Evaluating a North Carolina Workers' Compensation Claim

The Workers' Compensation Act (N.C.G.S. Ch. 97) provides nearly exclusive relief for workers injured on the job. The law contains specific factual and procedural requirements to successfully make a claim; this article explains the factual requirements of a valid claim for workers' compensation in North Carolina. 

There are two kinds of claims, occupational injuries and occupational diseases. There are special requirements for each.

Occupational Injuries

For occupational injuries, the injury must arise out of work. For all parts of the body except spinal (back or neck) injuries or hernias, the injury must be the result of an accident. If the injury comes as a result of just doing your normal routine work activity, it is not covered, but just about anything out of the ordinary or unusual can meet the requirement for an "accident." This includes not only twisting, landing, or lifting in a awkward position, but also doing something you might never or rarely do in your job. However, if you "don't know why" your knee (or other body part) gave out, it is not going to be considered an "injury by accident" and will instead be considered as arising from an idiopathic (pre-existing) condition. 

Spine injuries and hernias do not require an accident, but there must be a "specific traumatic incident." This means you should be able to point to a specific activity or occassion when you did something and "felt something in your back (or neck)" after which it began hurting. Hard work over the course of several hours or even days resulting slowly progressing pain does not qualify for workers' compensation because there is no specific traumatic incident. 

Pre-existing conditions are not a problem for a North Carolina workers' compensation claim, because the employer is deemed to take the worker "as they find them." This means that aggravation of a pre-existing condition or injury as a result of an accident, or for backs or hernias, a specific traumatic incident, should be covered by comp. If you previously had an on-the-job injury that was covered by workers' compensation and you have a new accident (such as a slip, trip, fall, etc) or specific traumatic incident at work that re-aggravates the problem, it should be treated as a new workers' comp injury and claim. You should get higher weekly benefits by filing it as a new claim rather than re-opening the old claim. 

Occupational Diseases 

If you have a disability or medical condition that develops over time, such as carpal tunnel syndrome or lung /breathing problems, it may be covered under the North Carolina Workers' Compensation Act. There are two things that you must prove to establish most occupational diseases:

1. The disease or condition must have arisen from the job, or your job must have at least been a significant contributing factor in the development of the disease. Even if your job is just a contributing factor, you must establish that the conditions of work can lead to the condition or medical problem.

2. Your work must have exposed you to a greater risk of developing the disease or medical condition, than the risk experienced by the general public.

To establish that you meet the requirements for an occupational disease under the workers' comp act, you need a doctor to say these things! The standard of proof is only more likely than not (as opposed to say "beyond a reasonable doubt," the burden faced by prosecutors in trying to convince a jury of a criminal defendant's guilt.) 

This article explains the factual requirements for the two types of workers' compensation claims. Future articles will provide information regarding procedural claim requirements, benefits, protecting your claim, "other work," and some common defense actions designed to thwart or diminish claims and benefits. If you have missed work because of an on the job injury, call the workers' compensation attorneys at Edelstein & Payne and schedule a consultation as soon as possible to ensure that you fully understand your rights and obligations, and feel confident that you are getting the benefits you deserve. Or, fill out our workers' comp intake form and start the process right away! 

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