North Carolina Workers’ Compensation: Filing, Benefits, & Appeals
Learn how to start your claim, how much you will receive, and how to appeal a denial.
If you are injured on the job or develop an occupational disease while working in North Carolina, you should file a workers' compensation claim. In North Carolina, employers with three or more employees are required to have workers’ compensation insurance. Workers’ comp provides benefits for work-related injuries or illnesses. The North Carolina Industrial Commission (NCIC) administers the state’s workers’ compensation laws.
Covered Workplace Injuries and Illnesses
North Carolina workers’ compensation laws provide coverage for all injuries and illnesses attributable to a work-related accident or occupational disease. Typical industrial injuries include back injuries, carpal tunnel syndrome, and knee, shoulder, and other joint conditions. North Carolina also covers occupational diseases, which are illnesses that arise out of environmental hazards in the workplace (such as exposure to asbestos).
To be covered, the injury or illness must have happened in the course and scope of your employment. Injuries sustained while commuting and during other non-work-related activities are not covered. (For more information, see What Injuries Aren’t Covered by Workers’ Comp?)
Filing a Claim
When you are injured on the job, your first step is to obtain immediate medical treatment if necessary. Tell your health care provider that you were injured at work and the name of your employer. This will ensure your health care provider bills your employer or its insurance company directly for the treatment.
At the earliest possible time, but no later than 30 days after your injury, notify your employer. You must provide oral and written notice of your injury to your employer within 30 days. The written notice does not have to be on a specific form; you simply need to write down what happened and when.
You must also file an official workers’ compensation claim. The form you complete is a Notice of Accident to Employer and Claim of Employee (Form 18). Your employer should provide you with a copy of the form, or you can download a copy at the NCIC’s website. Your employer will complete a separate form, Form 19. Your employer will send these forms to its workers’ compensation insurance carrier and to the Industrial Commission.
If your employer does not file the forms properly, you can submit Form 18 directly to the Industrial Commission. You must make sure that this form is filed within two years of the date of your injury.
Workers’ Compensation Benefits
Once your claim is allowed, you are eligible to begin receiving workers’ compensation benefits. These benefits can include medical treatment, compensation for lost wages, and compensation for permanent disability.
Medical benefits. Your employer, or its insurance company, is responsible for covering all claim-related medical care. Your employer can, however, require that you receive care from a certain physician or clinic. You can petition the Industrial Commission to receive treatment from another physician, but this can be a time consuming process and you may not have time to wait for treatment.
Temporary disability. If you are unable to work due to your industrial injury or occupational disease for more than seven days, you will receive temporary total disability benefits. These benefits are 66 2/3% of your lost wages, subject to a weekly maximum ($978 for 2017). These benefits cease when you are physically able to return to work or when you have reached maximum medical improvement (meaning your condition has improved as much as it is going to with treatment). If you are able to do modified or alternate work during this time, you can receive partial benefits.
Permanent disability. Once your condition has reached maximum medical improvement, your doctor will give you a permanent impairment rating. The Industrial Commission will use this rating to determine the amount of your monetary award for permanent partial disability. If you are permanently and totally disabled and can no longer work, you will continue to receive payments at your temporary disability rate for the rest of your life. If you have a partial disability, you will receive an award according to a state schedule, depending on the type and severity of your injury.
Appealing a Claim Denial
If your workers’ comp claim is denied, you will receive a notice with the reasons for the denial within 14 days of submitting your claim. Common reasons for denial include insufficient information regarding the injury and failure to prove that the injury was caused by a work-related activity. Claims may also be denied if they are reported too late or if the proper paperwork is not submitted.
To start your appeal, you must file a Request for Hearing (Form 33) within two years of the date of your injury.
Before a formal hearing, you will have a mediation conference. According to the NCIC, approximately 70% of cases are resolved at the mediation stage, eliminating timely and costly litigation.
You and your employer’s insurance company may select a mediator from an approved list from the NCIC. If you cannot agree on a mediator, the NCIC will appoint a mediator. You and the insurance company will share the costs of the mediator. The insurance company will likely have an attorney; it’s a good idea for you to consider hiring an attorney as well.
At the mediation conference, be prepared to present evidence showing why your workers’ compensation claim should be allowed. Look closely at the reasons listed on the notice of your claim denial. You should have evidence to refute each of the reasons your claim was denied. This can include documentation from your doctor showing that your condition was caused by work or documentation that you reported your injury or illness to your employer in a timely manner. You may wish to obtain signed statements from coworkers who witnessed your accident to show how the accident occurred.
After the mediation, the mediator will make a recommendation as to whether your claim should be allowed. The mediator will also file a report with the NCIC. However, if you do not agree with the recommendation, you will move on to a formal hearing with the NCIC.
A formal hearing with the North Carolina Industrial Commission is much like a trial. Both parties present witnesses and evidence, and a deputy commissioner makes a final determination regarding the issues.
Because of the sophisticated nature of the proceedings at a formal hearing, you should strongly consider hiring an attorney to represent you if you do not already have one by this point. You will be expected to have full knowledge of the rules of procedure and evidence applicable to the hearing; an attorney can help make sure that your case is presented in the best way possible.
At the formal hearing, you will present all the evidence for why your claim should be allowed. This may include medical evidence, testimony from witnesses to show the accident occurred as you describe, or evidence that you notified your employer of the injury or illness on time. After the hearing, the deputy commissioner will mail out a decision regarding your case.
Either party may appeal the deputy commissioner’s decision to the Full Commission. This is a panel of three workers’ comp judges who will review the record of your hearing, accept briefs submitted by the parties, and possibly hear oral arguments. To file your appeal, you must submit an Application for Review (Form 44) to the NCIC within 15 days.
If you are not happy with the Full Commission’s decision, you may appeal to the North Carolina Court of Appeals, and finally to the North Carolina Supreme Court.
Talk to an Attorney
If your case is complex, your claim is denied, or you suffered a severe injury, you should contact an experienced workers’ compensation attorney. An attorney can assist you in following the specific legal procedures necessary to successfully obtain benefits. North Carolina workers’ comp laws limit the amount lawyers can charge in workers’ comp cases and must approve all fees. (For more information, see How Much Will I Have to Pay a Worker's Compensation Lawyer?)