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Practice Areas

Workers’ Compensation
in North Carolina

Workers’ Compensation
in South Carolina

What is Workers’ Compensation in North Carolina?

Workers’ compensation is a no-fault limited recovery insurance system that is governed by the North Carolina Industrial Commission. The “no-fault” component of the system means that an injured worker is entitled to benefits even if the injury is the result of their own negligence. In exchange for the no-fault component, an injured worker is not entitled to any additional compensation beyond what is provided under workers’ compensation if the employer’s negligence caused the injury. In addition, an employee may not sue the employer for negligence by way of a civil lawsuit. The inability to sue the employer civilly means that an injured worker’s recovery is limited to only what is provided under workers’ compensation law. Importantly, this means that an injured worker is unable to receive compensation for pain and suffering as it is not a benefit provided in workers’ compensation.

What Injuries Are Covered?

1. General Injuries

Generally, all injuries or deaths that occur as the result of an “accident” while working for your employer are covered under workers’ compensation. For an event causing an injury to be considered an accident, there must be something unusual or unexpected that happens while performing your job that causes your injury.

2. Back Injuries

Back injuries are treated differently in North Carolina. In the case of a back injury, the injury must be the result of a “specific traumatic event,” which means that nothing unusual or expected must occur while performing your normal job to cause your back injury. However, you must be able to point to a specific point in time when you were working that your back injury occurred.

3. Occupational Diseases
Occupational diseases are caused by conditions specific to a particular type of work or employment. Examples include asbestosis, hearing loss, bursitis, and repetitive stress injuries. However, the disease must not be an ordinary disease of life to which the general public is equally exposed.

What Benefits Are Paid?

1. Medical Compensation

Workers’ compensation will pay your medical bills related to the treatment you receive for your injury. This includes prescriptions and reimbursement for mileage if the round trip is 20 miles or more. However, the insurance company or your employer have the right to choose what medical provider or doctor you see for your injury.

2. Disability Compensation
There are four different types of disability compensation that you may be entitled to receive depending on the circumstances of your case. One type is temporary total disability compensation which is designed to provide weekly payments while you are unable to work due to your injury. A second type is temporary partial disability compensation which pays you a weekly benefit when you return to work with work restrictions at a job that pays you less than you earned before your injury. The third type is permanent partial disability compensation which pays you based on a permanent partial impairment assigned by your doctor once it is determined that you are at maximum medical improvement. A final type is permanent total disability compensation which entitles an injured worker to lifetime benefits when the accident results in amputations or loss of multiple body parts, a spinal cord injury that causes paralysis, a serious brain injury, or severe burns.
3. Death Benefits
When a work-related accident causes death, the decedent’s spouse, dependent(s) or next of kin will be entitled to weekly disability up to 500 weeks and payment of funeral expenses up to $10,000.00.

How is my weekly disability benefit amount calculated?

1. Benefit Amount Calculation
Generally, in North Carolina your weekly rate of disability pay (called your compensation rate) is based on two-thirds of the pre-taxed average weekly wage with the employer of injury for the year before your accident. However, there are other methods for calculating your compensation rate that may apply depending on if you worked for only a short period of time with the employer before your injury or some other unique situation.

Common Reasons Injuries Are Denied

1. Insufficient proof that your injury was caused by a particular event at work

Under the workers’ compensation law, an injured worker has the burden to prove that his/her injury resulted from something that happened while he/she was working. If your workplace accident was not witnessed, or not reported immediately to your employer after it occurred, or there is some suggestion that you may have been hurt doing something outside of work, the workers’ compensation carrier may decide to deny your case. Often an insurance adjuster will look for any reason to deny your case. If your employer is unwilling to vouch for the fact that you got hurt at work, this could also give the adjuster a reason to deny your case. This is why it is so important to (1) immediately report your work-related accident to your employer (and follow up with an email, text, or written note); (2) go to the doctor that the employer tells you to go to; and (3) tell the first doctor or medical provider that evaluates you exactly how your accident occurred at work.

