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. The average weekly wage does include overtime, paid holidays, special allowance for boarding, lodging, etc. The weekly rate of compensation is subject to a minimum and a maximum amount, and the maximum weekly benefit is adjusted annually. The rate of compensation remains the same during the entire life of the claim.

What happens if the employee returns to work earning less wages?
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.

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. 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. An employee is entitled to collect for mileage for the purpose of obtaining medical treatment. The rate is 31 cents per mile for travel after June 1, 2000, provided that the employee travels 20 miles or more round trip. 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. The Industrial Commission has specific rules that govern the conduct of a nurse case manager. 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.

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. 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 does an employee contact the 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/).
-----------------------------------------------------------------------------------------------------------------

Lewis & Daggett Attorneys at Law, PA, publishes this web site as a service to our clients and friends for general informational purposes only. These materials do not, and are not, intended to, constitute legal advice. You should not act upon any such information without seeking professional counsel. These materials may be considered advertising in your state.

The information provided at the web site is not privileged and does not create an attorney-client relationship with Lewis & Daggett Attorneys at Law, PA, or any of the firm1s lawyers.

Lewis & Daggett Attorneys at Law, PA, has its principle office in Winston-Salem, North Carolina. Its attorneys are licensed to practice law only in North Carolina and not in any other jurisdictions. The firm does not intend to practice law in any jurisdictions where the firm is not licensed.