North Carolina and Virginia use a lot of confusing terms in worker’s compensation cases. An experienced work injury term understands these definitions. He knows how they affect your claims for lost income, payment of medical bills, and other aspects of your case. A few of the more common worker’s compensation terms are these:
- Accident. In both North Carolina and Virginia, work injury claims are brought based on two criteria. The first is that an employee suffers an accident at work. The second is that the worker suffers an injury. To prove an accident, there is no requirement to show the employer was negligent or failed to exercise proper care. There’s no need to assert or prove negligence or fault on the part of the employer. In North Carolina, except for back injuries, an “accident” is harder to prove than in Virginia. In North Carolina, there must generally be some kind of “slip, trip or fall,” that led to the injury. In Virginia, this is not necessary. For instance, in Virginia, if your job required that you pick up a 100 lbs item, and during that process, you felt a sudden “pop” in your shoulder which caused injury, then this would qualify as an “accident.” In North Carolina, that would not qualify as an “accident,” because there was no “slip, trip or fall.”
- AWW. Average Weekly Wage. This is the calculation of the amount the worker earned on weekly basis prior to the accident. This is the gross amount, prior to deductions for taxes or other items. For workers who worked for more than a year, it is generally the average of the worker’s earnings in the 52 weeks prior to the accident. Workers are generally entitled to 2/3rds of their AWW for the time they can’t work – up to preset maximums. If that calculation is not fair for whatever reason—for instance, if the employee received a significant promotion and wage increase during the prior 52 weeks, then adjustments can be made.
- Compromise and release. This is basically an overall settlement agreement so that workers can be paid in a lump sum instead of being paid on a weekly or monthly basis. It is usually used when the worker has reached his/her maximum medical improvement – the time when additional further treatment will not improve his/her condition. Experienced work injury lawyers work to get the right lump settlement based on many factors. Some of these factors including reasonable understandings of the patient’s future medical needs and expenses, his/her life expectancy, and other factors. In North Carolina this is often referred to as a “clincher.” In Virginia, it is simply referred to as a “full and final settlement.”
- Dependent. This term is used when a worker tragically dies due to a workplace accident or occupational illness. Generally, a surviving spouse and dependent children are presumed to be entitled to some worker’s compensation benefits on behalf of the deceased workers. Dependents include children under 18 and handicapped children 18 and over. Dependents can also include grandchildren and siblings. Even dependent parents and grandparents may be eligible if it can be shown they were financially dependent on the worker who died.
- FROI. First report of injury. This is essentially the notice/report that the worker gives the employer when he/she is injured. In addition to placing the employer on notice. Generally, the notice must be given to the employer within 30 days and should be preferably in writing. We have seen cases get denied when suddenly the folks you reported the accident to verbally are no longer around, or worse, deny that you reported the accident to them. This is also the terminology used to refer to the requirement that the employer report your injury to the Virginia Workers Compensation Commission or the North Carolina Industrial Commission, as the case may be. Note that the employer will often be heard to tell the employer “Don’t worry, we have filed your claim for you.” What the employer is usually referring to when they way that is the FROI. It has zero legal effect on your claim and you need to know that your employer cannot file your workers compensation claim for you. The report of injury is not a filing of your claim and does not provide you with any rights at all. The filing of your claim must be done by you or your attorney. In Virginia, that begins with a Claim for Benefits and in North Carolina, it begins with a Form 18. The filing of these forms makes clear to the insurance company and the Worker’s Compensation Commissions that you are demanding your wages, medical bills, and any other benefits.
- FCE. Functional capacity evaluation. This is an evaluation usually performed by a physical therapist or occupational therapist. It typically lasts for four or more hours and it is conducted to determine which of your job tasks you can and can’t do. The FCE professional will examine physical abilities such as how much you can lift or carry, how long you can stand without having to sit, your ability to reach, whether you can hold items with your hands, how well you can speak, and other functional abilities. After the examination, you will be rated on a continuum of physical ability, which goes from the lowest, meaning sedentary, to the highest, which his very heavy. These examinations are also often used to provide a permanency rating with regard to your injured body part (s). After the evaluation, a report will be drawn up and you will typically have a scheduled visit to review the results with your authorized treating physician, who will usually then sign off on the FCE, or make modifications.
- Future medical bills. It’s easy to calculate past due medical bills. Employees should understand that in worker’s compensation cases, the employer or the employer’s insurance company is required to pay all your future medical bills in relation to your work injury as well. Generally, workers seek medical help until they reach their state of maximum medical improvement. After that stage, many patients still need to continue seeing therapists and other health providers so their condition doesn’t worsen, or to decrease ongoing pain. Future medical bills also include the cost of medications, prosthetics, and medical equipment that you’ll need for the rest of your life. The insurance carrier should pay your medical bills as they become due. Additionally, your lawyer will work with your doctors to calculate the likely future medical bills if you want to enter into a lump sum settlement.
At the North Carolina and Virginia Law office of Joe Miller Esq., we answer your questions and guide you through each phase of your work injury case. We’ve been fighting for injured workers more than 30 years. To speak with a strong advocate, call 1-(888) 667-8295 or complete my contact form to schedule an appointment.