2. Insufficient medical evidence that the event at work aggravated a pre-existing medical condition
This is one of the most popular reasons for an insurance adjuster to deny your case. Remember: just because you suffered a prior injury or had issues with an injured body part before your work-related accident that does not mean that you cannot receive workers’ compensation benefits following an injury at work. A skilled attorney with experience reading and interpreting medical records and deposing doctors can help overcome a denial based on a pre-existing condition. The law provides for workers’ compensation benefits when your work-related injury materially aggravates a pre-existing condition.
3. The way you were injured does not qualify as an “accident” to be covered by workers’ compensation
In North Carolina, injuries to body parts other than your back must be caused by an “accident” that occurred at work. The term “accident” is term of art in the context of workers’ compensation law. In workers’ compensation, an accident is something that occurs in a way that is out of the ordinary of how you typically perform your job. For example, if your job requires you use a hammer to drive nails into pieces of wood and on one occasion your elbow pops while driving a nail into a piece of wood causing an injury to your arm, this would not be considered an “accident” under workers’ compensation. However, if you are driving a nail and the nail breaks unexpectedly and causes your hammer to miss the mark and you injure your arm, this would be an “accident.” As you might imagine, the smallest detail (or missing detail) can make something an accident or not. This is one reason I recommend that you speak with an attorney before you give a recorded statement to an adjuster. An attorney can make sure that every detail of what caused your injury is highlighted to avoid the adjuster jumping to the conclusion that your injury occurred while you were performing your job like you always did in the past.
4. The time, place or circumstance surrounding when, where, or how the event that caused your injury occurred is not covered by workers’ compensation
For a work-related injury to be covered under workers’ compensation it must occur in “the course and scope” of your employment. Sometimes accidents occur while the injured worker is not on the employer’s premises or not yet “on the clock.” For instance, accidents that occur while you are going to and coming from work are generally not covered by workers’ compensation. However, there are various exceptions to this general rule that may apply to a situation that makes the case covered by workers’ compensation. One such exception is the “traveling salesperson exception” that applies when the nature of the employee’s work requires him/her to travel on a trip out of town for an extended period. This exception says that the employee is continuously in the course of their employment during the duration of the trip although they are not necessarily performing actual work for the employer during the entirety of the trip. An experienced workers’ compensation attorney can evaluate the facts of your case and determine whether there is a viable exception that applies in your case so that your case is covered under workers’ compensation.
5. Failure to timely report the accident to your employer or file your claim with the Industrial Commission
In North Carolina, you have 30 days to report your workplace injury to your employer. This should be completed in writing (email, text, or written on a piece of paper). You have two years to file your claim with the Industrial Commission.

What is Workers’ Compensation in South Carolina?

Workers’ compensation is a no-fault limited recovery insurance system that is governed by the South Carolina Workers’ Compensation Commission. The “no-fault” component of the system means that an injured worker is entitled to benefits even if the injury is the result of their own negligence. In exchange for the no-fault component, an injured worker is not entitled to any additional compensation beyond what is provided under workers’ compensation if the employer’s negligence caused the injury. In addition, an employee may not sue the employer for negligence by way of a civil lawsuit. The inability to sue the employer civilly means that an injured worker’s recovery is limited to only what is provided under workers’ compensation law. Importantly, this means that an injured worker is unable to receive compensation for pain and suffering as it is not a benefit provided in workers’ compensation.

What Injuries Are Covered?

1. General Injuries
Generally, all injuries or deaths that occur as the result of an accident while working for your employer are covered under workers’ compensation.
2. Occupational Diseases
Occupational diseases are caused by conditions specific to a particular type of work or employment. Examples include asbestosis, hearing loss, bursitis, and repetitive stress injuries. However, the disease must not be an ordinary disease of life to which the general public is equally exposed.

What Benefits Are Paid?

