North Carolina Workers’ Compensation Claim Settlements

If you are currently unable to work, receiving weekly workers’ compensation benefits, or unable to return to your previous position at the same rate of pay, settling your case may not be in your interests. Before you accept an offer, you should contact a Hickory workers’ compensation attorney to better understand North Carolina workers’ compensation claim settlements and how they are negotiated.

Whether a settlement is in your interests depends on what benefits you may be giving up in exchange for a lump-sum payment. Here’s why:

Workers’ compensation claimants usually have two options once they decide to settle their case:

1. Receive a regular final payment by signing a Form 21 or Form 26A. This is usually based on a rating of a doctor or the average rating of all the doctors.
2. Settle a claim by a “clincher.” This will mean a greater size settlement, but it also means that the claimant waives the right to seek ongoing AND future medical benefits and the right to reopen their case.

What Happens If I Choose The First Option?

When you sign a Form 21 or Form 26A, you have two years in which to reopen the claim after receipt of the last wage loss compensation payment. However, in order to reopen a claim, there must be a real change of circumstances that affects your wage-earning ability. Just having on-going stiffness or pain is not sufficient.

When you obtain our services, we will carefully discuss your options with you when you have reached the point of maximum medical improvement or when your doctor has finally released you with a rating. We will then discuss the matter with and see which route makes the most sense for your situation.

What Happens If I Decide To Settle?

If you decide to settle your case by clincher, it may take as long as a month or so for you to receive the money. First, the written agreement, or clincher agreement, has to be prepared by an attorney for the insurance carrier, which is then mailed to us. It then has to be read carefully by you after which you may choose to accept or decline the offer. Our attorneys are available to answer any question you may have regarding the terms of the agreement or the process of accepting or declining the offer.

Once it is signed by you, it is returned to the insurance company for the signature of your employer and others. It is thereafter forwarded to the workers’ compensation Industrial Commission that then carefully reviews it, examines the entire file and then enters a written order approving the settlement if it is deemed fair.

Once a written order is received by us, the insurance company may take as long as two to three weeks to prepare your checks. We will contact you and let you know when the papers are in.

The Biggest Mistake Injured Workers Make When Settling a Claim

A shocking 2,488,400 people were injured or became ill due to work conditions in 2024, and certain missteps can compromise a claimant’s eligibility to receive benefits. Many injured workers focus on the size of a settlement check without considering what rights they may be giving up in exchange for that decision.

In North Carolina, the choice between accepting a permanent partial disability rating through Form 26A and entering into a clincher agreement can have long-term consequences. While a clincher often provides a larger lump-sum payment, it generally closes the door on future medical treatment and other workers’ compensation benefits related to the injury.

By contrast, accepting a disability rating may preserve important rights that would become valuable if the condition worsens.

Doctors’ Ratings Are Important, But Only Part Of The Story

Be very wary of signing a Form 21 or Form 26A to accept payment of your rating unless you are truly able to perform your old job. After you’ve been hurt on the job and have completed your treatment with the doctor, he or she usually says that you’ve reached a point called “maximum medical improvement” (MMI). This is a term used in North Carolina workers’ compensation cases that does not mean you are fully better but rather that you are as good as you’re going to get.

A doctor will normally put you at MMI when he or she is done treating you as a patient. At the same time, the doctor will decide whether or not you have any permanent disability — however minor — as a result of your injury. You may be given a permanent partial impairment (PPI) rating, which appears as a percentage. This is also when the doctor may give you permanent work restrictions.

What Is Disability Rating?

A disability rating is a tool the doctor uses to show how bad the injury is that you suffered. For instance, if a doctor says you have a 10 percent disability, they are saying that your injured body part is only 90 percent as good as it used to be.

