As discussed in our previous article, the North Carolina Workers' Compensation Act provides the exclusive relief for workers who are injured on the job. An injury that even temporarily prevents you from returning to work is a difficult experience under even the best circumstances. It is natural to worry about the future, about how the bills will be paid, and whether benefits available under workers' comp will be sufficient. This article is intended to explain those benefits and help injured workers plan for the future. There are basically four different types of benefits an injured worker can receive under the comp act:
1. Medical benefits: All of the reasonable and necessary medical treatment that arises from your injury or disease should be covered. This includes payment of medical expenses that are the consequence of your occupational disease or injury, such as payment for psychological counseling for depression that arises secondary to chronic pain from a back injury and the inability to return to normal work. Unfortunately, the employer or insurance carrier generally gets to pick the medical provider if they have accepted the claim and are paying medical expenses. Having a good doctor can be more important even than having a good lawyer in a comp case, so there may be times when a worker should use their own medical insurance or pay out of their own pocket to get a second opinion from a "non-company" doctor.
The obligation to pay for medical treatment ends two years after the last receipt of disability benefits unless there is is ongoing treatment or a motion is filed with the Industrial Commission asking that the case be kept open because of expected future treatment. One example of a situation where this issue might arise is a total knee replacement required several years after a knee injury.
2. Temporary total disability benefits paid to the worker: These benefits are two-thirds of your “average weekly wage” (AWW). The average weekly wage is usually calculated by totaling up gross pay of any sort that the worker received from the employer in the 52 weeks immediately preceding the injury. That amount is divided by 52 to give AWW. The injured worker's benefit amount is two-thirds of that. Benefits are due after one week of missed work- an injured worker out of work more than four weeks should receive pay for the first week out. North Carolina Workers' Compensation disability benefits are tax free under state and federal law.
The 2011 legislative amendments to the Workers' Comp Act limited Temporary Total disability benefits in most situations to a maximum of five hundred weeks “from the date of first disability”, which is about 9.6 years. There is a provision that allows benefits beyond the 500 week limitation, but it only applies in very extreme situations. However, workers who were injured before June 24, 2011 and have an on-going case can receive Temporary Total Disability benefits for the rest of their life if they turn out to be “permanently and totally disabled.”
The average weekly wage and weekly disability amount is “frozen” as of the date of the injury; there is no “cost-of-living” or inflation adjustment.
3. Temporary partial disability benefits or “wage differential”: If an injured worker returns to work and, because of the injury, earns less than at the time of the accident, the worker is entitled to receive two-thirds of the difference between the AWW and what is earned each week in the new, reduced-pay job. These are called Temporary Partial Disability (TPD) benefits or “wage differential”.
Under the 2011 amendments to the Comp Act, injured workers can receive up to 500 weeks of partial differential benefits, with any weeks of temporary total disability payments being deducted from that total. The 2011 amendments actually improved the partial disability benefits, as those who were injured before June 24, 2011, can only receive such benefits for a maximum of 300 weeks (12 weeks less than 6 years) from the date of the injury. That means that if a worker who was hurt before June 24, 2011, and has an on-going case, takes a lesser-paying job after they recover from their work-related injury, their weekly comp benefits will automatically stop after 300 weeks.
4. “Permanent Partial Disability” (PPD) payment as a lump sum:
If, after the injured worker has recovered from the injury as much as possible, there remains some permanent restrictions or disability, the worker can receive a lump sum payment for that. The amount of the payment is set by statute based on the number of weeks of benefits that the legislature has determined each body part is worth. For instance, loss of a leg is “worth” 200 weeks of benefits. The PPD is a percentage rating that your doctor assigns to the worker's injury.
Example: The doctor determines that after arthroscopic knee surgery there is a 10% permanent partial disability of one leg. That permanent partial disability would be compensated at 20 weeks of benefits. If the weekly benefit amount is $400, then the benefits amount would be $8,000.
An injured worker who is not satisfied with the rating assigned by the doctor has the
right to obtain another opinion on the rating from a different doctor, to be paid for by the employer or the employer's insurance carrier
An injured worker should NEVER take a lump sum payment for a PPD, unless the worker is back at work making at least the same amount they were earning pre-injury and does not anticipate future problems continuing to work. Once a lump sum payment for a PPD is accepted, an injured worker only has two years to
re-open the comp case if the disability worsens, preventing future work. (BUT REMEMBER, THE AGGRAVATION OF A PRE-EXISTING CONDITION, IF IT HAPPENS ON THE JOB, CAN BE A NEW COMP CLAIM)
This article is intended to outline the basic four types of benefits that an injured worker may obtain under the North Carolina Workers' Compensation Act. Every situation is different, and no amount of information can substitute for a live consultation with an experience workers' compensation attorney to discuss the myriad details of your case. The North Carolina workers' compensation attorneys at Edelstein & Payne have a stellar record of obtaining valuable benefits for injured workers, and are available for consultation or representation. Also, if you have an active workers compensation claim and would like an evaluation of the benefits you are being offered, give us a call and schedule a consult.