Discover More About The Basics Of Workers' Compensation

Who is covered by workers' compensation?

The law requires that most businesses that employ three or more employees on a regular basis to be covered by workers' compensation insurance.

When are employees entitled to workers' compensation benefits?

Injured workers in North Carolina are entitled to workers' compensation benefits in three situations. They are:

  • Accident: An accident occurs when employees are injured, while working for their employers by unusual, unexpected circumstances such as slip, trip, fall or other unusual activity.
  • Incident: A specific traumatic incident applies mostly to back injuries and occurs when employees are injured by normal work activities. There is an instantaneous occurrence but may not be an external cause, or unusual condition; but there must be a specific incident causing the hernia or back injury.
  • Disease: An occupational disease is a condition in which the job either contributed to or was the causing factor of a disease's development. In addition, the job must give the worker a greater risk of contracting the disease than the general public.

What steps should you take to obtain benefits after you have been injured?

Give the employer written notice within 30 days, or for occupational disease, 30 days of being advised by a doctor or medical authority. If notice is not given within 30 days, the Industrial Commission (IC) must be satisfied that the employer has not been prejudiced and that a reasonable excuse exists for the failure to provide the notice.

A Form 18 should be filed with the IC within two years after the accident, or for occupational diseases, within two years of being advised by a doctor or medical authority, otherwise the statute of limitations would bar any recovery. Form 18 must be sent to the employer or insurance carrier.

Your employer should report the injury to the Industrial Commission on IC Form 19 if your medical bills exceed $2,000.

Who should provide and direct your medical treatment?

The employer or its insurance company, under direct supervision of the IC, will provide and direct your medical treatment. In other words, they will choose your attending physician. The Industrial Commission may allow you to change the doctor of your choice if good grounds are shown. However, the doctor visit will only be covered if written permission is obtained before treatment is rendered; but it may later be approved by the IC.

If the employer allows you to be treated by a chiropractor, you are entitled to 20 visits if medically necessary. If you need additional visits, the chiropractor must request this from the insurance carrier or through a formal request from the IC.

What kind of benefits should you expect?

Temporary total disability: If you are unable to work after the first seven days of disability, you are entitled to weekly benefits equal to two-thirds of your average weekly wage up to the maximum compensation rate. After disability has continued for more than 21 days, the employee is entitled to receive compensation for the first seven days of disability.

Temporary partial disability: If you are unable to earn wages as great as those earned pre-injury, the employee is entitled to compensation to two-thirds of the difference between the post-injury and pre-injury average weekly wages, so long as this amount does not exceed the statutory maximum weekly benefit of 300 weeks from the date of injury.

Permanent total disability: If at the end of the healing period, there is a permanent impairment to one of the parts of the body, you may receive a set period of benefits without regard to your ability to earn wages. You are entitled to two-thirds of your average weekly wage, times the number of weeks determined for the body part not to exceed 300 weeks from the date of injury. If there is a dispute with the treating physician's rating, the employee may obtain a "second opinion" of another doctor.

Travel and prescription reimbursement: Injured employees who must travel at least 20 miles round trip for medical treatment are entitled to collect for mileage in workers' compensation cases. The rate of reimbursement is 54 cents a mile as of January 1, 2016. Employees are entitled to prescription reimbursement for medication prescribed by the approved treating physician.

What happens if they deny your claim?

If your claim is denied, you are entitled to a detailed statement from the employer or the insurance carrier of the grounds for denying the claim within 14 days of receipt, unless time is extended by the Industrial Commission. You can ask for a hearing before the Industrial Commission by filing an IC Form 33. This request must be made within two years of the date of the injury to preserve your right as an injured worker.

Parker & Frey PLLC focuses on assisting clients with workers' compensation in the Dunn and Fayetteville areas. Contact us to discuss your injuries with one of our board-certified attorneys by phone at 910-591-2551 or by sending us an email.