party to seek additional compensation.
If you qualify to file a personal injury claim against a third party responsible for your work injury, it is important to understand that fault is a major issue in this case. In North Carolina, a contributory fault rule applies to personal injury cases. This means that you must identify the party responsible for causing your injury and prove they are entirely at fault for causing it. If you bear even slight partial liability, it could be a complete defense to a personal injury claim. If your employer bears some responsibility for causing your injury, it could reduce your recovery against the third party.
Success with a third-party personal injury suit could yield compensation for damages that workers’ compensation insurance won’t cover. For example, you could seek compensation for the lost income that your disability benefits do not provide, as well as non-economic (“pain and suffering”) compensation. If you suffered a work injury requiring surgery, it will require an extensive recovery time. This translates to a potentially larger award for pain and suffering and other damages that are not available through our workers’ compensation system.
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A work injury requiring surgery has the potential to be a life-changing experience, and it is natural to have lots of pressing legal questions in the aftermath of such an incident. The team at The Sumwalt Group Workers’ Compensation and Trial Lawyers has years of experience helping injured clients navigate the complex workers’ compensation claim filing process and resolving the issues that arise with their claims. Our goal for every client is maximum recovery as swiftly as possible.
When you hire our team to represent you, we can immediately investigate the details of how your injury happened and help you prepare for the workers’ compensation and personal injury claims filing process. You can rely on us to resolve most disputes that arise with your employer or their insurance carrier, and if not, handle the court hearing or trial to try to resolve the dispute. If you have grounds for further legal recourse that may enhance your overall recovery, we can assist you with this as well.
It is important to connect with a lawyer centrally located in Charlotte for any injuries requiring surgery as quickly as possible after an injury to have the greatest chance of success with your recovery efforts. If you are ready to learn how our team can assist you, contact The Sumwalt Group Workers’ Compensation and Trial Lawyers today and schedule your free consultation with our team.