People get hurt on the job every day. Maybe it’s happened to you recently. If so, you probably have a lot of questions about how to get through this stage of your life – especially if you can’t return to work immediately. In North Carolina, most employers who have 3 or more employees are required by law to carry workers’ compensation insurance. This no-fault insurance can provide workers with medical benefits and wage replacement benefits when they get hurt at work, and it protects employers from being sued by injured workers.
Workers’ compensation laws spell out exactly what employers owe to their eligible workers who are injured on the job. Many injured employees do not realize that workers’ comp does not just cover medical bills – it also may include compensation for lost wages. Unfortunately, not all employers want to follow these laws, and the laws themselves can be complicated. We urge you to seek the advice of an experienced workers’ comp lawyer if you find yourself in this type of situation.
In this article, I have provided an overview of the major types of workers’ compensation benefits – it’s important to know what benefits may be available to you when you need them most. I’ve also included plenty of links to other pages if you want more details on specific workers’ comp topics.
Pay close attention to the warnings throughout the article where I’ve touched on the ways some insurance companies may try to avoid paying for your benefits. It’s important to be aware of these possible threats.
Types of Medical Benefits Covered by Workers’ Compensation
Medical care prescribed by an approved doctor is 100% covered by workers’ compensation if your workers’ compensation claim has been approved. This is good news! And there are no co-pays or deductibles. Even better news! And you get paid for travel expenses if you have to drive over 20 miles roundtrip. Great! So, let’s dig a little deeper to help you understand some of the specifics about the medical benefits to which you may be entitled.
If you’re injured at work, medical care benefits may be paid to you for products and services that are prescribed to help you recover from your injury – treatments focused on curing your injury, lessening your disability, and relieving your pain.
You might guess that benefits include physical therapy, surgeries, and visits to the doctor. But you might be surprised that workers’ comp may also cover the following:
- Travel costs to and from medical appointments (if more than 20 miles roundtrip)
- Attendant care (even if a spouse or family member is taking care of you)
- Medical equipment
- Home or vehicle modifications
Although approved medical benefits are 100% covered by your employer’s workers’ compensation insurance, the insurance company has the right to direct your medical care – including choosing which doctor(s) you see. The insurance company also has the option of sending you to a doctor of your choosing for a second opinion, but they rarely do. Instead, they often try to pick a doctor that will be helpful to them, not you.
WARNING: Some insurance companies may try to delay or deny your medical treatment. The law is clear that if you are hurt on the job, the insurance company must pay for the medical treatment that your authorized doctor recommends. However, some may refuse to authorize treatment or send you to a doctor they think will be more conservative about your treatment.
You may want to spend some time researching workers’ compensation lawyers in NC if you’re receiving workers’ compensation medical benefits and are unhappy with your medical care in any way. My firm will give you a free workers’ comp case evaluation.
Workers’ Comp Will Not Pay You for Pain and Suffering
Physical pain, mental suffering, strains on your finances and personal relationships, and a general sense that life is spinning out of control are often part of the recovery from a work injury. When it comes time to settle your workers’ compensation case, you might think you’ll be paid for the pain and suffering you’ve gone through. Unfortunately, that is incorrect.
Fair or not, the law doesn’t require insurance companies to pay you for pain and suffering when you are hurt on the job. So, it’s important to try to make sure the insurance company pays you the full benefits the law does require. Sadly, some insurance companies may try to save themselves money by denying benefits to injured employees.
As part of the “workers’ compensation bargain,” workers are not permitted to sue their employer personally (unless the employer intentionally caused the accident) and can therefore only receive benefits related to their medical needs and ability to work.
However, if your injuries were the result of a third party, then you might be able to pursue a claim against that party that takes into account the pain and suffering you have suffered because of the accident.
For example, if you are a truck driver and are involved in an accident that was not your fault while working, then you might be able to make a claim with the other driver’s insurance company. This claim might be able to include reimbursement for your pain and suffering. And this is in addition to your workers’ compensation claim.
Wage Replacement Benefits Covered by Workers’ Compensation
When you’re hurt on the job and are unable to work while you recover, the law requires that your employer’s insurance company pay your approved weekly wage replacement benefits. You may receive wage replacement benefits when:
- You have to take time off to rest and recover
- You can work some, but not as much, while you’re recovering
- Your injuries resulted in permanent damage, but you can still work (at least some)
- Your injuries resulted in permanent damage, and you cannot work at all
In general, wage replacement benefits cover two-thirds of an employee’s average weekly wage and are distributed in the form of weekly checks during the claim and sometimes as a lump sum settlement at the end of the claim.
