North Carolina Workers’ Compensation - The “injury by accident” requirement
If you are injured while on the job in North Carolina, you may be eligible for workers’ compensation benefits. These benefits are paid by your employer’s workers’ compensation insurance carrier and can include medical care, weekly disability benefits, reimbursement for mileage or other expenses, and, in some cases, help with retraining or finding another job.
There are many complexities, nuances, and tradeoffs inherent in the workers’ compensation system. One example is that while these benefits are available regardless of who was at fault for the accident, injured workers cannot sue their direct employer in negligence, even if the accident was the result of the employer or a co-worker’s negligent acts. This is one example of why, if you suffer an injury on the job, you should report the incident to your employer as soon as possible and consult with an experienced workers’ compensation attorney.
This blog entry deals with a peculiar and critically important aspect of North Carolina workers’ compensation law. Specifically, the “injury by accident” requirement. While this requirement might seem like an obvious precursor to making a claim - “How else would I get hurt if there wasn’t an accident?” - the law contains a “booby trap” which can doom your claim before it even begins. Many injured workers have had their claims denied and received no benefits whatsoever simply because they were not aware of this rule and said the wrong thing to a person investigating a potential claim. This is why it is imperative to contact an attorney as soon as possible if you suffer an injury of any significance at work, certainly before giving any kind of statement, written or oral, to your employer or an insurance adjuster.
How does this law work?
North Carolina General Statute § 97-2(6) provides as follows:
(6) Injury. — “Injury and personal injury” shall mean only injury by accident arising out of and in the course of the employment, and shall not include a disease in any form, except where it results naturally and unavoidably from the accident. With respect to back injuries, however, where injury to the back arises out of and in the course of the employment and is the direct result of a specific traumatic incident of the work assigned, “injury by accident” shall be construed to include any disabling physical injury to the back arising out of and causally related to such incident.
N.C. Gen. Stat. § 97-2
As we said above, it may seem obvious: “I must have suffered an accident, how else would I have been injured and need medical care?” But for your injury to be compensable in North Carolina, the law requires that, unless the injury is to your back (or spine), the condition must be the result of an “unusual” or unforeseeable occurrence outside the scope of your normal job duties. Thus, for example, if you are performing your normal job duties - turning a wrench, stepping down from a truck cab, moving a load in a warehouse, crouching down to adjust a sprinkler head - and you injure your shoulder, arm, or knee, if you tell your supervisor or an insurance adjuster that you were “just doing your normal job duties” when your injury occurred, your claim will be denied. There are counterarguments to this requirement: The fact that you were perhaps dealing with an unusually heavy load, or if a bolt was particularly difficult to dislodge, but, once your claim is denied based on an initial statement that “nothing unusual took place,” it is often difficult to get that decision reversed. And even if you win on appeal, it may be months or even years before you receive any weekly benefits or medical care.
Again, this is why if you are injured on the job, 1) you should immediately report the incident to a supervisor and tell as many potential witnesses (usually co-workers) as possible, 2) seek medical treatment straight away, 3) do not give a written or oral statement of what happened to an insurance adjuster, and 4) if you must provide an incident report to your employer, be sure to emphasize the unusual nature of what brought about your injury. And finally: Call an experienced workers’ compensation attorney.