Workers’ compensation insurance is required for any business that employs three or more people in North Carolina.
Any person who’s covered by workers’ compensation is entitled to benefits for lost wages and medical treatment related to their work-related injury. A work-related injury is one that happened while performing your job tasks, whether on or off your worksite.
Here are answers to the most frequently asked questions about North Carolina workers’ compensation:
A: You can receive benefits for lost wages and medical treatment.
Any medical treatment related to a work-related injury can be covered under workers’ compensation. This includes surgeries, doctor or hospital visits, prescription medications, assistive devices, therapies, and any other medical expenses.
You can also receive weekly benefits of two-thirds the amount of your wages from prior to the accident if you’re unable to return to work while recovering from the injury, up to a maximum amount set by the state.
Unfortunately, you can’t receive benefits for pain and suffering under workers’ compensation.
Workers’ compensation benefits include mileage reimbursement for your travel related to medical treatment, along with vocational services to assist you in returning to work, job placement, or retraining if you are unable to return to your previous job.
A: A deceased worker’s dependents can receive death benefits, along with funeral and burial costs.
Survivor benefits are two-thirds of the workers’ average weekly wage for up to 500 weeks. They are provided to a person who is wholly dependent on the deceased worker, including a spouse or minor child. If there are no dependents, the benefit is paid to the next of kin as a lump sum payment.
In North Carolina, workers’ compensation covers up to $10,000 of a deceased worker’s funeral and burial costs.
A: You must immediately inform your employer if you’re injured. You should submit a Form 18 to the Industrial Commission within 30 days, and you must file within 2 years of the injury.
You’re required to inform your employer as soon as possible of a work-related injury. If you’re unable to do so, you should ask a friend, family member, or coworker to report on your behalf. If you provided verbal notice, you must follow up with written notice within 30 days of the accident or discovery of the injury.
A: Any injury that happens while you’re at work or performing work-related duties would qualify for workers’ compensation.
Other injuries happen while you’re at work but might be unrelated to your actual job — for example, if you slip on a wet floor in the lobby of your office building or trip over a box left in a hallway.
There are 3 primary categories of injuries covered by workers’ compensation:
Workers’ compensation is a no-fault system. That means you can recover benefits without having to prove that your employer was negligent or at fault. You can receive benefits even if the injury was your own fault (as long as you weren’t intoxicated or breaking the law at the time of the accident).
In order to claim workers’ compensation benefits, you must prove 3 elements:
If your injury is work-related and eligible for workers’ compensation coverage, you are NOT permitted to file a personal injury lawsuit against your employer for that injury.
A: There are circumstances when your injury is caused by the negligence of someone who’s not your employer. If that’s the situation, you can file a personal injury lawsuit against that third-party person or company.
For instance, if you were injured as a result of defective personal protective equipment (PPE) like a harness or other garment specifically made to protect you while performing your job, you might have a product liability claim against the manufacturer of that item.
If your injury happened because of equipment or machinery that malfunctioned, it also might lead to a product liability claim against the product manufacturer.
If your injury is the result of a hazardous condition on property owned by someone other than your employer (for example, if you visit work sites, homes, or businesses as part of your job), you might be able to make a personal injury claim for premises liability.
A: Your employer will provide you a list of approved medical providers. You must go to an approved provider unless it’s an emergency situation. If you prefer to use your own physician or a specialist not on the approved list, you can make a request to your employer and their insurance carrier to see another provider.
You must receive permission from your employer, their insurance carrier, or the Industrial Commission before you receive treatment from a provider who’s not approved, or you’re not guaranteed payment for treatment costs.
A: If your claim is denied, you have a right to be notified with a detailed explanation. You can submit a Form 33 to request a hearing before the Industrial Commission.
A: Even if an employee is considered an independent contractor for tax purposes (i.e. you’re issued a Form 1099 rather than a W-2), there are situations where the employer must still provide workers’ compensation insurance.
The Industrial Commission would evaluate eligibility on an individual basis based on factors that include the degree of control that the employer has over the employee’s work process and other questions about how work is performed and paid.
A: You are not permitted to apply for unemployment insurance if you have a pending workers’ compensation claim or if your claim was denied. Even if you’re not able to return to work, you’re technically still on your employer’s payroll, you aren’t actively looking for a job, and you’re unable to go to work.
You may file a claim for disability insurance if your workers’ compensation claim is denied.
A: In North Carolina, you can receive temporary disability payments if you’ve missed more than 7 days of work because of your injury. Your benefits will continue on a weekly basis until your physician determines that you’re recovered and can return to work. If you miss more than 21 days of work, you can then recover benefits for the first 7 days.
If the injury left you permanently disabled and you won’t be able to return to work, you can receive your weekly benefits at the established rate for the remainder of your lifetime.
A: If your injury is minor, treatment costs are inexpensive, and you didn’t miss work time, you might be able to handle your claim on your own.
But if you’re looking at ongoing treatment or you’re unsure of future medical costs, you should consult a workers’ compensation lawyer near you. You need to be sure that the amount you’re being paid for future medical treatment will be enough to cover your costs — especially if it’s in the form of a lump sum settlement. Once you’ve agreed to an amount, you can’t change it if you find that your treatment will cost more than you expected.
Your lawyer knows the process, the laws, and the anticipated costs for future treatment. If your claim was denied and you’ve requested a hearing, it’s a good idea to have your lawyer handle that process.
Things can get confusing fast, and it might seem like everyone else involved knows more about the process than you do. Your best next step is to find a qualified, experienced North Carolina attorney who can help you get what you need and deserve after a work-related injury.