If you’ve been injured at work, workers’ compensation benefits can be a lifeline in your time of need. Potential benefits generally include payments for medical care and lost wages, which can be critical for your healing as well as to your ability to pay bills until you can return to work. A third type of workers’ compensation benefit, permanent disability benefits, may be available if your doctor concludes that you are permanently disabled because of the work accident.
There are state-specific rules on how long each type of workers’ comp benefit may be available.
As a workers’ compensation attorney licensed in both North Carolina and South Carolina, I have worked with injured employees for more than nine years and often hear concerns about whether their workers’ comp benefits will last long enough to sustain them through their recovery. In this article, I will address some of the most common questions I am asked about the length of workers’ comp benefits.
How Long Do Workers’ Comp Medical Care Benefits Last?
In North and South Carolina, workers’ comp medical care benefits generally continue for as long as the doctor says they are required, at which point he or she officially releases you from treatment. This is also known as reaching maximum medical improvement (MMI).
Typical medical care benefits provided to an eligible injured worker prior to reaching MMI may include:
- doctor appointments
- medical devices
- physical therapy
- travel to and from medical treatment
In North Carolina, you have the right to request additional medical treatment after your initial treatment ends, as long as there is not a two year lapse in the payment of benefits. Your attorney may be able to help you avoid this two year deadline by seeking approval for anticipated future medical needs from the North Carolina Industrial Commission via Form 18M.
Consult with an experienced workers’ comp attorney who can guide you through the required processes and forms if you think you may need additional medical care after your physician has declared that you have reached MMI.
In South Carolina, insurance carriers are generally required to pay for medical treatment that may lessen the period of disability whether or not you have reached maximum medical improvement. However, the insurance company may argue that the recommended treatment is not necessary. A workers’ compensation attorney can fight for the insurance company to authorize this additional treatment.
How Long Do Temporary Lost Wage Replacement Benefits Last?
While medical care benefits can last as long as needed, workers’ compensation laws in North and South Carolina typically cap wage replacement benefits for covered temporary injuries at 500 weeks. These benefits equal two-thirds of your average weekly wage while you are unable to return to work, and they are called Temporary Total Disability (TTD) benefits.
If you are able to return to work, but at a reduced capacity and lesser wage, you are generally entitled to two-thirds of the difference between your average weekly wage and your new lower wage. These are called Temporary Partial Disability (TPD) benefits.
Both of these types of temporary wage replacement benefits can continue until you are able to return to work, typically up to a maximum of 500 weeks. There are certain circumstances where you may be able to receive benefits in excess of 500 weeks. In North Carolina, you may be entitled to extended benefits past 500 weeks, but you have to file a hearing request and prove to the Commission that you should be able to receive continued wage loss benefits in excess of the cap.
Additionally, in North Carolina and South Carolina, you would generally be entitled to wage loss benefits for the rest of your life if you are determined to be permanently and totally disabled. Read on to learn about what injuries would qualify you for these lifetime benefits.
How Long Do Permanent Partial Disability (PPD) Benefits Last?
The amount of time permanent partial disability benefits can last depends on your specific injury and your state’s workers’ compensation laws.
When your injury is permanent and involves the partial loss of the use of a body part, your doctor will assign you an impairment rating when he or she releases you from treatment. This rating, also called a Permanent Partial Disability (PPD) rating, represents the percentage of permanent disability for your injured body part.
If approved by your state’s governing body (the North Carolina Industrial Commission or the South Carolina Workers’ Compensation Commission), the PPD rating is then applied to a state-specific schedule of the number of weeks you may receive PPD benefits, which are 66 and 2/3% of your average weekly wage.
These schedules take into account specific body parts and set the number of weeks PPD can potentially be paid for these body parts. Review the North Carolina schedule and South Carolina schedule to see how many weeks you may be eligible to receive PPD benefits for your specific injury.
An attorney can help you work with the doctor to try to ensure that you receive an accurate PPD rating. The medical provider should assign a percentage impairment based on the North Carolina Ratings Guide in NC, while a provider in South Carolina should use the AMA Guidelines.
While these guidelines are meant to objectively assess the level of permanent impairment, different providers may assign different ratings. If you believe that the percentage impairment is not an accurate reflection of your limitations, you should consult an attorney for guidance on how to try to rectify this situation.
How Long Do Permanent Total Disability Benefits Last?
There are certain times where you may be entitled to workers’ compensation benefits in excess of 500 weeks in North Carolina and South Carolina.
If your injury is permanent and total and prevents you from returning to work, you may be eligible to receive workers’ compensation permanent total disability benefits for the rest of your life.
In North Carolina, if you have a permanent total disability, you may be eligible to receive permanent total disability (PTD) payments (66 and 2/3% of your average weekly wages) for the rest of your life if you have:
- lost any combination of two of the following: hands, arms, feet, legs, or eyes
- suffered a spinal injury resulting in paralysis of the upper, lower, trunk, or whole body
- suffered a severe head injury or brain damage resulting in permanent disability
- suffered second or third degree burns to at least one third of the body
South Carolina workers’ comp law states that if your work injuries have left you a paraplegic, a quadriplegic, or if you have suffered brain damage, you may be eligible to receive permanent disability benefits for life.
You may still be able to show that you are entitled to extended benefits in excess of 500 weeks if your injuries and ongoing disability are significant but do not fall into one of these categories. It is hard to show disability in excess of 500 weeks so it is worth consulting an experienced attorney if you think that your injuries may place you in this category.
We Can Help You With Your Workers’ Compensation Claim
The Law Offices of James Scott Farrin has skilled workers’ compensation attorneys for North and South Carolina who understand the complexities of workers’ compensation law and have been advocating for injured workers for many years. We will challenge your workers’ compensation insurance company every step of the way as we fight for you to get adequate medical care and wage replacement benefits.
And if you have a permanent injury, we will work with your doctors to make sure they have the information they need to make fair impairment rating decisions, as well as help you understand your state’s permanent impairment rating schedules.
Our firm was named to the 2023 “U.S. News – Best Lawyers” ‘Best Law Firm’ list, our eighth year in a row being honored on the prestigious list.* The firm ranked at Tier 1, the highest ranking, for Workers’ Compensation Law.
*For standards of inclusion, visit https://www.usnews.com/.