Workers' Compensation Benefits

Workers’ comp will cover all medical care deemed “reasonably necessary” for your work injury or illness. This includes doctor visits, emergency room care, hospital stays, surgeries, medications, physical therapy, diagnostic tests (X-rays, MRIs), and even specialist referrals or rehabilitation services. Essentially, if a healthcare provider says you need it to treat your work injury, it should be covered – with no co-pays or deductibles charged to you. In North Carolina, authorized medical treatment can continue as long as needed, even if you have returned to work, until you either fully recover or reach a point where further improvement isn’t expected. You may need pre-approval from the insurance for non-emergency procedures, but they are obligated to pay for necessary treatment. Keep receipts for any out-of-pocket medical expenses and mileage (see below) to submit for reimbursement.

Yes, if your injury causes you to lose time from work, workers’ comp provides wage replacement benefits called disability benefits. The main types are:

• Temporary Total Disability (TTD): If you cannot work at all while recovering, you can receive TTD payments. In NC, TTD is generally 2/3 of your average weekly wage (based on what you earned pre-injury), up to a maximum set by state law. For example, if you made $600/week, TTD would be about $400/week. These benefits kick in after you’ve been out of work for more than 7 days (the first 7 days are not paid unless your disability lasts more than 21 days). You can continue to receive weekly TTD checks until a doctor releases you to return to work or you reach maximum medical improvement (MMI) (the point where your condition stabilizes).
• Temporary Partial Disability (TPD): If you can return to work part-time or on light-duty and earn some wages but less than before, you may receive TPD benefits. TPD pays 2/3 of the difference between your pre-injury wages and your post-injury earnings. For instance, if you used to earn $600/week and now earn $300/week in a reduced role, you could get roughly $200/week (which is 2/3 of the $300 difference). TPD helps supplement your income while you’re not back to full capacity.

These temporary disability benefits are subject to a state-set maximum amount per week (which adjusts annually) and can continue for a limited period.

If your injury leaves you with a lasting medical impairment, you may qualify for permanent disability benefits after you reach MMI. There are two categories:

• Permanent Partial Disability (PPD): This applies if you have permanent damage or loss of function to a body part, but you are not completely disabled from working. The doctor will give you an impairment rating (a percentage) for the injured body part once treatment is as complete as possible. NC law assigns a certain number of weeks of benefits for each body part based on that rating. For example, a 10% impairment to the arm might equal a certain number of weeks of pay. PPD is typically paid as a lump sum or weekly for that scheduled number of weeks. It’s essentially compensation for the permanent loss of use of the body part, even if you can work.
• Permanent Total Disability (PTD): If your injury is so severe that you are permanently unable to return to any employment, you may be categorized as permanently totally disabled. Examples might include losing both hands, paralysis, profound brain injury, or other catastrophic outcomes. In these rare cases, you can receive weekly benefits potentially for life. North Carolina law specifically allows lifetime benefits for very serious disabilities (like loss of both arms, both eyes, or similar). PTD means you will continue to get the weekly two-thirds wage benefits indefinitely, as long as you remain totally disabled.

The exact amount and length of permanent disability payments depend on the impairment rating and the statutory schedule (for PPD) or the nature of the injury (for PTD). If you disagree with a PPD rating, remember you can get a second opinion on the rating at the insurer’s expense.

Yes, North Carolina’s workers’ comp system provides a few additional benefits and rights for injured workers, including:

• Vocational Rehabilitation: If you cannot return to your old job due to your injuries, the insurer may provide “voc rehab services.” This could include job placement assistance, retraining, or education to help you find suitable employment within your physical restrictions. A voc rehab counselor might be assigned to work with you on updating your resume, job searches, or retraining programs. These services come at no cost to you.
• Travel Expenses: You are entitled to mileage reimbursement for travel to and from medical appointments, if the round trip is 20 miles or more. Keep track of your miles (and parking or tolls) for doctor visits, therapy, etc. The reimbursement is at the standard IRS mileage rate. This may also cover other reasonable travel costs related to treatment (e.g. overnight lodging if you must travel far for a specialist, with prior approval).
• Death Benefits: If a worker dies as a result of a work-related injury or illness, the worker’s dependents can receive death benefits. Typically, these consist of weekly payments (at 2/3 of the worker’s average weekly wage, up to the max) for a period of up to 500 weeks to the surviving spouse and/or minor children. The workers’ comp insurer also pays up to a certain amount for funeral and burial expenses (in NC, usually up to $10,000). Dependents should file a claim for death benefits within two years of the date of death.

