Types of Workers’ Compensation Benefits in North Carolina
North Carolina law establishes rules governing workers’ compensation benefits and requires most employers to offer them. If you’re eligible for benefits, the next question that arises is, “What should I be getting?”
That’s where things can get interesting. You may think you should be getting one thing, while your employer or the insurance company thinks you should be getting something else. The devil is in the details, and there are a lot of details to figure out. That’s why it’s helpful to consult an experienced workers’ compensation attorney, like an NC State Bar Board Certified Specialist in Workers’ Compensation Law at the Law Offices of James Scott Farrin.
There are seven forms of workers’ compensation benefits in North Carolina to which you may be entitled:
- Temporary Total Disability
- Temporary Partial Disability
- Permanent Partial Disability
- Total and Permanent Disability
- Medical Care
- Workplace Wrongful Death Benefits
Average Weekly Wage – The First Step in Calculating Compensation
One thing is necessary for any attempt at calculating North Carolina workers’ compensation benefits. In North Carolina, workers’ compensation wage replacement benefits require the calculation of the eligible worker’s Average Weekly Wage (AWW).
You’ll need this for calculations moving forward because wage replacement benefits in North Carolina are generally 2/3 of the AWW (66.67%). Calculating AWW may seem straightforward, at least at a glance. There are four different ways to determine AWW by law, based on your individual work circumstances:
For Employees Who Have Worked for More Than One Year
Note: The above formula is for workers who have been employed for more than a year (52 weeks), and excludes any periods of seven or more days not worked. If the worker received a raise during the last 52 weeks, the AWW is calculated using that pay rate.
For Employees Who Have Worked for Less Than One Year
Note: Again, this excludes any period of seven or more days not worked.
For Employees Who Have Not Worked for Long Enough to Determine a Fair Wage
In the event that a worker has not been on the job long enough to reasonably calculate their AWW, the wages of a similar employee are used to represent the injured worker’s earnings with one of the prior two formulae.
For Employees for Whom None of the Prior Formulae Will Work
Perhaps the most difficult method, if a worker’s AWW cannot reasonably be calculated with any of the three methods above, the AWW is set at the amount that most closely approximates what that worker would earn.
For purposes of the calculations below, we’ll be using the first method. We highly advise injured workers to consult with an experienced workers’ compensation lawyer if there is any confusion or disagreement about their AWW calculation. Also note that the NCIC caps weekly compensation amount, and that cap changes over time.
Use Your AWW to Calculate Compensation Rate
Using your AWW and the NCIC’s multiplier of 2/3 (66.67%), you can calculate a potential compensation rate.
AWW x 66.67% = Compensation Rate
Temporary Total Disability (and How to Calculate It)
When a workplace injury temporarily and totally disables a worker, Temporary Total Disability (TTD) benefits in North Carolina are the law’s way of financially protecting those who qualify. Whether or not you qualify depends on your particular circumstances.
The first seven days after your injury are a grace period. The law says that you will not receive any compensation during this time. Once that waiting period is over, qualifying employees are entitled to weekly benefits equal to two-thirds of their average weekly wage up to the maximum compensation rate set by the North Carolina Industrial Commission.
These seven days do not need to be consecutive, but they must be days you would have worked. Once your seven day period is up, you are eligible to receive benefits. If your disability lasts more than 21 working days, you would be eligible to retroactively receive compensation for those first seven days.
The circumstances surrounding how and why you receive Temporary Total Disability (TTD) can be the most significant disputes in workers’ compensation cases. Consult one of our North Carolina State Bar Board Certified Specialists in Workers’ Compensation law to help you handle your Temporary Total Disability (TTD) claim.
Calculating TTD Compensation, and Duration of Benefits
Your Pre-Injury Annual Gross Pay / 52 Weeks = Your Average Weekly Wage (AWW)
Your AWW x .6667 = Your Compensation Rate if eligible for benefits, as long as it does not exceed the maximum compensation rate set by the NCIC.
Generally, the maximum duration of TTD benefits is 500 weeks. There are exceptions, however, and you should consult with an attorney to find out if these exceptions apply to you. For example, for cases before June 24, 2011, there was no maximum duration.
Temporary Partial Disability (and How to Calculate It)
Temporary Partial Disability (TPD) compensation in North Carolina seeks to bridge the gap between what a worker earned prior to being injured, and what they’re able to earn while recovering from that injury. Essentially, you’ve returned to a job, but you’re not functioning or earning at the same rate you were prior to the injury – whether you’re simply not able to do as much work, or you’ve been placed in a job that pays less but that you can perform despite the injury.
You can typically receive TPD compensation after returning to work, even if you received TTD compensation before returning. The seven day waiting period is the same for TPD as it is for TTD compensation.
Calculating TPD Compensation, and Duration of Benefits
Your Pre-Injury Annual Gross Pay / 52 Weeks = Your Average Weekly Wage (AWW)
Your Post-Injury Gross Pay / Weeks in Pay Period = Your Post-Injury Weekly Wage
Your AWW – Your Post-Injury Weekly Wage = Difference in Wage
Difference in Wage x .6667 = Your TPD Compensation Rate if eligible, as long as it does not exceed the maximum compensation rate set by the NCIC.
Generally, the maximum duration of TTD benefits is 500 weeks. There are exceptions, however, and you should consult with an attorney to find out if these exceptions apply to you. For example, for cases before June 24, 2011, the maximum duration was 300 weeks.
