Injuries Covered & Benefits

What injuries are covered by Workers’ Compensation?

If your company has three or more employees, you may be eligible for workers’ compensation benefits. This is true regardless of your immigration status. North Carolina’s workers’ compensation laws cover injuries that result from an accident arising out of and in the course of employment. The law also covers “occupational diseases,” which include some lung conditions such as asbestosis and some repetitive-motion conditions, such as carpal tunnel syndrome. The law is very specific and insurance carriers are skilled at applying these rules to limit or deny claims. The issue of “fault” or “negligence” does not matter in workers’ compensation. You can recover compensation even if you are at fault in the accident. In most cases, you cannot sue your employer outside of the workers’ compensation system for your injuries. Workers’ compensation benefits are considered an “exclusive remedy” against your employer.

What benefits are available under Workers’ Compensation?

Workers’ compensation benefits fall into three basic categories: (1) payment for your medical treatment and related medical expenses; (2) compensation for lost wages at 2/3 your average weekly earnings, including overtime and bonuses (often called “TTD”); and (3) compensation for permanent disability (often called a “rating” or “PPD”). Pain and suffering is not recoverable under workers’ compensation law. Workers’ compensation benefits are not taxed.

How are my weekly benefits calculated?

Most workers should receive time and a half for every hour worked over 40 hours per week. The insurance company must take into account overtime when calculating your weekly benefits. Your weekly benefits are calculated by averaging your wages in the one year before your injury. You receive two-thirds of this amount for any week that you miss work due to your injury. Workers’ compensation benefits are not taxed, so the 2/3 wages is roughly your after-tax weekly earnings. This is called your “compensation rate” and must be paid to you for the times you miss work due to your injury. The adjuster may refer to this check as “TTD” which stands for “temporary total disability.”

The first week you miss work due to your injury is considered to be a waiting period. You do not get reimbursed for that week unless you are out of work for more than 21 days. If you are out of work for more than 21 days, then you get reimbursed for the first week. If you are only out of work for two weeks, then you do not get paid for the first week, but will get paid for the second week.

How long can I receive medical treatment?

Generally, you have two years after the insurance company pays your rating or your last medical bill, whichever is later, to see the doctor for your injury. For example, if you see the doctor six months after you receive payment for your rating, the two-year clock starts again from the date of your last medical appointment. As long as you are seeing the doctor at least once every two years, you should be entitled to medical benefits for as long as you need to see a doctor for your work-related injury.

Am I allowed to choose my own doctor?

If the insurance company accepts your claim, it gets to direct your medical treatment. However, if you are unhappy with the treatment you are receiving, you can request a change of physician to your own doctor. At the end of your treatment period when you have reached “maximum medical improvement” or “MMI,” the doctor may issue a “permanent partial disability rating” or “PPD” to the part of your body that was injured. The higher the rating, the more money your injury is worth. If the insurance company’s doctor gives you a low rating, you are always entitled to a second opinion on this rating with a doctor of your choice.

Do I get paid for mileage?

If your doctor’s appointment is more than 10 miles one way (20 miles round-trip) from your home, then you are entitled to mileage reimbursement. The reimbursement rate is modified each year, but it is currently at 56¢ per mile. If you do not have transportation, the insurance company must arrange for a car to come get you and take you to the doctor.