North Carolina Workers’ Compensation

How is Workers’ Compensation Defined in North Carolina?

If you have been hurt while you were working, or have contracted a disease or suffered an injury because of your job, workers’ compensation will allow you to be compensated for your injuries. Workers’ compensation was enacted in North Carolina so that workers could receive financial help for medical treatments and lost wages without putting employers at risk for a large financial loss. So, as an employee, you can think of workers’ compensation as a form of medical and income insurance that protects you and is paid for by your employer.

I’ve Been Hurt on the Job in North Carolina, What Should I do?

If you are hurt on the job in North Carolina, you are going to need to file a workers’ compensation claim by following these steps:

1. Get Medical Treatment.
   You should receive appropriate medical attention for your injury as soon as possible. You may choose which physician to examine you and provide initial treatment for your injuries, but make sure to inform him that your injury is work-related. In the State of North Carolina, you are able (generally) to choose which doctor will give you treatment for your injuries. However, your employer may ask you to visit an approved doctor to confirm your injuries after you give him notice.
2. Notify your employer of your injury.
   You will have thirty days to inform your North Carolina employer of your injury after the date of the incident. Your notice should be in writing, and should have the date of the incident that lead to your injury and a short description of what happened. Your employer should file a claim with his workers’ compensation carrier for your claim, but do not depend on this happening. You will need to fill out a form 18 from the North Carolina Industrial Commission. Then, send the form 18 back to the Industrial Commission to begin the claims process. You will need to keep a copy of this form, along with any other forms, documents, bills, or records that have to do with the claims process or your injury.
3. Confirm that your claim is approved.
   If your claim is approved, you should receive a form 60 from your employer’s workers’ comp insurance company that admits your right to compensation. You will have to wait seven days from the date of incident for your benefits to begin. If you do not receive a form 60 or any other form of notice from the insurance company with 30 days of filing a claim, you should contact the North Carolina Industrial Commission for more information.

You can expect to receive compensation after seven days of your injury, if your claim is approved.

How Will I Know if I’m Covered by Workers’ Compensation in North Carolina?

In general, any North Carolina business that has three or more employees is required to have workers’ compensation insurance, or be self insured. However, there are exceptions including:

• Certain railroad companies do not have to provide workers’ compensation insurance to its employees.
• Domestic servants who have been hired directly by a household are not covered by workers’ compensation.
• Employers who operated a farm that have less than 10 farm hands who are not seasonal employees do not have to provide workers’ compensation.
• Federal government employees are not required to be covered by workers’ compensation. This is because federal workers are covered by federal workers’ compensation.
• Some construction companies and trucking companies are required to provide workers’ compensation regardless of how many employees they have.

Sometimes, the best way to find out if you are covered by workers’ compensation is to simply ask your employer.

What Types of Benefits does Workers’ Compensation Provide in North Carolina?

Workers’ compensation will take care of any reasonable medical expenses that are associated with your injury. Workers’ compensation can also reimburse you for travel expenses if you must travel farther than 20 miles (round trip) to receive treatment. Workers’ compensation is mainly used to provide income benefits, which are:

1. Temporary Total Disability (TTD) Benefits in North Carolina
   If your injury prevents you from returning to work, but you are expected to recover enough to return to work, you may qualify for Temporary Total Disability (TTD) benefits. You must skip at least seven days of work because of your injury in order to receive TTD benefits, but these days do not have to be consecutive. TTD payments are equal to two-thirds of your average weekly wage before you were injured. TTD payments can last up to 500 weeks after the date of your injury. Although, you can extend the amount of compensable weeks for your claim in certain cases. You will not be compensated for the first seven days of your disability, unless your disability lasts longer than 21 days.
2. Temporary Partial Disability (TPD) Benefits in North Carolina
   If your injury limits the amount of work that you can do and has reduced the amount of income you receive as a result, but you are expected to fully recover from this injury, you may qualify for Temporary Partial Disability (TPD) benefits. TPD payments are calculated by subtracting your average weekly wage after the incident that led to your injury from the wage that you made before the incident. Your TPD payment will be equal to two-thirds of the remaining number. You may receive TPD payments for up to 500 weeks after the date of the incident that led to your injury.
3. Permanent Partial Disability (PPD) Benefits in North Carolina
   If your injury permanently limits the amount of work or income you can have, then you may qualify for Permanent Partial Disability (PPD) benefits. The amount of money and time that you are compensated for a PPD depends on the location of your injury on your body, and the extent of your injury. Your doctor will examine your injury and determine its “disability rating” which represents the extent of your injury. How many weeks you will be compensated for your injury is outlined in the North Carolina State Code in Article 1, section 97-31 of the Workers’ Compensation Act. To calculate how much you will be compensated for a PPD, multiply your disability rating by the number of compensable weeks allocated to your injury and your compensation rate (which is usually two-thirds of you average weekly wage before the incident). You will only be able to receive PPD payments once your doctor decides that you have reached “Maximum Medical Improvement” (MMI). You can also file for a “change in condition” that may allow you to receive more compensation or a longer time period of compensation, if your condition worsens. However, you will only have two years to file for a change in condition after the date you first received a receipt of compensation.
4. Permanent Total Disability (PTD) Benefits in North Carolina
   If you have sustained an injury that permanently halts your ability to return to work, you may qualify for Permanent Total Disability (PTD) benefits. There is a certain criteria to establish whether or not you can receive PTD payments, which are:
   If you have lost–

1. Both hands
2. Both arms
3. Both legs
4. Both feet
5. Both eyes
6. Have lost any one combination or more of the above body parts

If you have suffered a spinal injury that resulted in paralysis in–

1. Both arms
2. Both legs
3. Torso

Or if you have suffered severe brain damage, or have second or third-degree burns covering 33 percent of your body or more.

PTD benefits are equal to two-thirds of your average weekly wage before you were injured, and will last for the rest of your life if you qualify.

It is important to note that income benefits cannot be higher or lower than the limits set by the State of North Carolina’s average weekly wage, which has a maximum of $920.

What Should I do if My North Carolina Workers’ Compensation Claim is Denied?

Your claim may be denied for a number of reasons, like not having your claim filed correctly, or by not showing that your injury is clearly work-related. You will need to file for a claims appeal if this happens. You should contact the North Carolina Industrial Commission first, in order to gather more information on your case and what options you may have. If your claim is still denied by your employer’s insurer, you should retain an experienced workers’ compensation attorney.

An experienced workers’ compensation attorney can assess if you have a valid claim, walk you through the claims process, and represent you at a hearing if necessary. You have the legal right to retain a workers’ compensation attorney at any point in the claims process. If your case does go to trial, your employer’s insurer will try to limit your rights to fair compensation. Protect your rights, and retain an attorney if your claim is denied.

 

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Additional Resources

Industrial Commission Webpage

North Carolina Workers’ Compensation Act