Workers Comp FAQ
1. What kind of disability benefits does workman’s comp cover?
Workers’ compensation offers three major types of benefits, including:
- Weekly checks for time missed from work
- Payment for related medical expenses
- Payment for permanent injuries
The severity of your injuries or the length of time you’re away from work determines which benefits you may be eligible to receive.
At Henson Fuerst, we’re familiar with workers’ compensation laws in North Carolina, and we can determine the types of benefits you’re owed. If you need help filing a benefits claim, contact our North Carolina workers’ compensation lawyers at (919) 781-1107 or fill out a free initial consultation form. Let us put our experience to work for you—call today.
2. Does workers’ comp pay for long-term damages in North Carolina?
While your doctor has you written out of work, you are entitled to Total Temporary Disability (TTD). These are weekly checks in the amount of two-thirds of your gross weekly pay at the time of your injury. You also are entitled to payment for related medical expenses. Depending on the outcome of your treatment, your doctor may also assign something called a disability rating, which allows you to be paid for a permanent injury.
3. When should I consult a lawyer in North Carolina over a workers’ compensation claim?
It depends on the severity of your injury. If you have a minor injury that doesn’t require surgery and your doctor expects you to make a full recovery and return to work, then you probably don’t need an attorney. However, if you have a more severe injury that requires surgery and your ability to return to your previous employment is in doubt, then it’s advisable to talk with an attorney.
4. Will workers’ comp pay lost wages in North Carolina?
Your sick days will be used for the first seven days you are out of work from your injuries. After the first seven days, if your doctor still has not permitted you to return to work, then lost wage payments (called Total Temporary Disability or TTD) should start. If you are out of work for more than 21 days, the insurance company may go back and pay you for the first seven days. In most cases, though, there is no way to recover vacation or sick time.
5. How much money does workers’ comp pay?
If you’re eligible to receive workers’ compensation benefits, you may receive up to 66.7 percent of your average weekly wage. However, this amount cannot exceed $862 per week. The maximum weekly benefit is adjusted every year to match cost of living increases.
6. Do I have to file my claim if my employer has already reported the accident?
Yes. Whenever an accident happens, two reports must be made: one by your employer and one by you. You must file a Form 18.
7. How much is the maximum weekly benefit from workers’ comp?
According to the North Carolina Industrial Commission, the maximum weekly benefit for 2012, applicable to all injuries and claims arising on and after January 1, 2012, is $862.00. The minimum weekly benefit is $30.00.
8. Am I responsible for my own transportation to doctors’ appointments?
If you have no way to get to the doctor, the insurance company will usually provide transportation. However, many times the transportation provided by the insurance company is less than reliable. It’s always better to use your own means of transportation, if possible.
If you decide to use your own car or have somebody drive you, you will be entitled to mileage reimbursement.
9. Should I call my employer every day I am absent because of my injury?
Generally, no. Your doctor will provide you a written excuse to be out of work for blocks of time, and your employer will likely have a copy of the doctor’s note. However, if your company has a policy making it appropriate or essential for you to call in sick each day, be careful to limit the conversation. Many people say too much to their employer about their injuries, and their words come back to haunt them.
10. What do I do when my claim is denied by my employer or the workers’ compensation company?
Consult an attorney. Workers’ compensation law may be too complicated to handle on your own. Many people try to go it alone and make mistakes that can be irreversible. You need a knowledgeable North Carolina workers’ compensation lawyer to help you navigate the process. Your employer and the insurance company will definitely have attorneys, which puts you at a disadvantage unless you have your own representation.
11. What should I do when the doctor releases me with restrictions that prevent me from doing my job?
This question is actually a lot more complicated than it sounds. If this happens, you should consult an attorney. The insurance company will likely assign a vocational rehabilitation counselor to work with you or ask you if you want to settle your case. There are restrictions on how a vocational rehabilitation counselor can work with you, and it’s important that you protect your rights when interacting with them. Henson Fuerst can help.
12. Should I use my health insurance if my claim is denied?
Yes. Use any means available to you to seek medical treatment. From a health standpoint, you want to minimize the amount of time between an injury happening and having that injury treated. From a claims standpoint, you want to make sure that you are building a record of your injuries and resulting treatment from the very beginning. More claims are lost due to lack of documentation than almost any other reason.
13. What is a vocational rehabilitation counselor?
The North Carolina Division of Vocational Rehabilitation Services uses vocational rehab counselors to help people with disabilities and injuries live more fulfilling lives. These counselors assist by:
- Assessing their clients’ capabilities and limitations
- Working with their clients to set goals for employment and independent living
- Arranging training and therapy to meet those goals
- Facilitating job training and placement
14. Should I look for another job if my restrictions will not allow me to return to my job?
Yes. You should look for another job and keep a log of all efforts you make along the way. Having a record of your job search may help prove that you are unable to work, which will allow you to keep receiving your TTD checks. This documentation is critical in hearings or settlement conversations.
15. What is a permanent restriction?
A permanent restriction is a doctor’s order that says you can’t perform the work you did before you were injured. If you can’t perform your former job duties, your employer may give you an alternative work assignment. But if your employer can’t accommodate your restrictions, you may be eligible for TTD benefits while you look for another job.
16. Do I have to allow my nurse case manager to attend my doctors’ appointments?
Yes. The nurse case manager has the right to attend your doctor appointments. However, he or she has no right to be in the room with you while you are being examined by the doctor. If you elect to have a private exam, the nurse case manager must respect that request. When the exam is complete, the nurse case manager has the right to speak to your doctor, but you should always try to be in the room while your nurse case manager is talking to your doctor.
