Understanding Workers’ Compensation Benefits in North Carolina

A workplace injury can be a life-altering event, bringing not only physical pain but also significant financial stress. At the same time an injured worker may well be undergoing significant emotional stress. For employees in North Carolina who are injured on the job or develop an occupational illness, the state’s workers’ compensation system is designed to provide a vital financial and medical safety net. Benefits can be limited, so it is important for an injured worker to obtain all the benefits they are due.

Understanding the different types of benefits available is the first crucial step toward protecting your well-being and financial future, as well as your family’s. Here is a breakdown of the primary categories of workers’ compensation benefits in North Carolina.

1. Medical Benefits: The Foundation of Recovery

The most immediate and essential benefit is coverage for your medical care. North Carolina workers’ compensation covers all medical, surgical, and hospital services reasonably required to effect a cure, give relief or lessen the period of disability.

What is typically covered?

• Doctor’s Visits and Hospital Care: All necessary appointments, inpatient stays, and outpatient procedures.
• Prescription Medications: Any drugs prescribed by your authorized treating physician.
• Physical Therapy and Rehabilitation: Services needed to restore function and manage symptoms.
• Medical Equipment: Devices like crutches, wheelchairs, or braces.
• Mileage Reimbursement: Travel expenses for medical appointments if the round-trip distance exceeds 20 miles.

Important Note: In most cases, the employer (or their insurance company) has the right to direct your medical treatment, meaning they select the authorized doctor. You can, however, petition the North Carolina Industrial Commission (NCIC) to request a change of physician or for a second opinion.

One More Important Note: The insurance company will frequently deny treatment or medications, even when it is recommended by the physician they chose. In this case, the employee can file a Medical Motion with the Industrial Commission to force the carrier to authorize and pay for the treatment.

2. Disability Benefits: Replacing Lost Wages

When a work injury causes you to miss time from work, disability benefits, also known as indemnity benefits, provide cash payments to replace a portion of your lost wages. These are broken down into four key categories:

A. Temporary Total Disability (TTD)

• What it is: Paid when your doctor determines that you are unable to work in suitable employment, or when you have restrictions that your employer cannot accommodate.
• Payment: Generally two-thirds (66 2/3%) of your average weekly wage, up to a state-set maximum.
• Waiting Period: Benefits do not start until you have missed more than seven days of work. If you are out of work for 21 days or more, you are paid for the first seven days retroactively.
• Duration: Generally can be paid for up to 500 weeks, though exceptions for severe injuries can allow for lifetime benefits.

B. Temporary Partial Disability (TPD)

• What it is: Paid when you return to work but at lower wages than before your injury.
• Payment: Two-thirds (66 2/3%) of the difference between your pre-injury average weekly wage and your post-injury weekly wage, up to the maximum comp rate.
• Duration: Generally paid for up to 500 weeks.

C. Permanent Partial Disability (PPD)

• What it is: A lump-sum or weekly payment awarded after you reach Maximum Medical Improvement (MMI)—the point when your condition is not expected to improve further—and have a permanent impairment to a scheduled body part (e.g., an arm, hand, foot, eye, or back).
• Payment: The payment is calculated using your impairment rating (a percentage determined by your doctor) and the number of weeks assigned by law to the specific body part. 

D. Permanent Total Disability (PTD)

• What it is: Reserved for the most severe injuries, such as the loss of any two major body parts (hands, arms, feet, legs, eyes) or a severe spinal cord or brain injury resulting in permanent and total incapacitation for work.
• Payment: Two-thirds (66 2/3%) of your average weekly wage.
• Duration: Paid for life.

3. Other Important Benefits

• Disfigurement Benefits: Compensation may be paid for serious and permanent scarring or disfigurement to the body, which is not already covered by a PPD award.
• Damage to Important Organs and Body Parts: Compensation may be paid for permanent injury to an important organ or body part.
• Vocational Rehabilitation Benefits: If your injury prevents you from returning to your former job, the workers’ compensation system may provide vocational services like job training, job placement assistance, transferable skills analysis, and counseling to help you find suitable new employment.
• Death Benefits: In the tragic event a work-related injury or illness results in death, dependents may be entitled to financial support (typically 66 2/3% of the deceased worker’s average weekly wage) for 500 weeks, and coverage for burial expenses (up to a state-set limit).
• Attendant Care Benefits: Attendant Care Services (or home care) is a benefit available to an injured worker who requires assistance with daily tasks due to a work-related injury or illness. This is considered part of “medical compensation” under NC law.

4. The Next Steps for an Injured Worker

If you are injured on the job, it is critical to act promptly:

• Report the injury to your employer immediately.
• Seek medical treatment and tell the provider it is a work-related injury.
• File your claim with the North Carolina Industrial Commission (NCIC) using Form 18 (Notice of Accident to Employer and Claim of Employee). While you have two years to file, it is best to do it as soon as possible.

The North Carolina workers’ compensation system is a complex legal area. While this overview provides a general guide, every case is unique. Consulting with a qualified NC Workers’ Compensation Attorney is highly recommended to ensure your rights are protected and that you receive all the benefits you are entitled to.