Under North Carolina General Statute § 97-31, the North Carolina Legislature has set out the value of almost every body part in the Workers’ Compensation Act. For example:

Under North Carolina General Statute § 97-31, your back is worth 300 weeks of your compensation rate (which is two-thirds of your average weekly wage). If you made $600 a week before you got hurt, you should have been paid $400 a week while you were out of work. If the doctor assigns a 10 percent PPI, you are entitled to 10 percent of 300, which is 30 checks. At $400 a check, that equates to $12,000 in compensation for the permanent injury to your back.

After receiving a disability rating, you can probably expect an insurance adjuster to quickly try to get you to sign an Industrial Commission Form 21 or Form 26A to accept that $12,000 payment. The adjuster may even offer to throw in extra money if you give up the right to future medical care. Again, this is known as a “clincher.” You may be willing to take this, but you shouldn’t unless you’ve already returned to work making as much or more as you did when you were first hurt.

Attorney Lyndon R. Helton explains: “The size of a settlement is only one part of the equation. Before accepting any offer, you need to understand what rights you’re giving up, especially if the agreement closes the door on future medical treatment.”

Discuss Your Settlement Options With an Experienced Workers’ Compensation Lawyer

Before accepting a workers’ compensation settlement, make sure you understand how it could affect your future benefits and medical care. Attorney Lyndon R. Helton has more than 30+ years of experience helping injured workers make informed decisions. Contact our office today for a free consultation.

Understanding Total Disability And Partial Disability

Under our laws, if you are totally disabled from work, you get paid up to two-thirds of your average weekly wage. If you are partially disabled, meaning you are able to work but you are not able to earn as much as you did before you got hurt, you are entitled to be paid for two-thirds of the difference between what you used to make and what you can make now under North Carolina General Statute § 97-30.

Using the example from above:

The injured worker was originally capable of earning $600 per week. Let’s assume that as a result of his injury, he has returned to work but can now only work part time at $7 per hour. He is now only making $210 per week, which is a wage loss of $390 per week. Under our state’s workers’ compensation laws, the insurance company has to pay two-thirds of that partial disability, which comes out to $260 per week. That can be a lot more than just the rating.

How long do partial workers’ compensation payments continue? Unfortunately, under North Carolina General Statute § 97-30, this wage loss is limited to only 500 weeks from the date of injury.

How Are Workers’ Compensation Settlements Calculated in North Carolina?

There were 2,488,400 work-related injuries in 2024, and knowing how compensation settlements are paid is critical. Permanent partial disability settlements are often calculated using three factors: the impairment rating assigned by the doctor, the number of weeks assigned to the injured body part under North Carolina General Statute § 97-31, and the workers’ compensation rate.

Several factors can influence the amount an injured worker may recover.

1. The severity of the injury. More serious injuries generally require longer recovery periods, result in greater physical limitations, and may lead to higher impairment ratings.
2. Pre-injury wages. Because workers’ compensation benefits are based on an employee’s average weekly wage, higher earners may be entitled to larger benefits.
3. Future medical needs. If an injury is expected to require additional treatment, surgery, medication, or rehabilitation, those anticipated costs can affect settlement negotiations.
4. Permanent work restrictions. Restrictions that prevent a worker from returning to their previous place of employment can have long-term financial consequences and reduce future earning capacity.
5. Age. An older worker who faces greater challenges finding comparable employment after an injury may experience more significant economic losses than someone with decades remaining in the workforce.

Why You Should Carefully Review Any Settlement Option

In fiscal year 2024-2025, North Carolina saw 56,921 workers’ compensation claims opened, and the outcomes of those cases have significant consequences for injured workers. Often, the insurance company begins discussing settlement options after a worker reaches Maximum Medical Improvement (MMI). MMI means that your doctor believes your condition has stabilized and that additional treatment is unlikely to result in significant improvement.

Insurance companies often seek to resolve claims after MMI because they have a clearer picture of the long-term recovery potential for that worker. An early offer may not fully account for future medical treatment, disability, ongoing wage losses, or reduced earning capacity. Research has found that injured claimants who take the time to negotiate settlements generally receive better outcomes for their claims.

