Accident – An accident in NC Workers’ Compensation is any event that is unexpected or untoward, that causes an injury. An “accident” can also be an interruption of your normal work routine. Most on the job injuries require that you suffered an “injury by accident” in order to be covered. We have devoted an article on this web site to “injury by accident” so read that page for more information.
Average Weekly Wage (“AWW”) – This is the most important number in your case, and the insurance company does not always get it right. AWW is the injured worker’s gross average weekly wages for the 52-week period immediately preceding the date of his or her injury. Some occupations, such as volunteer fireman and school employees, have special computation rules for their AWW. Employees who have been on the job for less than a full year can take the average gross pay for the number of weeks that they have worked. Overtime, bonuses, commissions, and all other earnings count. NCGS 97-2(5).
Clincher Agreement – A “clincher” is a full and final settlement of a workers’ compensation claim. The insurance company will pay a lump sum of money to the injured worker, and in return, the worker permanently gives up any rights to further workers’ compensation benefits and medical compensation. Clincher agreements are usually negotiated by one’s lawyer or arrived at during the mediation with the help of the mediator.
Compensation Rate (“CR”) – This amount is exactly 2/3 of the number that represents the “AWW” as defined above. The Compensation Rate is the amount an injured worker receives each week while he or she is totally disabled from work due to the injury. It is also the amount that is plugged into the math equation to determine the value of the worker’s “PPD” or Permanent Partial Disability rating, which is assigned by the treating doctor upon reaching MMI (maximum medical improvement).
Election of Benefits – When you reach MMI, you get to choose your permanent benefit from the benefits for which you qualify. You are allowed to choose the benefit that pays you the most money. The insurance adjusters usually will NOT tell you this, and they will offer you the benefit that pays you the least, because their job is to save the insurance company money. When you reach MMI, if you qualify for either TTD or TPD, then you can choose that benefit instead of the PPD rating money. Sometimes the TTD or TPD is a lot more money. But be careful-you really need legal advice to sort this out and not make a mistake. It can become quite complicated, depending on your situation.
Hearing – A hearing is a court proceeding. In workers’ compensation, disputes about your case often go to an evidentiary hearing before a Deputy Commissioner of the Industrial Commission. The Deputy Commissioner is a trial judge who just hears workers’ compensation cases, and he or she will take testimony under oath in a courtroom, and review the documentary evidence admitted by the parties, to determine the answer to the dispute. The Deputy’s ruling is called an “Opinion and Award.” This decision can be appealed to the “Full Commission” where the parties get a new decision based on the record of evidence created by the Deputy Commissioner hearing.
Industrial Commission – The North Carolina Industrial Commission is the state agency that has subject matter jurisdiction over the entire North Carolina Workers’ Compensation Act. Every dispute that occurs in the workers’ compensation arena is in this jurisdiction, and the Commission administers claims and adjudicates the disputes.
Maximum Medical Improvement (“MMI”) – An injured worker has reached MMI when he or she has reached the end of the medical “healing period.” Upon reaching MMI, the treating doctor will typically “rate and release” the worker. This means that the doctor will release you from treatment, and send you back to work, either with or without work restrictions, and assign a PPD rating to the injured body part. Upon reaching MMI, the insurance company will typically ramp up its interest in settling your case on a full and final basis.
Mediation – This is a Mediated Settlement Conference or “MSC” and is required whenever a party requests a hearing. The parties meet with a certified Mediator and the Mediator facilitates a settlement discussion, with the goal of resolving whatever the dispute is in the case. About 72% of mediations result in a settlement of the claim.
Occupational Disease – An occupational disease can be one of the conditions listed in the Workers’ Compensation Act at NCGS 97-53, such as various types of poisoning, synovitis, asbestosis, and hearing loss, or it can be a condition such as carpal tunnel syndrome that “is proven to be due to the 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 general public is equally exposed outside of the employment.” See, NCGS 97-53(13).
Permanent Partial Disability (“PPD”) – When you have healed from your injury and have returned to work, you may still have some residual partial disability. It can take the form of lower earnings due to restrictions or functional limitations attributable to the injury. If you have returned to work making your AWW or higher, you would not be entitled to a partial disability compensation check, but you might be entitled to a “scheduled benefit” payment under NCGS 97-31. This is known as your “rating.” This statute, GS 97-31, sets forth a “schedule of injuries” that determines how much your PPD rating is worth in dollars. For instance, a 10% rating to the shoulder is worth 24 weeks times your compensation rate. A 10% to the spine is worth 30 weeks times your compensation rate. NCGS 97-31
Specific Traumatic Incident – An “STI” is an event that occurs during your assigned work that causes an injury to your back or neck, or causes a hernia, and any such injury resulting from the STI is covered by workers’ compensation, even though the incident does not arise to the level of an “accident.” Injuries occurring to other body parts require an “injury by accident” to be covered or “compensable.” As an example, if you were lifting a heavy box and hurt your lower back, that would be covered as an STI. But if you lifted the same heavy box and hurt your arm or leg, those injuries would not be covered unless you could show that lifting the box constituted an “interruption of your normal job routine” and therefore an “accident.”
Temporary Partial Disability (TPD) – This occurs when your injury results in work restrictions from the treating doctor, and those restrictions cause you to earn less in wages than you earned prior to your injury. Specifically, you are entitled to TPD in an accepted case when your injury results in your earning less than the AWW established in your case. TPD benefits are paid by taking your AWW and subtracting your gross earnings each week post injury, and finding 2/3 of that amount. That 2/3 amount is your TPD compensation rate. The insurance company should pay you this amount every week in addition to the wages you are earning at your job. NCGS 97-30
Temporary Total Disability (“TTD”) – This occurs when a worker is completely unable to work due to the injury. Typically, the doctor will have “written you out of work” completely, and if your workers’ compensation claim has been “accepted” then you will receive a weekly TTD check in the amount of your “compensation rate.” Under NC law, TTD can continue for up to 500 weeks from the date of your first disability from work. NCGS 97-29
Workers’ Compensation Act – This is Chapter 97 of the North Carolina General Statutes (NCGS), a body of law originally enacted by our state legislature in 1929 and maintained since then with many revisions and amendments over the years. This Act sets forth the basic rules and laws of workers’ compensation in North Carolina. It is currently comprised of almost 200 separate statutes, or sections, and encompasses almost 600 pages in the current statute books. The General Assembly last made a major revision to it in 2011. The Industrial Commission has the primary jurisdiction and authority to interpret and administer the Workers’ Compensation Act. Our appellate courts, the NC Court of Appeals and the NC Supreme Court, have also rendered many decisions over the years that interpret the statutory provisions. The Act must be read in conjunction with the appellate decisions from those courts to be properly interpreted and applied to a particular issue or case.
Workers’ Compensation Lien – When your on-the-job injury was caused by a third party (a party other than your employer or co-employee), but workers’ compensation has either paid benefits or settled with you, the workers’ compensation employer and insurance company has a reimbursement claim against the proceeds you are able to get from the third-party wrongdoer. We are able to get these liens reduced or eliminated in some cases by going to Superior Court for a “(j) hearing” pursuant to NCGS 97-10.2(j).