Workers Compensation Benefits – An Overview

You can also find a copy of this article on Workers Comp Benefits under the “Start Here” heading on the navigation bar…  I thought I would post it here for those that subscribe to my RSS feed.  (If you are not already, you probably should!)

Workers Comp Benefits take several forms in North Carolina.  It is important that you understand the different types of benefits that you might be entitled to, so that you can be informed when it comes time to settle your case.

The major Workers Comp benefits that you are entitled to if you are injured in an accident at work in North Carolina include having the insurance company pay your medical expenses (this is often the biggest benefit), as well as receiving a weekly check that amounts to 2/3 of your “Average Weekly Wage”.  We’ll take these one at a time:

Medical Expenses as a Workers Comp benefit:  When you are injured in a workplace accident, the insurance company is required by law to pay for your medical expenses that are associated with that accident.  These may be expenses for various treatments that are designed to cure the injury or relieve you from pain, or they could be for prescription medications.  You should be aware that there is no deductible, no co-pay, and no requirement that you miss work to receive these medical benefits.

As you will see in other areas of this website, the insurance company, if they accept your claim, has the right to direct your medical care.  This means that they can pick your doctors.  However, if you feel that the doctor is biased, or that they are releasing you to do more work than you feel you can physically do, then you have the right to a second opinion with a doctor of your choice – which the insurance company or employer must pay for.  If the insurance company balks at this, which they frequently do, then you have the right to request a hearing before the NC Industrial Commission to resolve these issues.  You should also know that if you go two years without receiving medical treatment that is paid for by the workers comp insurance carrier than you run the risk of losing your medical benefits forever.

Weekly Disability Payments:  The second type of Workers Comp benefits you could receive after you have been injured in an accident at work involve weekly disability checks.  These checks will traditionally pay out at 2/3 of you Average Weekly Wage.  There are two types of checks you could receive:

  • Temporary Partial or Total Disability Checks.  When your doctors orders you to stay out of work for longer than 7 days, then you are entitled to receive Temporary Total Disability checks at 2/3’s of your Average Weekly Wage amount.  After you have been out for three weeks, then by law you are entitled to the first week as well.  Temporary Partial Disability only comes up where you are able to work, but you have to cut your hours and are unable to earn the same amount as before the accident, in which case you are entitled to 2/3’s of the difference between your average weekly wage and what you are earning now – but only for 300 weeks.
  • Permanent Partial or Total Disability Checks.  Once you have been declared permanently partially disabled by your doctor, they will assign a disability rating.  Your benefits will then be determined using a formula which factors in the average weekly wage, the part of the body that was injured, and the disability rating assigned by the doctor.  As of right now, injured workers are entitled to lifetime benefits if they are permanently and totally disabled.  (The insurance companies want to limit this – click here for more information about what you can do to stop them).

There is one other Workers Comp benefit that you should be aware of – the “Clincher” Agreement.  In some cases, workers are offered a lump sum amount to settle their case.  If you agree to a clincher, do not do sue without carefully weighing all of your options with your attorney.  When you sign a clincher, you are frequently agreeing to not pursue additional benefits or reopen the case should your condition worsen.  This may also mean giving up all of your medical benefits – which is often a huge benefit if you are unable to obtain group health coverage after your case is completed.