You Have Options – Contact A NC Workers’ Comp Lawyer

What the adjuster probably won’t tell you is that you don’t have to take the rating. If you think your wage loss is going to pay out more than the payout for your rating, go that route. Insurance companies hate that because it makes them keep their files on you open as they keep writing you checks week after week. They would rather tell you all you can have is your rating and hope you believe them.

Should you take the rating or the wage loss? In the example we’ve been using:

Let’s assume that the injured worker is finally able to go back to work and gets that low-paying, part-time job exactly one year, 52 weeks, after the date of his injury. If that’s true, then he’s entitled to draw wage loss checks for another 448 weeks. If he were never to get a raise or increase his hours, the insurance company would have to pay him $116,480 ($260 x 448 weeks). As you can see, it’s advantageous for an insurance adjuster to have the injured worker sign the Form 21 or Form 26A and lock him into a rating.

Also keep in mind, the Form 21 and Form 26A can also affect your ability to get other benefits. In fact, if you sign these forms and then go out of work again, the insurance company will argue that you don’t get more benefits because you “elected” to receive the rating instead of ongoing temporary benefits. It is a maneuver that insurance companies use all too often and one attorney Lyndon R. Helton knows how to fight against.

Why You Should Hire a Workers’ Compensation Lawyer

One Martindale NOLO survey reported that accepting the first settlement offer resulted in final settlements averaging $15,600, and hiring an attorney increased the final settlement by about $5,500. In addition, a lack of representation can mean missing key details. For example, in NC, injured workers have to notify their employer of their injury. This must be done within 30 days, and it must be a written notification.

An experienced North Carolina workers’ compensation attorney can manage your case based on their many years of experience and knowledge of workers’ compensation laws.

Law Office of Lyndon R. Helton, PLLC, has represented injured North Carolina workers for more than two decades. Our founding attorney previously worked for insurance companies as a defense lawyer, so he understands how those companies work to devalue claims. When you hire a workers’ compensation lawyer from our firm, you can trust our dedicated litigators to protect your rights and interests at every step, including if you have a third-party claim.

FAQs

What Is the Average Workers’ Comp Settlement in North Carolina?

There is no single average workers’ compensation settlement amount in North Carolina because every case is unique. The value of your settlement could depend on the severity of the injury, your pre-injury wages, any permanent impairment rating assigned by a physician, future medical needs, and whether the injury affects your future earning capacity. Legal representation can play a positive role in helping you claim what you are owed.

What Is the Difference Between a Form 26A and a Clincher Settlement?

A Form 26A settlement is generally based on a worker’s permanent partial disability rating and may allow certain rights and benefits to remain available under the Workers’ Compensation Act. A clincher agreement, by contrast, is a full and final settlement that closes the claim in exchange for a lump-sum payment. In most cases, a clincher also ends the worker’s right to seek future medical treatment related to the injury.

When Does a Workers’ Comp Provider Offer a Settlement?

Insurance companies often begin discussing settlement offers after an injured worker has sufficiently recovered. When a doctor finds that a patient has recovered to the fullest extent possible, they may issue a finding that the individual has reached maximum Medical Improvement. While this is an important milestone, it is only one factor that can shape a settlement offer.

Can I Negotiate a Workers’ Comp Settlement in NC?

Yes. Workers’ compensation settlements are frequently negotiated, and injured workers should not assume that the first offer by an insurance company represents the full value of a claim. Factors such as future medical treatments, reduced mobility, and other long-term setbacks can affect the value of your settlement. Studies have found that negotiated settlements often result in more favorable figures for injured workers.

Contact Our North Carolina Worker’s Compensation Settlement Firm

To schedule your free initial consultation, call our law office in Hickory, North Carolina, at 828-328-9966 or toll free at 888-321-0494. You may also send us a confidential email. We proudly serve Burke County, Catawba County, and Caldwell County.