For example, let’s say you work in construction and make $600 per week on average. But one day, you fall off a ladder, break your leg, and have to stay out of work for a while. Ouch! If your workers’ compensation claim is approved, you may receive $400 per week (which is two-thirds of $600) for the time you’re out of work.
WARNING: Some insurance companies have been known to drag their feet in sending you these checks. Other insurance companies have sent workers less than they were entitled to receive. And sometimes, wage replacement benefits are calculated incorrectly.
If you’re receiving wage replacement benefits, you may want to have a North Carolina State Bar Board Certified Specialist in Workers’ Compensation Law look over your case. You can contact the Law Offices of James Scott Farrin for a free case evaluation.
Wage replacement benefits can be divided into two ways – benefits for the time you had to take off of work and benefits to make up for wages you might lose in the future.
Benefits for Time You Had to Take Off of Work
This category is fairly straightforward. Continuing with the example above of you breaking your leg at work: If you then had to stay at home and rest for six weeks per the doctor’s orders, you would likely receive benefits for the six weeks you were unable to work.
Benefits for time off of work might also include trips to the doctor, time out for physical therapy, working fewer hours or less strenuous jobs that pay less, etc. The workers’ compensation benefits in this category are Temporary Total Disability (TTD) and Temporary Partial Disability (TPD).
Benefits to Make Up for Wages You Might Lose in the Future
This category of wage replacement benefits can be a bit more complicated. If your work injuries leave permanent damage that may make your job difficult in the future or may prevent you from being able to return to work, you may be eligible for benefits in this category.
For example, let’s say instead of breaking your leg, you fall off a roof at work and hurt your back. And after it’s healed as much as possible (or you have reached “maximum medical improvement” – or MMI – in workers’ comp terms), you cannot stand on your feet for long periods of time as is required of your construction job.
Once you reach MMI, a workers’ compensation attorney can help you negotiate a settlement with the insurance company for future Temporary Total Disability benefits or Permanent Partial Disability (PPD). PPD is a system where your level of disability is given a Permanent Partial Disability rating from your approved doctor, and your benefits are calculated based on that rating. In cases of some severe injuries, you might be eligible for Total and Permanent Disability, which is when you can no longer work at all.
WARNING: Some insurance companies may try to save money by sending you to a doctor who they think will give an opinion about your disability that is more favorable to the insurance company.
NC workers’ compensation lawyers can’t help you heal faster, but they may be able to push insurance claims adjusters to resolve your claim more quickly once you have reached MMI and help you set up medical treatment in the meantime to try to help lessen your financial burdens.
Other Types of Workers’ Compensation Benefits
In addition to the two major categories of workers’ compensation benefits, medical benefits and wage replacement benefits, you may also be eligible for:
- Vocational rehabilitation, which pays for resume help, job placement services, and educational assistance, if you need to switch careers due to your injury
- Death benefits, which pay for funeral expenses and wage replacement benefits, if your spouse or parent (if you’re a minor) died while working
Does Workers’ Comp Cover Long-Term Health Conditions Caused by the Job?
North Carolina workers’ compensation law may provide coverage for people who have suffered a long-term health condition as a result of their work. Qualifying conditions can be caused by an injury that resulted from the job or exposure to harmful chemicals or conditions on the job.
The law determining whether a person is entitled to workers’ compensation benefits for a health condition believed to be caused by working is fairly complex. Essentially, you must show that your work caused the specific condition and that your job placed you at a higher risk for that condition than the general population.
For example, Black Lung Disease is generally caused by exposure to coal dust, so workers in coal mines are at higher risk of developing Black Lung Disease. Coal workers who developed this illness would likely be entitled to workers’ compensation benefits in North Carolina. Another example includes industrial workers who developed the deadly cancer mesothelioma as a result of exposure to asbestos.
How Long Does Workers’ Comp Last in NC?
Workers’ comp medical benefits generally continue until the doctor has released you from treatment. In general, you have the right to additional medical treatment for an additional two years after your initial treatment ends. And TTD benefits are generally capped at 500 weeks from the first date of disability for North Carolina workers injured after June 23, 2011.
Fortunately, there is no cap for permanent and total disability for catastrophically injured workers.
If You Have Been Hurt On the Job, Call an Experienced Workers’ Comp Lawyer Today
In my experience, some insurance companies may not tell you about all the benefits for which you may qualify. And some might even employ delay and deny tactics to avoid paying your expenses. If you’ve been hurt at work, I strongly recommend that you speak with an experienced workers’ compensation lawyer about your rights.
You can check out our workers’ compensation team’s credentials. We’ve dedicated ourselves to helping injured workers fight for the benefits they need. If you would like a free case evaluation, give us a call at our 24/7 hotline – 1-866-900-7078 – or contact us online today.