North Carolina's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers and sole proprietors.
Exemptions from coverage may apply to certain employees, including employees of small agricultural operations, and domestic servants.
Medical Benefits are provided to employees entitled to workers' compensation benefits, with coverage for medical care reasonably related to the injury, subject to utilization review. Limits are placed on chiropractic care, and inpatient medical services may require pre-authorization.
The employer makes the initial choice of treating physician. The employee may change physician subject to the approval of the workers' compensation commission. An injured worker may request one second opinion for a permanent partial disability (PPD) rating, and may request an independent medical exam (IME) with the consent of the employer or workers' compensation insurer or by order of the commission.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 7 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 21 days indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's average pre-injury weekly wage, subject to a cap, and continue for up to 500 weeks. Benefits can potentially be extended if the injured worker has sustained a total loss of wage-earning ability. Offsets may apply for unemployment insurance and Social Security retirement benefits.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In North Carolina PTD benefits are calculated based upon 2/3 of the injured worker's pre-injury wage, subject to a cap, and may continue for up to 500 weeks, subject to a possible extension if the worker has sustained a total loss of wage-earning capacity. Offsets may apply for unemployment insurance and Social Security retirement benefits.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In North Carolina PPD benefits are determined based on a disability rating of the injured worker, along with a statutory schedule of the weeks of benefits assigned for the injured body part, and are calculated based upon 2/3 of the worker's pre-injury wage, subject to a cap.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In North Carolina, TPD benefits are paid based upon 2/3 of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Benefits may be payable for up to 300 weeks.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 2/3 of the worker's average weekly wage, subject to a cap in amount and duration. Benefits may continue for minors until the age of 18. Spousal benefits end upon remarriage.
Attorney fees cannot be unreasonable, and are subject to review by the state Industrial Commission.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
North Carolina Industrial Commission
4340 Mail Service Center
Raleigh, NC 27699-4340
(919) 807-2501 or 1-800-688-8349