Permanent Partial Disability (and How to Calculate It)
Permanent Partial Disability (PPD) is a benefit you may be entitled to when you sustain permanent damage to parts of your body or your senses. You can continue to work, but your capacity for work is permanently reduced due to the injury.
In North Carolina, once you reach Maximum Medical Improvement (MMI) for your injury, the treating physician will determine the level of disability and assign what is called a PPD rating, also known as a permanent impairment rating. It is important to know that you have the right to a second opinion on your impairment rating, and can seek that opinion from a provider of your choosing at the insurer’s expense.
Many injured workers mistakenly believe that PPD is a “final” determination, and only find out about their PPD rating via Form 26. Before you consider or sign Form 26, consider consulting with a workers’ compensation attorney to try to ensure you’re being offered a fair settlement.
Calculating PPD Compensation, and Duration of Benefits
Calculating permanent disability benefits is done through the use of a schedule defined in §97-31 of the North Carolina Workers’ Compensation Act. The schedule sets out a value for specific parts of the body. To calculate possible compensation, you can use the following formula:
PPD Rating x (Compensation Rate x Weeks Assigned in the Schedule) = Potential PPD Compensation
Depending on what you choose, there are different forms to fill out. It is also important to know that, even after choosing to accept Permanent Partial Disability, this is not necessarily a closing of your case. Typically, you still have two years from the date you receive payment to file a claim for “change in condition” should your condition worsen over time.
Total and Permanent Disability (and How to Calculate It)
When you’re injured in such a way that you can no longer work after reaching Maximum Medical Improvement (MMI), you may be entitled to Total and Permanent Disability (PTD) compensation in North Carolina. These are injuries that often completely destroy quality of life as well as rendering you unable to earn a wage. These injuries can also deteriorate over time, causing other conditions to develop.
This can be the worst case scenario for any injured worker. These injuries result in high medical and care costs, burden families, and can be financially shattering without compensation. Note that, since June 24, 2011, PTD benefits require one of four conditions to be present:
- The worker must have lost any combination of two of the following: hands, arms, feet, legs, eyes. For example, the worker may have lost both hands, or one foot and one eye.
- The worker must have suffered a spinal injury resulting in paralysis of the upper, lower, trunk, or whole body.
- The worker must have suffered a severe head injury or brain damage resulting in permanent disability.
- The worker must have suffered second or third degree burns to at least one third of the body.
Calculating TPD Compensation, and Duration of Benefits
Your Pre-Injury Gross Pay / Weeks in Pay Period = Your Average Weekly Wage (AWW)
Disfigurement – Damage Beyond Work
There is another thing to consider in determining what benefits an injured worker may receive for an injury in North Carolina. Disfigurement may or may not affect your ability to “do work,” but it certainly affects you as a person and can affect your ability to earn by making you less able to do certain jobs. It is different from permanent disability under the law.
Disfigurement payments are at the discretion of the NCIC, and are based on what part of the body is disfigured. The disfigurement must be serious, permanent, and observable, and affect the worker’s ability to earn wages. Note that disfigurement compensation is separate from disability payments – if a worker lost a limb and received disability compensation, the worker cannot “double dip” and claim disfigurement as well.
The amount of a disfigurement award depends on the breadth of the injury and what part(s) of the body are affected. Consult a workers’ compensation attorney if you believe you may be entitled to disfigurement compensation.
With the current state of healthcare, the medical costs relating to a workplace injury could easily be many times what you earn. The physician will be chosen by the insurance company, but you may request a different physician if you do not agree with the care plan provided.
If you receive medical care for your injury, it should cover diagnostics, physician and specialist costs, and medications. And if the insurance-appointed physician deems treatment unnecessary, you can file a motion with the NCIC to try and compel treatment. You may also be entitled to receive a pre-authorized medication account to help offset out-of-pocket costs.
Medical care is another thing that may seem straightforward, but leaves a great deal of room for debate or interpretation. Consult with a dedicated workers’ compensation lawyer to help you understand your rights, your options, and what you may be entitled to receive.
In North Carolina, injured workers who cannot return to their former employment or are returned to a lower paying job may be entitled to Vocational Rehabilitation at the expense of their employers. This may include on-the-job training; transferable skills analysis and testing; resume, interviewing, and job application services; job search assistance; and education and tuition payment for retraining, among other things.
Workplace Wrongful Death Benefits
Beyond Total and Permanent Disability is the tragedy of a workplace fatality. Without their wages, support, and presence, families of workers killed on the job are left to pick up the pieces.
North Carolina law provides multiple benefits for the eligible families of workers who are killed at work. To learn more about the benefits to which survivors may be entitled, please refer to our workplace wrongful death page, and please consider hiring an attorney to represent your best interests in your time of need.
Hurt on the Job? That’s a Job for Us
Don’t take chances with the insurance company or your employer. Even if you think they’re looking out for you, there may be benefits you’re not getting. And if you’re being ignored, denied, or hurried back to work, you should definitely question why.
Better yet, let us do it.
The Law Offices of James Scott Farrin has several NC State Bar Board Certified Specialists in Workers’ Compensation Law. Two of our attorneys have served on the NCIC – we know how the law works and what your rights are. We also know how to fight for the maximum compensation and benefits to which you may be entitled. Don’t let them push you around. Tell them you mean business. Call us at 866-900-7078, or contact us online for a free case evaluation.