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Video Summary
In this legal discussion, experienced lawyers outline the specific benefits available to injured employees under North Carolina’s workers’ compensation laws. The system functions as an exclusive remedy, meaning workers receive medical coverage and wage replacement but are barred from seeking damages for pain and suffering. A critical focus is placed on the average weekly wage calculation, as insurance companies frequently underpay claimants by failing to account for overtime or accurate earnings. These calculations directly impact temporary total disability payments, which provide tax-free income at two-thirds of a worker’s gross pay. Furthermore, the sources explain permanent partial disability, where doctors assign a rating to reflect lasting physical impairment that determines additional financial compensation. Ultimately, the experienced lawyers emphasize that having legal advocacy ensures these complex calculations are accurate and that workers receive their maximum entitled recovery.
Transcription of the Video
Clark Speaks: I’m Clark Speaks, the catastrophic injury lawyer. Welcome to The Verdict. I’m here with Brian Ger. Brian, can you tell me about what benefits I am entitled to in North Carolina after a workplace injury, assuming it meets the definition of a compensable accident?
Brian Ger: It’s a great question. It is the one thing that I probably talk with clients about the most, and that is what you are not entitled to, because workers’ comp is an exclusive remedy. That also means there are exclusive benefits that you are entitled to. As discussed previously, there are two components to your case: the medical side and the indemnity side. The indemnity side deals with your wage loss. The medical side involves the treatment and having your treatment covered, whether it is your prescriptions or your travel to and from a provider, the treatment itself, MRIs, injections, and surgery. All of those items are covered under medical benefits.
The second side is indemnity, which is the wage loss. If you are out of work, you could be entitled to Temporary Total Disability (TTD) benefits. This is intended to replicate your net earnings on a weekly basis. This is why it is important to provide your wage records to us early on so we know the correct figures. Often, insurance carriers will just estimate this amount. They might say a worker was making $10 an hour for 40 hours a week, so the average weekly wage is $400. They are going to pay you two-thirds of that because they are paying you post-tax earnings.
We want to know your actual wage records. When we acquire those records, we may see you worked significant overtime at time-and-a-half, meaning your average weekly wage was actually $600, not $400. We do not know that without those records. Typically, we collect that from the employer, but you can also help by providing pay stubs or a W-2 to show what you actually earned. This helps us determine if you were making more than what the insurance carrier paid you. Those are TTD benefits.
Clark Speaks: When people try to do this by themselves and interact with the insurance company regarding this average weekly wage issue, do the insurance companies ever calculate it incorrectly and pay them less than they should?
Brian Ger: They calculate it incorrectly frequently. A lot of times, I hear from a client saying, “I just don’t feel like I’m being paid correctly.” But they don’t know for sure because this is a compensation check, not a standard paycheck. They don’t know what it technically represents or what it is supposed to reflect. They assume it is correct because the person adjusting their claim is a professional. I’ve had cases where the employee didn’t reach out for a long time and we found they were underpaid by significant amounts, sometimes $10,000 over a year and a half. It is common to be underpaid $50 or $100 a week.
If your case stays open for a year or more, that underpayment adds up. You want to make sure you are being paid correctly because your case hinges on that average weekly wage. Not only does it affect TTD checks, but there is also Permanent Partial Disability (PPD). This is a rating a doctor typically assigns at the end of a case to reflect the amount of usage lost in a body part. For example, a back injury is worth 300 weeks of PPD benefits by statute. If you are assigned a 10% rating, you receive 10% of those 300 weeks, which is 30 weeks of benefits. You receive that regardless of whether you are back to work. If the average weekly wage is inaccurate, you will receive less for these benefits as well. This impacts TTD, PPD, and Temporary Partial Disability (TPD) benefits, which apply if you return to work but earn lower wages.
Clark Speaks: Can you explain why workers receive two-thirds of the average weekly wage instead of the full amount?
Brian Ger: The reason is that it reflects your post-tax earnings. If your gross earnings are $300 a week, your take-home pay after taxes and Social Security might be $200. Your TTD check reflects that take-home amount because you receive that money tax-free. The IRS does not tax these weekly checks. Likewise, when you settle your case, that settlement is also generally tax-free because the benefits reflect post-tax earnings.
Regarding other benefits, workers’ compensation does not provide for emotional distress or pain and suffering. While that is frustrating for many, it is the trade-off of the workers’ comp system. You are entitled to medical benefits and wage loss benefits (TTD, TPD, or PPD).
Clark Speaks: In an automobile accident, a person might recover pain and suffering, but they might be limited by the insurance policy amounts. There are pluses and minuses to each system. Ultimately, you are in a better position if you have an advocate in your corner who understands these laws to help you reach the maximum recovery permitted.