North Carolina Workers’ Compensation FAQ

This page provides basic information on the North Carolina Workers’ Compensation Act as provided on the North Carolina Industrial Commission’s web site. The North Carolina Industrial Commission is an agency of the State of North Carolina created by the General Assembly in 1929 to administer the North Carolina Workers’ Compensation Act. This page is not intended to answer all questions. For specific information about your situation, you should talk with a Social Security representative.

Who is required to provide workers’ compensation coverage?

Any employer who employs three or more employees.

NOTE: Every executive officer selected or appointed and empowered in accordance with the charter and bylaws of a corporation is considered an employee of such corporation. For example, a corporation with two officers and one employee would be required to provide workers’ compensation coverage. Any employer in which one or more employees are employed in activities that involve the use of or presence of radiation is required to have coverage.

What if my employer does not have workers’ compensation insurance?

The employee should report the lack of workers’ compensation insurance or approved self-insurance to the NCIC Fraud Section and, if injured, should file a Form 18 and Form 33 with the Commission.

What must an employee do when an injury occurs?

Report the injury to the employer, orally and in writing, immediately and in any event within 30 days.

What should be done if the employer fails or refuses to report an injury?

The Employee should file a claim (Form 18 or 18B) within two years of the accident with the Industrial Commission.

Who provides and directs medical treatment?

The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The employee may petition the Commission to change physicians or approve a physician of employee’s selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.

Chiropractic Rules:
If the employer grants permission to seek medical treatment from a chiropractor, the employee is entitled to 20 visits if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the employer.

When can reimbursement for sick travel be collected?

If employees travel 20 miles or more round trip for medical treatment in workers’ compensation cases, they are entitled to collect for mileage at the rate of 25 cents a mile for travel prior to June 1, 2000; 31 cents a mile for travel between June 1, 2000 and January 17, 2006; 44.5 cents a mile for travel between January 18 and December 31, 2006; 48.5 cents a mile for travel between January 1 and December 31, 2007; 50.5 cents a mile for travel between January 1 and June 30, 2008; 58.5 cents a mile for travel between July 1 and December 31, 2008; and 55 cents a mile for travel on or after January 1, 2009. Special consideration will be given to employees who are totally disabled.

Note: The Industrial Commission has given the self-insurers and insurance carriers permission to pay drug and travel expenses directly to the employee without approval from the Commission.

What happens if, in an emergency, the employer fails or refuses to provide medical treatment?

The employee may obtain the necessary treatment from a physician or hospital of his own choice, but must promptly request the Commission’s approval.

When do I become eligible for lost wage compensation?

No compensation is due for the first seven (7) days of lost time unless the disability exceeds 21 days. Therefore, the first check will not include payment for days 1-7. Payment for those days will be made should the disability continue beyond 21 days.

How often are compensation payments made?

Weekly, but the Commission can authorize payments on a monthly basis in some circumstances.

At what rate of pay are compensation payments made?

66 2/3% of the average weekly wage, not to exceed $816.00* (2009 maximum) per week.
* The maximum weekly benefit is adjusted annually.

How long is the employee eligible to receive lost-time weekly benefits?

Until the employee is able to return to work.

What is permanent partial disability?

Total loss or partial loss of use of a member of the body or inability to earn the same wages in any employment as earned at the time of injury.

Who determines permanent partial disability?

The Commission, based on the impairment ratings of physicians or evidence of consideration of wage earning capacity.

What happens when the employer refuses to acknowledge the claim?

When liability for payment of compensation is denied, the Commission, claimant, his or her attorney (if any), and all known providers of health care shall be promptly notified of the reason for such denial. The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the denial of liability.

If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.
Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers’ compensation claim.

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