North Carolina Workers Compensation Basics

In North Carolina, every employer who has three or more employees regularly employed in the same business or establishment is required to carry workers compensation insurance. If the employer has one or more employees who work in the presence of radiation, the employer must have workers compensation insurance. If the employer works in the field of agriculture or has domestic servants, the employer must have workers compensation insurance if the employer has ten or more regular, non-seasonal employees. Executives of corporations and partners in partnerships are counted in the number of employees.

Obtaining Coverage:

To obtain workers compensation coverage in North Carolina, the employer has two options:

Purchasing a workers compensation insurance policy from a state approved insurance company.
Qualifying as an approved self-insured employer with the North Carolina Industrial Commission.
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Claim Reporting:

The employee must provide written notice of the injury to the appropriate manager at the employer within 30 days of the occurrence. The employer is required to file the Employer’s First Report of Injury form, Form 19, with the North Carolina Industrial Commission within 5 days of the report of the injury, if the employee misses one day from work or has medical bills of $2,000 or more. The employer also must send the employee a blank Form 18, Notice of Accident and Claim of Employee for the employee to complete. The employee must file the Form 18 with the North Carolina Industrial Commission within two years of the date of the accident or the date of last payment of medical compensation.

Medical Benefits:

The employer, or the employer’s insurance company,selects, provides and directs the medical treatment in North Carolina, subject to any Industrial Commission ruling. If the employee is unsatisfied with the medical treatment of the employer’s doctor, the employee can petition the Industrial Commission for a change in the medical provider. The Industrial Commission will approve the change in medical provider if the employee can show good cause. Payment of medical care from a different doctor is not required unless the employer, insurer or Industrial Commission has provided written permission to change the medical provider prior to the rendering of medical treatment.

The North Carolina Industrial Commission has a unique program for all medical payments on workers compensation claims. The medical providers send the medical bills to the insurer or self-insured. The insurer or self-insured compiles the medical bills and submits them to the Medical Fees Section of the Industrial Commission. The Medical Fees Section reviews each medical bill and determines the appropriate amount to be paid in accordance with the Industrial Commission’s Medical Fee Schedule. The Medical Fees Section returns the medical bills to the insurer or self-insured with instructions on how to much to pay on each medical bill. Drug bills and mileage reimbursements are exempt from this process.

All authorized medical care and associated expenses (prescriptions, prostheses, mileage reimbursements) are covered by workers compensation.

Temporary Total Disability Benefits:

The temporary total disability (TTD) benefits are calculated as two-thirds of the employee’s average weekly wage over the 52 weeks prior to the injury, not to exceed 110% of the state average weekly wage. The maximum amount of TTD benefits that can be paid weekly is adjusted annually on January 1st. The 2010 maximum was $834 per week and the 2011 maximum is $836 per week. The state minimum weekly benefit is $30. The indemnity rate remains the same throughout the life of the claim, it is not adjusted annually.

The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits are paid for the duration of the disability.

Temporary Partial Disability Benefits:

In North Carolina, if the employee is able to return to any type of work, but at a lesser rate of pay then the amount the employee was earning prior to the injury, the employee is entitled to temporary partial disability (TPD) benefits. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage. The TPD benefits are paid until the employee is physically able to return to the type of work done prior to the injury or for a maximum of 300 weeks.

Permanent Partial Disability Benefits:

North Carolina employees are paid permanent partial disability (PPD) benefits for any permanent disability suffered as the result of an on-the-job injury. For less than total disability, the percentage of disability is based on the medical provider’s rating of physical disability. If either the employee or the employer is unhappy with the physician’s disability rating for the employee, they can obtain a second opinion. If the employer and the employee still do not agree on the disability rating, both doctor’s ratings are sent to the Industrial Commission who then decides the disability rating.

North Carolina uses a schedule of injuries for limbs, vision and hearing. The loss of an arm is worth 240 weeks of indemnity benefits (with a week calculated the same as TTD). The schedule decreases as the size of the limb decreases down to a small toe being worth 10 weeks of benefits. A person with an injury to body as a whole is worth up to 300 weeks of indemnity benefits. For example, if the treating doctor gives the employee a 10% disability rating to the back, and the employee’s TTD rate was $600 per week, the employee will receive $18,000 ($600 X 300 X 10%).

Total and Permanent Disability:

For an employee to be classified as totally disabled in North Carolina, the employee must meet the narrow parameters set by the state. Total and permanent disability in North Carolina is defined as: The loss of both hands, both arms, both feet, both legs, or both eyes, or any two thereof, constitutes total and permanent disability, and entitles the worker to weekly benefits and medical compensation during his or her lifetime. When an employee is classified as having a total and permanent disability, indemnity benefits – calculated the same as the TTD rate – are payable for life.

Disfigurement and Damage to Internal Organs:

Facial scars and head scars that seriously disfigure an employee will entitle the employee to indemnity compensation up to $20,000. Serious body scars that disfigure the employee will entitle the employee to indemnity compensation up to $10,000. For the loss of an important body organ, the employee can be compensated up to $20,000. The employee cannot collect both disfigurement and a permanent partial disability rating for the same body part.

Death Benefits:

The burial expenses in North Carolina are covered for a work-related death up to $3,500. The death benefits for a dependent spouse and children are based on two-thirds of the employee’s average weekly wage with the maximum not to exceed the state’s average weekly wage [this differs from the way TTD benefits are calculated] for a minimum of 400 weeks. A minor child or a disabled spouse can receive more than 400 weeks of death benefits. Death benefits can be paid to a child up to age 18, or age 22 if enrolled in college. Death benefits to a spouse end when the spouse remarries.

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Vocational Benefits:

North Carolina’s workers compensation law requires vocational rehabilitation if the injured employee is unable to return to their prior job due to disabilities from their on-the-job injury, North Carolina requires the employer / insurance company to pay for the cost of retraining the injured employee to perform another job. In addition to job retraining, vocational benefits include:

Vocational assessment
Vocational exploration
Counseling
Job analysis
Job development
Job placement
Labor market surveys
Vocational or psychometric testing
Analysis of transferable skills

10.Work adjustment counseling

11.Job-seeking skills training

12.On the job training

Vocational rehabilitation is in the best interest of the employer, the employee and the insurance company as placement in a new job reduces or eliminates the amount of PPD that will be paid, and stops the employee from making a claim for permanent and total indemnity benefits.

NOTE: State laws change frequently. Nothing in this article is meant as legal guidance. For legal advice on a particular state’s most current law, please consult with you legal adviser.

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: [email protected] or 860-553-6604.

WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

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