17. How long do I have to wait to start getting workers’ comp benefits in NC?
After you apply for workers’ compensation benefits, there is a seven-day waiting period during which time you will not be compensated for time lost. The only exception to this is if the injury you incurred leaves you unable to work for more than 21 days. In that case, you may receive compensation during the first seven days.
It is important to note that those who must wait seven days may elect to use their earned sick days or vacation leave during this period.
18. Who pays for workers’ compensation?
Generally speaking, your employer is responsible for paying for your workers’ compensation insurance as established in the North Carolina Workers’ Compensation Act.
Employers typically purchase coverage through private insurance companies, which will payout in the event an employee becomes injured. Those that are unable to get coverage through private insurers may be eligible to get coverage through NC’s assigned risk pool, which is administered through the North Carolina Rate Bureau. Another option some employers choose is to self-insure. This means that the employer pays for their employees’ claims out-of-pocket.
19. Can I be fired while I’m out on workers’ compensation?
While some people avoid filing for workers’ compensation for fear of retaliation, you cannot be fired because you have filed for workers’ compensation but you can be fired while you have an open claim for workers’ compensation. However, in order to fire you, your employer must be able to demonstrate that there was another reason for doing so that had nothing to do with your open claim.
20. Are workers’ comp settlements taxable?
Workers’ compensation benefits are usually not taxable. However, there may be an exception for those individuals who also receive disability benefits via Social Security disability insurance (SSDI) or Supplemental Security Income (SSI).
If an individual’s workers’ compensation benefits and disability payments are above a specific threshold, the Social Security Administration (SSA) may reduce these benefits so that the combined total remains below the threshold.
The only money through workers’ compensation that is taxable is the amount by which the SSA can reduce your monthly benefits. For example, if the SSA lowers your monthly SSDI check by $300 (to keep your total below the threshold), then $300 of your workers’ compensation is taxable.
Most people who receive workers’ compensation and Social Security benefits don’t make enough taxable income to even owe federal taxes. However, even those who do generally pay little in taxes on workers’ compensation.
21. What benefits other than medical care can I receive?
If your claim is compensable, you may be eligible to receive the following:
- Temporary total disability benefits may be issued to you if your doctor has written you completely out of work, or if you have restrictions that your employer cannot accommodate. The amount is two-thirds of your average weekly income. However, these benefits cannot exceed the state’s maximum weekly compensation rate under the law, which is set each year. For 2020 the maximum benefit is $1,066 per week. These benefits are capped at 500 weeks.
- Temporary partial disability benefits may be issued to you if you return to work, but have restrictions that cause you to earn less. The amount is two-thirds of the difference between your income prior to the injury and your income after. For example, if you earned $1000 weekly before the injury but are now earning $400, the difference is $600. Two-thirds of $600 is $400, which is what you would earn in benefits weekly. Temporary partial disability payments are paid out for no more than 500 weeks.
- Permanent partial disability benefits may be issued if a doctor finds that you have a permanent disability to a specific body part. If it is determined that you have a permanent disability to your arms, hands, legs, feet, ears, eyes, or back you may receive two-thirds of your average weekly income for a limited number of weeks. The number of weeks you receive these benefits is dependent on what part of the body is permanently disabled according to the North Carolina Workers’ Compensation Act.
For example, the total loss of the use of your hand would provide you with two-thirds of your average weekly income for 200 weeks. Therefore, if you suffered a 50 percent loss of the use of your hand, you would receive two-thirds of your average weekly income for 100 weeks.
- Scarring or damage to an organ: In lieu of a disability rating, The North Carolina Industrial Commission can issue awards for scarring, disfigurement, or damage to an internal organ. Such payments include:
- Up to $20,000 for serious disfigurement to the head or face;
- Up to $10,000 for serious disfigurement to another part of the body; and
- Up to $20,000 for permanent disability to an internal or external organ.
- Permanent total disability benefits may be issued if a doctor finds that you are permanently or totally disabled. These benefits are not subject to the 500-week cap. These benefits are only awarded if you suffer from one or more of the following limitations as a result of your injury:
- The loss of both hands, both arms, both feet, both legs, both eyes, or any two thereof.
- Spinal injury involving severe paralysis of both arms, both legs, or the trunk.
- Severe brain or closed head injury as evidenced by severe and permanent:
- Sensory or motor disturbances;
- Communication disturbances;
- Complex integrated disturbances of cerebral function; or
- Neurological disorders
- Second-degree or third-degree burns to thirty-three percent (33%) or more of the total body surface.
22. Who qualifies for workers’ compensation?
Generally speaking, in order to qualify for workers’ compensation you must meet four requirements:
- You must be an employee;
- To qualify for workers’ compensation you must be an employee. It is important to note that independent contractors and volunteers are not usually entitled to workers’ compensation benefits.
- You must have a work-related injury or illness;
- In most cases, if you are performing a task for the benefit of your employer it is considered work-related. Therefore if you meet these criteria and become injured, it is a work-related injury.
- Your work-related injury must be the result of an accident or occupational disease; and
- Not every injury or illness that occurs on the job entitles you to benefits. Generally, the injury or illness must have been caused by an accident or exposure. There are many exceptions, but in general you will not be eligible for benefits if an injury occurs spontaneously while performing your regular job duties.
- You must meet North Carolina’s deadlines for reporting the injury and filing a workers’ compensation claim.
- Within thirty days, or as soon as practical, after you have been injured you must give written notice to your employer. Be sure to include the date of the accident and a brief description of your injury in the statement and to keep a copy of it for your records. Within 2 years of the date of the accident, a Form 18 Notice of Accident must be filed with the NC Industrial Commission. The attorneys at Henson Fuerst can help you do so.