When a worker suffers a workplace accidentOne of the first questions that arises is: who pays for the medical expenses and the time I am unable to work?
In North Carolina, there is a system called workers' compensation designed to cover certain work-related injuries.
“The best way to look at it is as an insurance policy,” he explained to Enlace Latino NC Jessica Yañez, lawyer at the firm James Scott Farrin.
Employee compensation: mandatory insurance for many companies
Yañez explained that in North Carolina, every company with three or more employees must have a workers' compensation policy.
In the event of a workplace accident, it is not the employer The person who pays the benefits is not directly involved, but rather the insurance company.
The lawyer pointed out that some people hesitate to file a claim because they don't want to harm the business owner. However, she explained that the purpose of the law is to protect people when they are injured on the job.
What does workers' compensation cover and how does it work?
The law provides for three main types of benefits:
1- Medical treatment
Workers' compensation covers medical treatment related to the injury.
“Since they pay for it, they’re the ones who will tell the worker which doctor they can go to,” Yañez explained. In other words, the worker can’t choose their own doctor during the process, but they will have coverage to pay for their healthcare expenses.
2- Payment for lost income
If the doctor indicates that the person cannot work for more than seven days, they may receive payments for lost income.
These begin on the eighth day and are not automatic.
“It’s not automatic,” Yañez warned, recommending that the process begin as soon as possible to avoid delaying the benefits.
The payment is equivalent to two-thirds of the usual salary and no taxes are deducted.
3- Compensation for permanent disability
If the injury leaves a permanent consequence, the worker may receive additional compensation.
“They will assign compensation based on how one is left in the future,” the lawyer explained, noting that it depends on the type of injury, for example, whether it affects the arm or the back.
What types of accidents or illnesses qualify?
Not all injuries are covered.
“If it wasn’t because of something that happened at work, it’s not covered,” Yañez said.
In North Carolina, workers' compensation applies in three specific situations:
- An injury from an accident at work, even if the worker was at fault.
- A specific back injury, such as when lifting a box.
- A disease that develops over time due to working conditions, such as repetitive movements or exposure to chemicals.
If a person gets sick outside of work, for example with the flu, they do not qualify under this system.
What should the worker do after the accident?
The period following an accident can be confusing. That's why Yañez recommends acting quickly.
“The best thing to do is to report it on the same day the accident happens,” he said.
The report can be made by text message, directly to the supervisor, to human resources, or following the company's internal protocols. Although the law allows up to 30 days to report it, the lawyer insists on not letting time pass.
He also advises doing it in writing.
“If it’s in writing, they can’t deny it,” he explained, because otherwise it could become the worker’s word against the company’s.
Additionally, it recommends requesting a copy of the incident report.
He clarified that reporting the accident does not automatically mean the company will open a formal workers' compensation claim, so it is important to start that process.
You may be interested: Three reasons why you need a Spanish translator when dealing with an insurance company
Mistakes that can complicate the process
One of the most serious mistakes is hiding the fact that the injury occurred at work.
“Sometimes the company owner or the boss says, ‘Okay, I’ll take you to the doctor, but don’t say it happened while you were working,’” Yañez recounted. “That’s a huge mistake.”
If there is no evidence that the injury occurred at work, it may be impossible to continue with the case.
Another common mistake is not seeking medical treatment for months, which makes it difficult to prove that the injury is related to the workplace accident.
He also warned against accepting money directly from an employer without using the formal workers' compensation system. Even if the employer promises to pay, they can stop doing so, and the worker could end up facing large medical bills.
In that regard, Yañez emphasized that the system not only protects the worker, but also the employer, since the insurer assumes the costs when an unexpected accident occurs.
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