Source: http://www.tatumlawfirm.com/the-workers-compensation-system-in-north-carolina/
Timestamp: 2019-04-20 10:41:37+00:00

Document:
Worker’s Compensation Laws provide a legal framework for workers to be compensated for injuries sustained in the course of their employment. Procedures for submitting claims and decision making on compensability rest with the North Carolina Industrial Commission who administers the state worker’s compensation system.
The North Carolina Workers’ Compensation Act requires that all businesses that employ three or more employees carry workers’ compensation insurance for their employees.
Further, any employer who provides agriculture or domestic services, with 10 or more full-time, non-seasonal workers is not required to carry worker’s compensation coverage. N.C. Gen. Stat § 97-13 (b).
However, any company with one or more employees who work with radiation must provide worker’s compensation coverage. N.C. Gen. Stat § 97-13 (b).
Casual employees are defined in N.C. Gen. Stat § 97-2 as persons whose employment is “not in the course of the trade, business, profession, or occupation of his employer“ Put simply, employment is casual when it is not permanent or when work is not assigned periodically, even if the employment is brief or isolated. Further, “employment is casual when it is irregular, unpredictable, sporadic and brief in nature. Clark v. Mills, Inc., 12 N.C.App. 535, 183 S.E.2d 855 (1971).
An independent contractor is defined as “one who exercises an independent employment and contracts to do certain work according to his own judgment and method, without being subject to his employer except as to the result of his work.” Cooper v. Publishing Co., 258 N.C. 578, 129 S.E.2d 107 (1963).
N.C. Gen. Stat. § 97-19.1 requires that workers’ compensation coverage be in place to cover certain trucking owner/operators, even if the operator is deemed to be an independent contractor.
In order to receive worker’s compensation benefits an injury must be “compensable.” In North Carolina, a person must have either sustained an “injury by accident” or have an “occupational disease” to have their claim be deemed compensable. Unlike a personal injury claim, which focuses on whether an individual was injured because of a breach of the duty of care, worker’s compensation law resolves the question of liability through the concept of compensability. Compensability does not consider the employer’s conduct as determinative of compensability rather it focuses on whether an employee suffered an injury or occupations disease and whether that injury or occupational disease arose out of the course of employment.
Gallimore v. Marilyn’s Shoes, 292 N.C. 399, 402, 233 S.E.2d 529, 531 (1977).
Further, the compensability analysis requires an injury “disabled” the employee. Hendrix v. Linn-Corriher Corp., 317 N.C. 179, 185, 345 S.E.2d 374, 378. Disability means “incapacity because of injury to earn the wages which the employee was receiving at the time of injury in the same or any other employment.” N.C. Gen. Stat. § 97-2(9).
his or her incapacity to earn was caused by his or her injury.
The first element of compensability involves an “injury by accident” or an unusual or unexpected event that arise in the workplace. North Carolina Courts have construed this to mean an injury occurring unexpectedly from the operation of internal or subjective conditions, without the prior occurrence of any external event of an accidental character. Stokes v. First National Bank, 410 S.E.2d 248, 306 S.C. 46 (1991). Similarly, an injury that arises from normal work conditions will be treated as an injury by accident. “No matter how great the injury, if it occurred under normal working conditions and the employee was injured while performing his regular duties in the usual and customary manner, no accident has occurred.” Swindell v. Davis Boat Works, Inc., 337 S.E.2d 592, 78 N.C. App. 393 (Ct. App. 1985).
A compensable injury must arise from a condition that is the natural and probable consequence of the work being conducted. Gallimore v. Marilyn’s Shoes, 292 N.C. 399, 402, 233 S.E.2d 529, 531 (1977).
If the injury arises from a hazard that is common to the public and not specific to the employment, it does not arise out of the employment and thus not compensable. Roberts v. Burlington Industries, 86 N.C.App. 126, 356 S.E.2d 794 (1987).
Lastly, an injury by accident must be sustained in the “course of employment.” To determine the “sustained in the course of employment” element key issue is whether, at the time of the injury, was the employee was doing what the employer hired him to do. Generally, the employee must be engaged in conduct authorized by the employer and intended to benefit the employer’s business, directly or indirectly. Gallimore v. Marilyn’s Shoes, 233 S.E.2d 529, 292 N.C. 399 (1977). Roberts v. Burlington Industries, Inc., 356 S.E.2d 794, 86 N.C. App. 126, 321 N.C. 350 (Ct. App. 1987).
Under the Worker’s Compensation Act, certain occupational diseases are compensable.
Any disease, other than hearing loss covered in another subdivision of this section, which is proven to be due to causes and conditions, which are characteristic of and peculiar to a particular trade, occupation or employment, but excluding all ordinary diseases of life to which the public is equally exposed outside of the employment.
Under N.C. Gen. Stat. §97-2(18) for a hernia to be a compensable the injury must result in the sudden appearance of a hernia (or rupture) that develops immediately following an accident. The hernia must not have been there prior to the accident.
did not exist prior to the accident.
Pernell v. Piedmont Circuits, 104 N.C. App. 289, 292, 409 S.E.2d 618, 619 (1991).
The North Carolina Workers’ Compensation system pays benefits that can be classified into the following five areas of cash benefits and wage replacement benefits that apply to situations of varying severity of injury and subsequent level of disability.
An employee who, due to a compensable injury, remains unable to earn wages after the first seven days of disability, is entitled to weekly benefits equal to two-thirds of his average weekly wage up to the maximum compensation rate. If the disability exceeds 21 days, the employee is entitled to receive compensation for the first seven days of disability. Weekend days, holidays, and any workday in which the injured employee does not earn a full day’s wages because of the injury are counted as a day of disability, even though the employee may earn some wages. Temporary total disability benefits can continue for up to 500 weeks. N.C. Gen. Stat. §97-29 (b). Benefits terminate when the employee returns to work or when the employer provides credible evidence to the North Carolina Industrial Commission that the employee is no longer disabled.
An employee who at the end of the healing period, also known as maximum medical improvement, is left with complete loss or loss of use of any member or part of the body may receive permanent total disability benefits notwithstanding his ability to earn wages. The rate of compensation is determined from the use of medical evidence which provides an opinion as to the percentage disability rating (loss of function) for the affected body part with 100% representing a total loss of function and 0% representing full functioning. The percentage disability rating is then compared to one of the body parts listed in the schedule of injuries contained in N.C.G.S. 97-31. Under the schedule of injuries, each body part is assigned a specific number of weeks of benefits.
After an injury occurs, an employee must report the injury to his employer using North Carolina Industrial Commission Form 18 (Notice of Accident to Employer and Claim of Employee) within 30 days. N.C. Gen. Stat. §97-22.
Failure to file Form 18 with an employer or the North Carolina Industrial Commission effectively bars the right to claim worker’s compensation benefits.
When liability for payment of compensation is denied the employee may request a hearing before the Industrial Commission by submitting Form 33 (Request for Hearing) with the North Carolina Industrial Commission.
When an employee submits Form 33 the North Carolina Industrial Commission will automatically issues an Order for Mediated Settlement Conference to all parties. Cases involving expedited medical motions, administrative appeals and injured workers represented by counsel, cases involving non-insured employers are generally mediated only if all parties agree to mediate and the matter including the Deputy Commissioner.
At the conclusion of the mediation, the mediator will make recommendations to the parties If the parties are unable to reach an agreement, either party may request a formal hearing before the North Carolina Industrial Commission.
A formal hearing with the North Carolina Industrial Commission is much like a trial. All parties present witnesses and evidence, and a judge makes a final determination regarding the issues.

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