These benefits are all part of the workers’ comp system’s aim to support you and your family after a workplace injury. Keep in mind there are maximum and minimum limits on weekly payments set by the state each year, and your exact benefits will depend on your average wage and injury details. If you’re uncertain about what benefits you should receive, don’t hesitate to ask the adjuster or consult the NCIC informational resources.

The duration of benefits depends on the type of benefit and the specifics of your case:

• Medical Benefits: There is no fixed time limit on medical treatment – it can continue for as long as necessary to treat your work-related condition. Even years after your injury, if you need additional treatment (say, a surgery to replace an earlier implant), it should be covered, provided it’s reasonable and related to the original injury.
• Temporary Total Disability (TTD): In many cases, TTD wage benefits can continue up to a cap of 500 weeks (which is about 9.6 years) from the date of injury. However, you won’t get the full 500 weeks unless you remain completely out of work that long. If you reach Maximum Medical Improvement (MMI) and can work, TTD may end sooner. There are exceptions where TTD can go beyond 500 weeks – for example, if you can prove you are totally incapable of any wage-earning (essentially permanently and totally disabled, but from an injury after the 500-week cap rule). In such cases, you can apply for extended benefits beyond 500 weeks by showing total loss of wage-earning capacity. The law also allows extended or lifetime benefits for certain severe injuries (like the loss of both arms, both legs, or similar catastrophic injuries) which effectively qualify as permanent total disability.
• Temporary Partial Disability (TPD): TPD benefits (for partial wage loss) are also subject to a maximum of 500 weeks from the date of injury. They would typically stop sooner if you either go back to earning your old wage or you hit the 500-week mark.
• Permanent Partial Disability (PPD): PPD is paid according to a schedule in the law that assigns a certain number of weeks of benefits for each body part, multiplied by the impairment rating. For example, the loss (or 100% loss of use) of a hand is 200 weeks, an arm is 240 weeks, a foot 144 weeks, etc.. A 10% rating to the arm would be 10% of 240 weeks = 24 weeks of pay. So the duration of PPD benefits varies – it might be a few weeks to a few hundred weeks – depending on the rating and the body part. Once PPD is paid out (either weekly or as a lump sum), that’s the end of your compensation for that injury unless you later qualify for more under a different category (like if your condition worsens significantly, you might petition to reopen the claim within certain time limits).
• Permanent Total Disability (PTD): If you are classified as permanently totally disabled, you can receive weekly benefits for the remainder of your life in NC. There is no week limit in such catastrophic cases (aside from the possibility of a settlement). PTD cases are relatively rare and usually involve extremely serious injuries or a combination of injuries (for example, losing use of two major members like both legs, both arms, or vision in both eyes, etc.).

Keep in mind, returning to work (even part-time) can affect your benefits. If you go back to work earning what you did before, wage benefits stop (though medical can continue). If you earn less, TPD kicks in instead of TTD. Additionally, many claims end before the maximum duration because the parties reach a settlement.

Yes. Injured workers in North Carolina often have the option to negotiate a settlement with the insurance company, usually in the form of a one-time lump sum payment. In NC this is commonly called a “clincher” agreement – a full and final settlement. In a settlement, you agree to give up further claims related to the injury (and typically close the case) in exchange for a negotiated amount of money. A settlement can include money for future medical expenses and disability benefits in one package.

Some points about settlements:

• You usually consider settling after you’ve reached MMI and have some idea of any permanent disability, or if you can’t return to work in your previous capacity. That way you and the insurer can reasonably estimate the value of future benefits.
• Settlements are voluntary – you don’t have to accept an offer and the insurer can’t force you to settle. You also aren’t required to settle at all; you can continue receiving weekly benefits and medical treatment for as long as entitled by law.
• If you do settle, the agreement must be approved by the Industrial Commission to ensure it’s fair. Once approved, you’ll receive the lump sum and the case will be closed (with very limited exceptions). This means you generally can’t come back later and ask for more money or medical coverage if your condition worsens, so consider future needs when negotiating.
• Many people seek legal advice during settlement discussions, because you want to be sure you’re not giving up benefits without adequate compensation. While not a requirement, an attorney can help value the claim (including future medical costs, etc.) and negotiate on your behalf.

In summary, yes – a lump sum settlement is possible and common. It can provide a definite payout and closure, but make sure you understand the rights you’re signing away. Never rush into a settlement if you’re still hurt or unsure of the long-term outlook of your injury.