Question: Who is required to provide workers’ compensation coverage?
Answer: Any employer who employs three or more employees.
Q: What must an employee do when an injury occurs?
A: Report the injury to the employer in writing immediately, and in any event within 30 days.
Q: What should be done if the employer fails or refuses to report an injury?
A: The employee should file a claim (Form 18 or 18B) within two years of the accident with the Industrial Commission.
Q: Who provides and directs medical treatment?
A: The employer or its insurance company,subject to any Commission orders, provides and directs medical treatment. The Commission may permit the employee to change physicians or approve a physician of the employees’ choice when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier or Commission before treatment has begun.
Q: What are the rules for chiropractic treatment?
A: If the employer grants permission to seek medical treatment from a chiropractor, the employee is entitled to twenty visits if medically necessary.If additional visits are needed, the chiropractor should request this authorization from the employer.
Q: When can reimbursement for sick travel be collected?
A: Employees are entitled to collect for mileage for medical treatment in workers’ compensation cases at the current rate (currently 55 cents per mile).Special consideration will be given to employees who are totally disabled.
Note: The Industrial Commission has given the self-insurers and insurance carriers permission to pay drug and travel expenses directly to the employee without approval from the Commission.
Q: What happens if the employer fails or refuses to provide medical treatment in an emergency?
A: The employee may obtain the necessary treatment from a physician or hospital of his own choice but must promptly request the Commission’s approval.
Q: When do I become eligible for lost wage compensation?
A: No compensation is due for the first seven days of lost time unless the disability exceeds 21 days. Therefore, the first check will not include payment for days one through seven. Payment for those days will be made if the disability continues beyond 21 days.
Q: How often are compensation payments made and at what rate of pay?
A: Weekly at 66 2/3 % of the weekly wage, not to exceed $816* per week.
*(2009 maximum, adjusted annually)
Q: How long is the employee eligible to receive lost-time weekly benefits?
A: Until the employee is able to return to work.
Q: What is permanent partial disability?
A: Total loss or partial loss of use of a member of the body or inability to earn the same wages in any employment as earned at the time of the injury.
Q: Who determines permanent partial disability?
A: The Commission, based on the impairment ratings of physicians or evidence of consideration of wage earning capacity.
Q: What happens when the employer refuses to acknowledge the claim?
A: When liability for payment of compensation is denied, the Commission, claimant, his or her attorney (if any), and all known providers of health care shall be promptly notified of the reason for such denial. The denial form (Form 61) shall not be worded in general terms but must detail the exact reason for the denial of liability.
1. If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting Form 33, Request for Hearing.
2. Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers’ compensation claim.
Q: How long does it normally take for medical bill approval?
A: Medical Fees must wait for the insurance carrier to send the bill. Once received, bills are approved on a daily basis. After approval, Medical Fees sends the insurance carrier or self-insured a medical bill analysis, stating the approved amount.
Q: How long should a medical provider have to wait for reimbursement?
A: General Statute (G.S.) 97-18i states, “If any bill for services rendered under GS 97-25 by any provider of health care is not paid within 60 days after it has been approved by the Commission and returned to the responsible party, or within 60 days after it was properly submitted, in accordance with the provisions of the Article, to an insurer or managed care organization responsible for direct reimbursement pursuant to G.S. 97-26(g), there shall be added to such unpaid bill an amount equal to ten per centum (10%) thereof, which shall be paid at the same time as, but in addition to, such medical bill, unless such late payment is excused by the Commission.”
Q: Who is my employer’s workers’ compensation insurance carrier?
A: Contact Statistics at (919) 807-2506 for your employer’s insurance coverage. We need to verify the period of coverage and determine what insurance carrier or Third-Party Administrator handled their claims during that injury date.
Q: What is my claim number?
A: Contact Statistics at (919) 807-2506.
Q: How can an injured worker be referred to Medical Services?
A: We have a referral form which provides us with important information when completed. These forms may be requested by calling (919) 807-2616 or by letter request to the N. C. Industrial Commission, 4340 Mail Service Center, Raleigh, NC 27699-4340. Referrals are accepted from anyone.
Q: I did not know the Industrial Commission had nurses. How much do their services cost?
A: Nurses have worked for the Industrial Commission for more than 22 years, and their services are free.
Q: Do I have to work for the State to qualify for Medical Services from the Industrial Commission?
A: No. Anyone covered by the North Carolina Workers’ Compensation Act is eligible for services.
Q: Do I have to allow my Rehabilitation Provider or Nurse Case Manager in the exam room while being examined by my doctor?
A: No, workers have a right to a private exam by their doctors. We do encourage the worker to allow the provider to meet with both the worker and the doctor immediately following the exam when the doctor discusses findings and recommendations for treatment. This allows everyone to be aware of treatment plans and expectations.
Q: My doctor has told me that I can go back to work, but my employer does not have a job for me or my job is now too physically demanding. Can you help me?
A: Since you have reached the medical improvement expected following your injury, we would refer you to the N.C. Division of Vocational Rehabilitation for reemployment, counseling and guidance.
Q: If I hire an attorney, how is he/she paid?
A: All attorney fees must be approved by the N.C. Industrial Commission. Although circumstances vary, generally the fee will be 25 percent of the benefits collected for you by the attorney.