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The benefits covered by workers’ compensation include payment for medical compensation to cover doctor visits, hospital visits, diagnostic testing, and even wage replacement. Two-thirds of the average weekly wages are paid to the injured worker if the doctor prohibits them from working or gives them work restrictions that their employer cannot accommodate. In this case, they are entitled to out of work benefits under Temporary Total Disability (TTD).

In order to receive workers’ compensation benefits, though, the person must report in writing to their employer or supervisor and seek medical treatment as directed by their employer within 30 days of their injury. To ensure that you are receiving the benefits you deserve, it is important to have an experienced Raleigh workers’ compensation lawyer by your side.

The Role of a Lawyer

The role of a workers’ compensation attorney depends on the nature of the claim. The circumstances of the claim include whether the claim should be denied, or if the insurance company should deny payment of any of the benefits that the worker is entitled to receive.

The attorney assists with filing a claim at the North Carolina Industrial Commission to return the insurance company’s decision, and to litigate the claim on behalf of the injured worker. If the claim is accepted, the attorney considers settlement options that may benefit the injured worker by turning over control of the claim to the individual worker so that they are not relying on the insurance company to provide the medical compensation or wage replacement. 

A person seeking workers’ compensation should work with a Raleigh workers’ compensation lawyer because the injured worker wants to be confident they are getting all the benefits to which they are entitled. There are certain number of hidden claims and workers’ compensation that an attorney can usually find for an injured worker. In addition, many times an injured worker is under a great deal of stress, especially if they are the breadwinner of the family. The injured worker can turn that stress over to the attorney and have the attorney deal with the insurance company on their behalf.

When a Person May be Barred from Compensation 

There are certain defenses that may prevent someone from being entitled to workers’ compensation benefits.

Intoxication

If the injured worker was intoxicated at the time of their accident, they may not be entitled to compensation.

Not Injured at Work

Another issue may be that the person was not actually at work, they were going to or from work. If the person works in the office or in the factory, they are not entitled to compensation if they are injured in an accident before they get to their place of work. There are certain exceptions that apply, especially if the injured worker travels for work. If they are not required to travel for work, however, that particular issue prevents them from receiving benefits.

Dishonesty About the Injury

When the person is not truthful about the injury or how it happened, that prevents them from being entitled to compensation.

Application to Future Needs

If the injured worker is able to settle their workers’ compensation claim, the workers’ compensation insurance company provides lifetime medical payments. In addition, if the doctors believe the injured worker needs further medical treatment, the insurance company provides for up to 500 weeks of wage replacement if the injured worker continues to be temporarily disabled from gainful employment.

Role of Unemployment Benefits

A person may or may not be able to obtain workers’ compensation benefits and unemployment benefits at the same time. The injured individual should check with a workers’ compensation lawyer to verify whether they are eligible to receive both simultaneously. In some cases, if an injured worker receives unemployment benefits, there may be a credit or an offset to the workers’ compensation insurance company.

Impact on Taxes

When injured, a worker receives two-thirds of their average weekly wage through TTD benefits. TTD benefits are not taxable. For detailed information about tax consequences and workers’ compensation claims and payments, it is recommended that you seek a tax professional’s advice.

What is an Average Weekly Wage?

The average weekly wage is determined by looking at the prior 52 weeks of gross earnings of the injured worker prior to the day they were hurt. If they injured worker is employed by an employer for less than one year, different calculations are used to determine the average weekly wage. The average weekly wage is important because the compensation rate, which is two-thirds the average weekly wage, is a very important number that is used in workers’ compensation plans. Average weekly wage is determined by taking the gross earnings, which are the total earnings pre-tax amount, to calculate the average weekly wage.