Answers To Your Frequently Asked Questions
If you’re looking at our website, it’s because you have questions and concerns. The Sumwalt Group Workers' Comp and Trial Lawyers has spent over two decades working with people throughout North Carolina and South Carolina. We have taught Continuing Legal Education courses on workers’ compensation and other laws and have courtroom experience to let you know how the system really works. Below is a list of frequently asked questions for your reference. If these do not fit what you are wondering about, we welcome your call with any questions. There are no fees or charges for this, and if you remember one thing, THERE ARE NO BAD QUESTIONS. Your questions are about your case. And they’re important. You can reach us in our Charlotte office at 704-859-8584 or by filling out our contact form.
Do I need a lawyer?
Most of the time, no. Most of the calls we get are about cases where the caller does not need a lawyer. And we tell them that up front.
About a century ago, our country’s first workers’ compensation systems were designed to lessen the legal complexities and to provide quicker compensation for workers injured on their jobs. The laws later expanded to cover occupational diseases from workplace exposures and repetitive stress. As the law grew, its complexity did, too. Making these complexities make sense is where lawyers can help.
Experience and qualified lawyers can help you figure out if there is a cost-benefit to you prosecuting a workers’ compensation claim. Experience and qualified lawyers can help you understand what benefits might be available to you, as well as options outside of the workers’ compensation system. Best of all, our initial conversations are free. We will shoot straight with you and lead you in the right direction. That’s our promise.
Does my employer have workers’ compensation?
In the State of North Carolina, all businesses with three or more employees must have workers’ compensation coverage for their employees. In South Carolina, businesses with four or more employees must have workers’ compensation coverage. If they don’t, they are breaking the law and can face serious fines.
If your direct employer does not have workers’ compensation insurance, there’s a chance to find insurance coverage through related business entities, such as general contractors or joint employers. Not every case involves these relationships, and an experienced and qualified attorney will help you figure out if your claim involves them.
What should I do after an injury?
First, seek medical care. Injuries are urgent, and workers who call lawyers first instead of seeking medical care send red flags up to the insurance companies on the other side of your case. This is one reason why experienced and qualified attorneys are going to need a full medical workup on your injury or occupational exposure before letting you know their evaluation of your chances in the workers’ compensation system or what benefits you might qualify for.
Next, and as soon as possible, report your injury to your employer—in writing. While you have 30 days to do this under our law with some exceptions, which usually throw a case into litigation before you can get coverage. Putting it in writing puts when your employer found out beyond all doubt. (And keep a copy of the notice you give!)
There is a different rule for occupational diseases and workplace exposure claims on when the notice period starts to run. Generally, it starts to run when you are diagnosed with a disease or medical condition that (1) disables you and (2) a doctor or other competent medical authority has told you is more likely than not related to your work. “Possible” links to work are not enough.
Third, talk to an experience and qualified lawyer. Insurance companies have a duty to investigate workers’ compensation claims in good faith, and these investigations sometimes involve recorded statements, where an adjuster gets to ask you questions about your injury. One question they always ask is, “Were you doing your normal job in the normal and customary way when the injury happened?” This is a trick question, which gives insurance companies a reason to deny your claim, because 99.9% of workers are doing their normal work when an injury happens. There are other factors that are significant, and an experienced and qualified lawyer can figure out if they are involved in your case.
Can I go to the doctor of my choosing?
In denied cases, yes.
In accepted cases, maybe. It depends if the other side has accepted the specific medical condition you need to go to a doctor for. If your employer and its insurance company have not formally accepted a body part that’s causing you trouble (even if they’ve accepted injuries to other parts of your body in the workers’ compensation claim), you are free to see any doctor you want under your own insurance or self-pay. There are some conditions that attach when the other side has accepted your injured body part and is authorizing treatment for it. If you feel that you won’t be properly taken care of, you can ask the Industrial Commission to change physicians. We can help look into the pros and cons of doing this in your case.
How much compensation am I entitled to?
