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What Is Not Covered by Workers’ Compensation in NC?

Hand flip wood cube with icon healthcare medical and coin on woodWorkers’ compensation insurance in NC is not like using any other kind of insurance:

  • There are no co-pays.
  • You’re assigned a “nurse” who chooses your doctors and treatments.
  • And some things may not be covered (like “pain and suffering”).

As NC Workers’ Compensation Attorney Barry Jennings said in our video, the best way to answer this question is to tell you what is covered by workers’ compensation insurance in North Carolina.

In most cases, Workers’ Compensation covers injuries that happen as a result of an accident while working – regardless of whose fault the accident was. (It can also cover occupational diseases and sudden injuries to the spine, depending on the circumstances of your case).

If you qualify for workers’ compensation benefits, there are two basic categories. They are:

  1. Medical Benefits
    Medical benefits are any treatments that help you to recover from your injuries. You might guess that they can include things like physical therapy, surgeries, and visits to the doctor, when those things are necessary. But you might be surprised that workers’ comp medical benefits can include 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)
    • Disfigurement (that’s not covered by PPD benefits)
    • Medical equipment
    • Home or vehicle modifications in general, medical benefits cover items that will:
      • Cure the injury
      • Lessen the disability
      • Relieve your pain

      Approved medical benefits are covered 100% by workers’ compensation insurance companies. There are no co-pays or deductibles.

      However, the insurance company has the right to direct your medical care – including choosing which doctors you see, when you see them, and which treatments you receive.

      If you’re receiving workers’ compensation medical benefits and are unhappy with your medical care in any way, you may want to contact a workers’ compensation lawyer in NC.

     

  2. Wages Lost Benefits
    Sometimes an injury means time off of work. That’s when wages lost benefits come in.In workers’ compensation, you may receive wages lost 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 allIn general, wages lost benefits cover two-thirds of the employee’s average weekly wage.For example, let’s say you work in construction and make $600 per week on average.  But one day you slip and fall off a ladder, break your leg, and have to stay out of work for a while. If your workers’ compensation claim is approved, you should receive $400 per week for the time you’re out of work.WARNING: wages lost benefits are sometimes calculated incorrectly.

      If you’re receiving wages lost benefits, you may want to have a North Carolina Board Certified Specialist in Workers’ Compensation Law look over your case.

     

Still Have Questions About Workers’ Comp in NC?

These are just the two main categories of workers’ compensation benefits. There are some others – such as vocational rehabilitation benefits.

If you still have questions, just give us a call at 1-866-900-7078  or contact us online. Our representatives are available 24/7 to assist you.