What is the Workers’ Compensation “No-Fault” System in North Carolina?

From the team at Huggins Law Firm, P.C., we want to talk to you about one of the most stressful things that can happen to a family: a workplace injury.

One minute, you are on the job, doing the work you’ve done for years. The next, you’ve fallen, a machine has failed, or you’ve hurt your back lifting something.

You are in pain. But you are also scared. You are scared about your job. You are scared about your paycheck. You are scared about the medical bills that are about to start piling up.

Your boss might be acting “nice,” but your supervisor is already on the phone with a big, out-of-state insurance company. And that insurance company has one job: to pay you as little as possible.

We are a law firm that has been protecting families in North Carolina for decades. Our team has deep, broad experience in Personal Injury, Criminal Law, Family Law, Estate Planning, and Bankruptcy.

We are not just “workers’ comp lawyers.” We are a full-service firm for families. This is so important, because a workplace injury doesn’t just hurt you. It hurts your whole family.

You need a lawyer who understands that. You need a team that is right here in your community, from Greensboro and Winston-Salem to Burlington and Asheboro.

This page is your simple, clear guide. We are going to tell you the truth about the “workers’ comp” system. It is not a Personal Injury case. It is a completely different set of rules, and it is a trap for people who try to go it alone.

Key Takeaways from This Page

We know you are overwhelmed. If you only read one part, make it this one:

• It is a “No-Fault” System. You do not have to prove your boss was “at fault” or “careless.” But, you also cannot sue your boss for pain and suffering.
• You MUST Report Your Injury. You must tell your employer you were hurt, and you should do it in writing, as soon as possible (the deadline is 30 days).
• The Insurance Company Chooses Your Doctor. This is the hardest, most frustrating rule in North Carolina. The insurer has the right to “direct your medical care.” A lawyer can help you fight this.
• You Only Get 2 Things: The system is only designed to give you two main benefits: (1) your medical bills get paid, and (2) you get a part of your lost wages (about two-thirds).
• A “Denial” is NOT the End. The insurance company will look for any reason to deny your claim. This is a tactic. It is not the final word.
• You Need a Lawyer. The insurance company has a team of experienced lawyers. If you’ve been denied, or if your injury is serious, you need your own experienced lawyer to fight for you.

What Does “No-Fault” Mean? (The “Grand Bargain”)

This is the most important concept in all of workers’ comp. It is a “trade-off,” which lawyers sometimes call the “Grand Bargain.”

Here is the “trade”:

• The “Bargain” You Get: You get automatic benefits (medical and lost wages) even if the accident was 100% your fault. If you trip over your own feet and break your arm, it’s covered. You do not have to prove your boss did anything wrong.
• The “Bargain” You Give Up: In exchange, you give up the right to sue your employer in a normal court. You cannot get money for “pain and suffering,” “mental anguish,” or “loss of enjoyment of life.”

This is the opposite of a car accident case. In a car accident or a truck accident, your lawyer must prove the other driver was 100% at fault. And you can get “pain and suffering” money.

In workers’ comp, “fault” does not matter. But your benefits are limited to just the “bill pile” and a “wage pile.”

This is why the system is so tough. The only two things you are owed… the insurance company will fight tooth and nail to limit.

What Are the 2 Main Benefits I Can Get?

The law says that if you are hurt on the job, you are “entitled” to two main things.

Benefit 1: Medical Compensation (The “Bill Pile”)

The law says your employer (or their insurance) must pay for 100% of all “reasonable and necessary” medical care to “effect a cure or give relief.”

This includes:

• The ER visit
• The ambulance bill
• Your surgery
• Physical therapy
• Prescriptions
• Even your mileage for driving to and from the doctor

…BUT, Here is the “Catch.” (This is the most important part).

In North Carolina, the employer/insurance company has the right to direct your medical care. This means they pick the doctor.

You cannot just go to your own family doctor in Greensboro or High Point. The insurance company will send you to their doctor, who they have worked with a hundred times.

This is a huge problem. These “company doctors” often try to push you back to work before you are ready. They might say, “Oh, you’re fine,” or, “This is just an old injury.” They are not on your side.

This is one of the main reasons you need a lawyer. An experienced workers’ comp lawyer knows how to fight this. We can file motions to get you a “second opinion.” We can fight to have your doctor’s opinion heard by a judge.

Benefit 2: Wage Replacement (The “Wage Pile”)

If the doctor they chose says you cannot work, you are entitled to get paid. But you do not get your full paycheck.

