North Carolina Lawyer Explains What Work Injuries Are Covered by Workers’ Compensation

When you’re hurt on the job, you assume that your work injury will be covered, right? Not so fast.  One of the most common reasons insurance companies use to deny your Worker’s Compensation claim is to characterize your injury as not being caused by an “Accident.” So in this guide, we explain the types of injuries and workplace incidents that qualify as “Accidents” under North Carolina law, what claims workers’ compensation covers vs. denies, and what you can do to avoid hurting your claim (or getting it denied) if you talk to the insurance carrier before hiring a North Carolina workers’ comp attorney.

What Types of Injuries are Covered by Workers’ Compensation in North Carolina?

Any workplace injury is covered by workers’ compensation in North Carolina if it is the result of an accident.  Our courts have interpreted “accident” as “an unlooked for and untoward event which is not expected or designed by the injured employee.” As explained below, injuries that are expected to occur from the type of work or job functions you have are typically NOT covered by workers’ comp.

The Difference Between Regular Duty Injuries and Work Injuries in North Carolina

The simplest way to explain this rule is to provide examples:

                1:            Employee A, a merchandise associate, is stocking shelves with bags of dog food.  While she is doing that, her right shoulder pops and is immediately painful.  She is found to have torn her labrum and needs surgery.

                2:            Employee B, another merchandise associate called in to sub for injured Employee A, attempts to finish unloading the dog food bags.  He apparently didn’t put one of the bags completely on the shelf and it falls on top of his right shoulder.  The falling bag tears Employee B’s labrum, and he needs surgery.

Under North Carolina workers’ compensation, Employee A’s claim would almost certainly be denied, while Employee B’s would be accepted.  That is because Employee A’s injury was the result of her regular performance of her regular duties, whereas Employee B’s was caused by something completely out of the ordinary. 

How Should You Respond to a Workers’ Compensation Recorded Statement in North Carolina?

The most important thing you can do to prevent the denial of your claim on this basis is to be aware of it during the carrier’s investigation.  Frequently, an adjuster will try and get a recorded statement from you.  As part of this, the adjuster will ask seemingly innocuous questions, such as “this was something you normally do?” or “how was this different than any other time you’ve performed this task?”  These are trap questions intended to get you to talk your way out of coverage.

Here’s an example of what not to do/say:

In this example, agreeing that it was “a normal part of your job” and that he “lift[s] it the same way every day” ultimately caused his claim to be denied.

So if there is ANYTHING out of the ordinary about your work leading up to your injury, it may be sufficient to qualify it as an “accident.”  Make sure that you tell the adjuster exactly how this event was different, because if you don’t do it in your statement, it will be hard to bring it up during litigation.

Back Injuries Are (Almost) Always Covered By Workers’ Compensation in North Carolina

The statute carves out back injuries from this rule.  So long as an injury to your back arose out of a specific traumatic incident at work, workers’ compensation will cover it, regardless of whether the incident causing the injury was an “accident.” 

Why Do You Need a Lawyer for a Work Injury Accident in North Carolina?

An experienced workers’ comp lawyer can take care of all the forms, filings, and interactions with your insurance company to make sure that you can focus on what’s most important -- getting better. A workers’ comp lawyer can also take care of everything else to make sure you receive everything that you’re entitled to receive from the insurance company. Most importantly, an workers’ comp lawyer can help you avoid the tricks insurance carriers use to try and deny your claim.

Schedule a Free Case Evaluation With Our Work Injury Attorneys in Raleigh, NC

If you were injured at work or during work hours, contact our experienced workers' comp lawyers in Raleigh, North Carolina for a free consultation.  We can help you recover compensation for medical bills, lost wages, and permanent disability.  Our Raleigh workers’ compensation lawyers have experience in these cases to help ensure that you recover the maximum amount of compensation that you deserve for your damages.