What injuries are covered under Workers’ Compensation?
Employees are entitled to receive benefits if they suffer an injury that “arises out of and in the course and scope of their employment” with the employer. The injury must occur while the employee is carrying out activities for the benefit of their employer. In addition, the injury must be an “accident,” be the result of a “specific traumatic incident,” resulting in a hernia or back injury, or an “occupational disease,” such as carpal tunnel syndrome, etc.

What should an employee do when an injury occurs on the job?
An employee should immediately report the injury to the employer orally and in writing, or at least within 30 days of the injury. The employee should also file a claim with the North Carolina Industrial Commission within two years of the injury using Form 18.

What benefits does an employee receive while out of work?
An employee is eligible to receive a “temporary total disability” check each week when completely unable to earn wages as the result of the work-related injury.  The employee is eligible to receive total disability benefits until he or she is able to return to work.  An employee is not due compensation for the first seven (7) days of lost time unless the period of disability exceeds 21 total days. Therefore, payment for days one through seven is made only after the total disability continues beyond 21 days.

What amount is the employee paid in weekly benefits while out of work?
The total weekly disability check is two-thirds (2/3) of the employee’s “average weekly wage.” Usually, the average weekly wage is figured by averaging all wages earned by the employee in the place of employment in which the employee was injured during the 52 weeks prior to the injury date.

How is the Average Weekly Wage determined?
USUALLY, the average weekly wage is figured by averaging all wages earned by the employee in the employment in which the employee was injured during the 52 weeks prior to the injury date.  The average weekly wage includes overtime, paid holidays, special allowance for boarding, lodging, etc. The weekly rate of compensation is subject to a minimum and a maximum amount.  For example, for injuries occurring during the year of 2008, the minimum benefit is $30.00 and the maximum weekly benefit is $786.00.  The maximum weekly benefit is adjusted annually. The rate of compensation remains the same during the entire life of the claim.  

What if I don’t receive my benefits on time?
The check for your workers’ compensation benefits should arrive approximately on the same day each week.  Occasionally, it may be a day or two late.  If it is more than several days behind schedule, then this may be a problem that you may want to discuss directly with the insurance company, with the Industrial Commission, or with an attorney.

What happens if the employee returns to work earning less wages than before the injury?
The employee may be entitled to receive a partial disability check if the employee returns to work and the pay received for this work is not as much as the average weekly wage earned before the injury. The amount of this partial disability check will be two-thirds (2/3) of the difference between the average weekly wage the employee made before the injury and the weekly wage earned after the return to work. You normally must submit your pay stubs or have your employer submit pay information to the insurance company in order for you to receive your weekly checks on time.

Who provides and directs the medical treatment of the employee?
If the employer or its insurance company has accepted the employee’s claim and is paying for medical expenses, then the employer or the insurance company generally provides and directs medical treatment in North Carolina. The Industrial Commission may allow an employee to change physicians or may approve a physician of the employee’s desire when proper grounds are shown.  In all cases, be sure to follow your doctors’ orders.  For example, if home exercises are prescribed, then you should do them.  If medicine is prescribed, then you should take it.  If additional pain or other symptoms occur with either home exercises or the prescribed medication, let your doctor’s office know at once.

What if I miss a medical appointment?
Keeping your appointments is very important. There is rarely a good reason to miss appointments with your medical care providers. By doing so, you imply that you are not hurt, that your injuries do not matter, and that you do not need help. Not keeping the appointments could affect your weekly compensation checks and could affect the value of your case.

Can I be reimbursed for Mileage for driving to and from Medical Treatment? What about Medication and Medical Equipment?
An employee is entitled to collect mileage reimbursement for miles driven to and from medical treatment if the round trip is 20 miles or more. You may have to submit this information to the employer or carrier on Industrial Commission forms.  Also, if an employee pays for medication and/or medical equipment out-of-pocket, the employee may be eligible for reimbursement by the employer or its insurance company.

What role does a Nurse Case Manager or Rehabilitation Nurse play in a claim?
The employer or insurance company will often ask a nurse case manager to oversee the employee’s medical treatment and return to work. A rehabilitation nurse is hired by the insurance company, not by your doctor. The Industrial Commission has specific rules that rehabilitation nurses must follow in workers’ compensation cases, and the nurse case manager is supposed to provide a copy of these rules to you. In general, the rules limit the ability of a nurse case manager to go with an employee into the examining room when the employee visits the treating physician. If an employee does not want the nurse case manager to accompany him or her into the exam room, the employee should instruct the nurse to wait outside the room. The nurse can talk with the physician after the visit and the examination. The employee has the right to be present at any such meeting between the nurse and the physician.

What role does a Vocational Rehabilitation Specialist play in a claim?
An employee may need vocational retraining or help finding a new job at the expense of the employer or its insurance company when the employee cannot return to his or her former job with the employer. In such a situation, the employer or its insurance company may assign a vocational rehabilitation specialist to help the employee find suitable employment. There are certain rules and laws that protect the employee when searching for suitable employment. There are also certain rules and laws that an employee must follow when returning to work, or an employee’s case and ability to receive compensation may be affected. This process can be very confusing. Do not hesitate to seek advice from an attorney concerning vocational rehabilitation and return to work issues.

What is a permanent partial disability rating?
Total or partial loss of use of a member of the body directly caused by a work-related injury may result in permanent partial disability. The Industrial Commission ultimately determines permanent partial disability based on the impairment ratings of physicians. When there is a permanent impairment to one or more of the parts of the body listed in the Workers’ Compensation Act, the employee may receive a set period of benefits without consideration of the employee’s ability to earn wages. Permanent partial disability benefits are generally based upon a combination of the impairment ratings, the parts of the employee’s body involved, and the employee’s average weekly wage.

When should an employee file for a hearing with the Industrial Commission?
There are many issues that may cause disputes between an employee and the employer or its insurance company that require the employee to file for a hearing with the Industrial Commission. Very few cases actually go to a hearing before the Industrial Commission. It may take six to nine months or more from the date the hearing is requested until it is actually held. In particular, when an employee’s claim is denied, the employee must file for a hearing within two years of the injury date or the ability to receive benefits may be lost. A hearing request is filed with the Industrial Commission by use of Form 33.

How do I contact the North Carolina Industrial Commission?
If an employee needs to contact the North Carolina Industrial Commission in Raleigh, the phone numbers are 1-800-688-8349 or 1-919-807-2501. The Industrial Commission’s Internet site can also be a helpful resource. (http://www.comp.state.nc.us/).
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