Here is how it works:

1. The 7-Day Waiting Period: You must be out of work for at least 7 days before you can get paid. (If you are out for more than 21 days, they will go back and pay you for that first week).
2. The 2/3 Rule: You get two-thirds (66 2/3%) of your “Average Weekly Wage.”
3. The “Cap”: There is a “maximum” amount. Even if you are a high-earner, you cannot get more than the “state maximum” for that year. For injuries in 2024, the maximum is $1,340 per week. (Source: N.C. Industrial Commission).

This “Average Weekly Wage” (or “AWW”) is another place they fight. Did you get overtime? Bonuses? A “per diem”? The insurance company will try to not count those, to make your AWW (and your check) as low as possible.A good lawyer will fight them to make sure every single penny you earned is counted, so your check is as high as the law allows.

The “Secret” Stat: How Big is This Problem?

When you are hurt, you feel alone. You are not. This is a huge problem in our state.

In North Carolina, in one recent year, private industry employers reported 70,100 non-fatal workplace injuries and illnesses. (Source: U.S. Bureau of Labor Statistics).

That is 70,000 families just like yours, who are now in a fight with an insurance company.

And these are just the reported ones. Many workers, especially in construction or “gig” jobs, are scared to report their injuries. They are afraid they will be fired or called “trouble.”

This is why you must have a lawyer. We are your shield.

What is the “North Carolina Industrial Commission”?

This is another big, confusing part. If you have a problem with your case, you do not go to the “regular” courthouse in Greensboro or Asheboro.

Your case is handled by a special, separate court system called the North Carolina Industrial Commission (NCIC).

This is a state agency. It has its own set of rules. It has its own forms (with names like “Form 18” and “Form 61”). It has its own judges (called “Deputy Commissioners”).

This is a “secret” legal world that you cannot be expected to know. And the insurance company’s lawyer? They live in this world every single day. They know the judges. They know the rules. They know the tricks.If you walk into a hearing at the NCIC without your own experienced lawyer, you have already lost. Our team of lawyers knows this system. We are in it all the time. We know the rules, we know the defense lawyers, and we know how to fight for you.

“My Claim Was Denied!” — This is a Tactic, NOT the Final Word

This is the phone call we get every day. “I did everything right. I told my boss. I went to their doctor. And now I got a letter saying my claim is DENIED.”

You will get a letter (a “Form 61”) that says why. And the reasons will sound “official,” but they are often just tricks.

• “The injury did not ‘arise out of’ your employment.” (They are saying it’s not “work-related”).
• “It is a ‘pre-existing’ condition.” (They are blaming your old high school football injury).
• “You failed to report the injury in time.” (They are using a technicality).
• “You refused medical treatment.” (You missed one appointment).

This is a tactic. It is not the end. They want you to give up. They are hoping you will be so scared and frustrated that you will just go away, or try to use your private health insurance.

DO NOT do this. The moment you get a “denial” letter is the moment you must call a lawyer.

This is when you are searching for the “best workers’ comp lawyer near me” because you know you are in a real fight.

A lawyer will file the right forms (like a “Form 33”) to ask for a hearing. We will appeal the denial. We will gather the medical records. We will get your side of the story.

A “denial” is just the start of the fight. It is not the end of it.

Why a Local Lawyer in the Triad is Your Best Hope

When you are in a fight, you want someone from your corner. You see the 1-800 ads for “national” firms. They are not here.

Your hearing will be in (or near) Greensboro, Winston-Salem, or High Point. You need a lawyer who knows the local system.

• Our lawyers know the local defense lawyers. We have worked cases against them for years. We know their “playbook.”
• Our lawyers know the local Deputy Commissioners (the judges). We have stood in front of them. We know what evidence they look for.
• We are part of this community. We are not just a Personal Injury firm. We are the same firm your neighbors in Graham, Burlington, Kernersville, and Asheboro trust with their Family Law case, their Will, or their Bankruptcy filing.

We are a stable, trusted, local law firm that is here to fight for our community.

We Are Here to Handle the Fight

This is a fight you cannot win on your own. The system is built against you. Your boss is not your friend. The insurance adjuster is not your friend. The “company doctor” is not your friend.

You need one person who is 100% on your side. That is our job.

Your only job is to get better. Your job is to go to your doctor’s appointments. Your job is to rest. Your job is to take care of your family.

Our job is to handle the rest.

• We handle the phone calls.
• We file the forms.
• We fight the insurance company.
• We get the medical records.
• We take the case to a judge.

It costs you nothing to talk to us. It costs you nothing to hire us. All of our workers’ compensation cases are on a “contingency fee.” We only get paid if we win your case.

Call us. Let our team be your shield.