Most people have heard of workers’ compensation insurance, but very few have any idea as to when an injured employee can receive NC Workers Compensation weekly benefits. There are so many myths and misconceptions about North Carolina workers’ compensation benefits, especially concerning weekly cash benefits. We must first look at accepted versus denied WC claims.
Accepted vs. Denied Workers Compensation Claim and NC Workers Compensation Weekly Benefits
In NC Workers' Compensation, the term "accepted" is not as straightforward as it sounds. It would seem logical that in accepted workers’ compensation cases, the injured worker should be receiving weekly wage loss benefits from the workers’ compensation insurance carrier when they are missing time from work due to their accident-related injuries.
Unfortunately, the workers' compensation insurance carrier can accept a case but only agree to pay for medical expenses (Form 63, Section 2). Also, according to North Carolina General Statute §97-29, an injured worker must be completely written out of work by their authorized treating physician to receive NC Workers Compensation Weekly Benefits after being out of work for at least seven (7) days. Please note that the "authorized treating physician" is a physician whose services are paid for by the Workers' Compensation insurance company.
So, you can only receive weekly workers' compensation benefits if your claim is accepted AND the doctor paid for by the insurance company says you can not work. To add to that, the amount of compensation you will receive is less than your wages. The injured worker is paid a compensation rate that is based on a calculation which is equal to 66 2/3% (sixty-six and two-thirds percent) of his/her pretax average weekly wage.
In denied workers compensation claims weekly wage loss benefits are not paid. The insurance company is denying that you have a viable work injury claim. We have seen various reasons for these denials:
- employees are classified as independent contractors and thus are not eligible for workers' comp;
- pre-existing condition not caused by work accident;
- occupational disease not caused by work;
- accident did not happen at work;
- refusal of workers' comp insurance to accept all injuries from the work accident;
- employer is headquartered in another state and thus the other state's workers' compensation law applies to the case
- and the list goes on.
Insurance companies can come up with various reasons to deny, partially approve or not pay weekly benefits on a claim. This puts the injured worker in a particularly difficult situation. If this is happening to you or someone you case for, we offer free case reviews by phone and online.
What about Doctor's Restrictions to Reduced Work Hours?
Another lost wage scenario may involve an injured worker that has returned to work, but they are under doctor’s restrictions to work limited hours. If the injured worker’s ability to earn wages has been reduced because of their on-the-job accident related injury, then they are eligible to receive wage loss compensation in an accepted workers’ compensation case. The injured worker will be paid based on a wage loss compensation rate that equals sixty-six and two-thirds percent (66 2/3%) of the difference between his/her average weekly wages before the date of injury and the average weekly wage in which he/she is able to earn after the injury.
Termination of NC Workers' Compensation Weekly Benefits
If the authorized treating physician returns you to work at full duty or you return to work full time, your weekly benefits can be terminated. In certain instances, the workers' compensation insurance can terminate benefits automatically and in other instances they will have to ask the NCIC for permission to terminate benefits).
It is the goal of the insurance company to get you back to work as soon as possible so they can avoid paying for lost wage compensation or additional medical expenses. If you are healed and ready to return to work at full capacity, you should. The problem arises when an injured worker is not healed but expected to return to work at full duty. If this is happening to you, you should consult a NC Workers' Compensation lawyer as soon as possible.
There are many confusing issues surrounding an injured worker’s workers’ compensation claim that at times it can be quite overwhelming for a North Carolina injured worker. The injured worker who is out of work due to their accident-related injury has enough on his/her plate. He/she should not have to worry or be concerned with wage loss compensation issues with their workers’ compensation claim. The Bishop Law Firm helps Workers' Compensation clients in Raleigh, Durham, Rocky Mount, Wilson, Smithfield, Louisburg, Fayetteville, Chapel Hill, Roanoke Rapids and surrounding areas in North Carolina. Contact us today at (919) 615-3095 for a free evaluation.
