What is the Injury-by-Accident Rule in Workers’ Compensation in North Carolina?
North Carolina law has some very unusual provisions that are not found in most other states’ workers’ compensation laws. One of the biggest is the “injury by accident” rule.
The “Injury by Accident” Rule in North Carolina
North Carolina generally requires that an injured worker be hurt in an “accident” in order to recover Workers’ Compensation benefits. There are many exceptions, most notably that this rule does not apply to back injuries (with back injuries, an injured worker may recover workers’ compensation benefits if the back injury was the result of a “specific traumatic incident” that occurred while in the course and scope of their employment duties). But for most other injuries, an injured worker must prove that he was hurt as the result of an “accident”.
What is an “Accident” in North Carolina Workers’ Comp Law?
So what is an “accident”? Well, that term has been the subject of countless lawsuits and courts of appeals decisions. The North Carolina Industrial Commission explains that an accident as defined by North Carolina law is an interruption of the normal job routine arising out of, and occurring in the course of, the employee’s employment.
That sounds simple. But in practice, it can be very complicated. If you have been hurt in a wreck, one of the first things that will happen is that an insurance company adjuster will contact you and request that you provide them with a recorded statement. And one of the common questions they will ask you is, ‘Was there anything unusual about the job you were doing when you were hurt?” Most people will answer that question (or some variation on it) by saying, “No, it was just a normal day on the job.” Sounds like an innocent question and a normal, routine answer. Well, unfortunately, that answer to that question might now become Exhibit A in a hearing before the Industrial Commission. Because the adjuster might use that response as evidence that the workplace injury in question was not an “accident” because there was nothing unusual about the job that led to a workplace injury that day.
Sounds crazy, doesn’t it? A person is hurt on the job, while he or she is on the clock, doing his or her normal job duties for their employer, and they get hurt — common sense says that this should be a workers’ compensation claim. But common sense doesn’t always win the day when workers’ comp laws are concerned.
Examples from Our Experience in North Carolina Workers’ Comp Law
Here are some real examples that our firm has handled over the years that we have been representing victims of workplace injuries in North Carolina.
Denied Workers’ Comp Due to Lack of an “Accident”
A man works in a warehouse. He’s walking down an aisle with his supervisor and two co-workers looking for a certain pallet and he suddenly feels a sharp pain in his knee. He hobbles over to a chair and tells his supervisor. His boss asks him if he slipped on something, or if he fell. The man says no, he just felt his knee give out under him. He is asked to put this in writing and does so. He gets taken to the emergency room where they find he has torn his ACL. The supervisor and employee then fill out the paperwork to open a workers’ compensation claim, thinking this is clearly a workplace accident. It happened while he was on the job. He wasn’t at lunch, or on break. He wasn’t violating any company policy. He had no prior knee issues. There is no argument that this happened while he was at home because the injury is severe enough that we know he didn’t tear his ACL earlier in the day; it clearly happened at work with several witnesses. But the insurance company gets the claim and quickly denies coverage of the claim. They explain that because there was never an “accident” as defined by North Carolina law, the injury does not qualify as a workers’ compensation claim.
Approved for Workers’ Comp Due to an “Accident”
Now, take a very similar situation, but one with important differences. Another warehouse worker is walking down an aisle looking for a certain pallet and he slips and falls to the ground. He doesn’t know what he slipped on. There is nothing on the floor. Maybe he just tripped over his own feet. He tries to get up, then realizes he is really hurt. There are no witnesses. He’s had pain in his knee before and has been in and out of therapy for knee pain for years. He actually takes ibuprofen many days for knee pain. He gets taken to the emergency room and finds that he has torn his ACL. He reports the claim to his supervisor, who reports to their workers’ compensation insurance company, and they quickly accept the claim. They decide that because the man tripped, he qualifies for workers’ compensation coverage because he had an “accident.”
How are these two situations different? Why does the second man deserve to get covered by workers’ comp, while the first one gets no coverage? Are we rewarding someone for tripping on their own two feet? Well, it isn’t about what is fair. It’s about who meets the letter of the law. And the second man described his incident such that it sounds more like an “accident” than the first man’s situation.
Injured on the Job?
Insurance companies know these rules. Injured workers usually don’t. If you have been hurt on the job, it’s important to talk to a qualified workers’ compensation lawyer to learn about your rights.
For a FREE, no-obligation consultation with an experienced North Carolina workers’ comp lawyer, please call 1-800-525-7111 or complete the fast and convenient form below. We can help you with applying for workers’ comp and appeal a potential denial. Our goal is to get our clients maximum compensation for their workplace injuries.
There are no upfront costs, and we don’t get paid unless you get workers’ compensation benefits. It’s as simple as that.