Every case is different, and our attorneys are committed to finding the best possible result. Other helpful information to know is that payments are typically made weekly. However, some organizations may offer it monthly. The amount you are given will be specific to your injury, the length of time you need to recover and the cost of your medical expenses.
In many cases, the overall benefits you are entitled to do not depend on the workers’ compensation system alone. Rather, they look at the combined receipt of benefits not only under workers’ compensation, but also short-term disability, long-term disability, union benefits under collective bargaining agreements, private disability policies, accident and injury policies, State disability programs (like the Local Government Employees Retirement System or similar programs), and Social Security disability.
Medical coverage that sometimes overlaps with workers’ compensation coverage includes Medicare, Medicaid, VA benefits, ChampVA, Tricare, ERISA plan coverage, and coverage under the Affordable Care Act (“Obamacare”). Coordinating your workers’ compensation coverage with these alternative coverages is critical, because these other plans might—or might not—be entitled to reimbursement for their payments from any recovery you might get through workers’ compensation.
Can I get Social Security disability while I’m on workers’ compensation?
Yes, as long as you meet the medical and non-medical criteria for federal disability benefits under the Social Security Act.
Our first goal is to help all our clients get back to work. Unfortunately, this is not always possible for medical and other reasons. When this happens, our goal becomes to put everyone in a situation where they are as safe and secure as they can be financially once their workers’ compensation issues resolve and they move forward into the next phase of their lives. Social Security disability helps to provide this safety and security.
We have handled countless Social Security disability claims for our clients over the past 45+ years and are knowledgeable about the unique issues these disability claims play in concurrent workers’ compensation claims. If Social Security disability is an option for you while you are also on workers’ compensation, you will need help in coordinating the two types of benefits to avoid any overpayments of federal benefits, to understand how the federal benefits are taxed (even if you don’t receive them), return-to-work options, and other issues that come up when you get disability payments under more than just the workers’ compensation system.
Can I apply for short-term disability or long-term disability if I am on workers’ compensation?
Usually “no” for short-term disability and “yes” for long-term disability.
Most short-term disability plans have an exclusion for disabilities caused by work-related medical conditions. This exclusion normally prevents workers from receiving both workers’ compensation payments and short-term disability payments at the same time.
The same is not true for most long-term disability plans. For long-term disability, the plans usually provide for a reduction of long-term disability benefits by the net amount of workers’ compensation received. Under the requirements of the long-term disability plans, the worker must also apply for Social Security disability, which further complicates the coordination of benefits between the different programs, including workers’ compensation.
Experienced and qualified attorneys can explain how these different benefits work to your advantage or disadvantage. They can also help to coordinate these different benefit plans to reduce the likelihood of an overpayment and reimbursement obligation.
Can I sue my employer?
Not in negligence or any other fault-based theory. Like the law of every other State, the North Carolina Workers’ Compensation Act makes workers’ compensation the “exclusive remedy” against your employer. In the political bargain that endorsed workers’ compensation laws, the trade-off was that business and industry would benefit from limited exposure (the restriction of remedies to “economic” losses only, with no damages for “pain and suffering” or for punitive reasons), while employees would benefit from a no-fault system without long and drawn out litigation. These are sometimes ideals that do not always live up to what they promise on paper.
When someone other than your employer is at fault for your injury, you might have the chance to prosecute a “third-party claim” on top of your workers’ compensation claim. Third-party claims are fault-based lawsuits, just like any other personal injury or wrongful death lawsuit you would have for negligence or common law. If this chance is available, it is possible that you are better off prosecuting both claims, because the remedies available under them are different from each other.
What if I’m receiving workers’ compensation under another State’s laws?
The North Carolina Workers’ Compensation Act lets you receive benefits under whichever State’s law pays you more. This is known as “concurrent jurisdiction,” or when your workers’ compensation claim could be filed in more than one State.
Although our lawyers are licensed in North Carolina and South Carolina only, the Sumwalt Group is networked and co-counsels with experienced and qualified attorneys in other States, to make sure that the prosecution of workers’ compensation claims in one State or another provides the best benefits available to our clients. This requires a careful comparison of benefits available in North Carolina compared to benefits available in the other State.