1. Medical Compensation
Workers’ compensation will pay your medical bills related to the treatment you receive for your injury. This includes prescriptions and reimbursement for mileage if the round trip is 10 miles or more. However, the insurance company or your employer have the right to choose what medical provider or doctor you see for your injury.
2. Disability Compensation
There are four different types of disability compensation that you may be entitled to receive depending on the circumstances of your case. One type is temporary total disability compensation which is designed to provide weekly payments while you are unable to work due to your injury. A second type is temporary partial disability compensation which pays you a weekly benefit when you return to work with work restrictions at a job that pays you less than you earned before your injury. The third type is permanent partial disability compensation which pays you based on a permanent partial impairment assigned by your doctor once it is determined that you are at maximum medical improvement. In South Carolina, the Commission will also consider other factors such as your work restrictions and ongoing pain to arrive at an award of permanent partial disability beyond the impairment rating assigned by your doctor. The fourth type of disability compensation is permanent total disability which pays you 500 weeks of disability benefits when the Commission determines that you are unable to return to work due to your injuries to two or more body parts, the extent of permanent partial disability to your back, or the accident results in paraplegia, quadriplegia or severe brain damage.
3. Death Benefits
When a work-related accident causes death, the decedent’s spouse, dependent(s) or next of kin will be entitled to weekly disability up to 500 weeks and payment of funeral expenses up to $12,000.00.

How is my weekly disability benefit amount calculated?

1. Benefit Amount Calculation
In South Carolina, the calculation is typically based on two-thirds of your pre-taxed average weekly wage for the year before the quarter in which your accident occurred. For example, if your accident occurred on July 15, 2024, the one-year period in the calculations would run from July 1, 2023 through June 30, 2024. Additionally, if you were working two different jobs at the time of your accident (known as concurrent employment), you can combine the pre-injury wages in the calculation. There are other methods for calculating your compensation rate that may apply depending on if you worked for only a short period of time with the employer before your injury or some other unique situation.

Common Reasons Injuries Are Denied

1. Insufficient proof that your injury was caused by a particular event at work

Under the workers’ compensation law, an injured worker has the burden to prove that his/her injury resulted from something that happened while he/she was working. If your workplace accident was not witnessed, or not reported immediately to your employer after it occurred, or there is some suggestion that you may have been hurt doing something outside of work, the workers’ compensation carrier may decide to deny your case. Often an insurance adjuster will look for any reason to deny your case. If your employer is unwilling to vouch for the fact that you got hurt at work, this could also give the adjuster a reason to deny your case. This is why it is so important to (1) immediately report your work-related accident to your employer (and follow up with an email, text, or written note); (2) go to the doctor that the employer tells you to go to; and (3) tell the first doctor or medical provider that evaluates you exactly how your accident occurred at work.

2. Insufficient medical evidence that the event at work aggravated a pre-existing medical condition
This is one of the most popular reasons for an insurance adjuster to deny your case. Remember: just because you suffered a prior injury or had issues with an injured body part before your work-related accident that does not mean that you cannot receive workers’ compensation benefits following an injury at work. A skilled attorney with experience reading and interpreting medical records and deposing doctors can help overcome a denial based on a pre-existing condition. The law provides for workers’ compensation benefits when your work-related injury materially aggravates a pre-existing condition.
3. The time, place or circumstance surrounding when, where, or how the injuring event occurred is not covered by workers’ compensation
For a work-related injury to be covered under workers’ compensation it must occur in “the course and scope” of your employment. Sometimes accidents occur while the injured worker is not on the employer’s premises or not yet “on the clock.” For instance, accidents that occur while you are going to and coming from work are generally not covered by workers’ compensation. However, there are various exceptions to this general rule that may apply to a situation that makes the case covered by workers’ compensation. One such exception is the “traveling salesperson exception” that applies when the nature of the employee’s work requires him/her to travel on a trip out of town for an extended period. This exception says that the employee is continuously in the course of their employment during the duration of the trip although they are not necessarily performing actual work for the employer during the entirety of the trip. An experienced workers’ compensation attorney can evaluate the facts of your case and determine whether there is a viable exception applies in your case so that your case is covered under workers’ compensation.
4. Failure to timely report the accident to your employer or file your claim with the Workers’ Compensation Commission.

In South Carolina, you have 90 days to days to report your workplace injury to your employer. This should be completed in writing (email, text, or written on a piece of paper). You have two years to file your claim with the Workers’ Compensation Commission.