Workers’ compensation can provide a robust financial safety net if you get injured on the job. However, not everyone knows what all workers’ compensation can include.
You may have many questions about what your employer’s insurance will and won’t cover. Having the right answers can help you decide which treatments you can pursue and what coverage you can expect from your employer’s insurance provider.
How workers’ comp works in North Carolina
In the Tar Heel State, your employer’s insurance company typically administers your workers’ compensation benefits. To receive benefits, you must file a claim within two years of your injury. Then, your employer and their insurance provider decide if your injury is valid under their policy. Then, they can either approve or deny your claim.
If they deny it, you can appeal their decision. If they approve it, you can usually start receiving benefits after being out of work on a doctor’s note for more than seven days. However, not every employer sets up their workers’ compensation procedures the same way. Talk to your company’s HR department to learn how theirs works.
Benefit payments typically last for as long as you need benefits. Additionally, the length of time you need to be on it can vary. Some people may only need coverage for a few months. Others may need it for a year or more.
What can it pay for?
Most workers’ comp benefits can cover:
- Medical care related to your injury: North Carolina says workers’ compensation insurance must cover treatment that provides some cure or form of pain relief for a worker’s injury. If your workplace injury was an accident and your employer meets the proper criteria under the NC Workers’ Compensation Act, your employer should be able to cover your injury-related medical expenses. Such expenses can include doctor’s appointments, surgical procedures, medications, and prosthetics. Usually, insurers and employers can choose your medical providers. However, you can seek a second opinion or request to switch doctors.
- Medical care for conditions stemming from your injury: Workers’ compensation can also cover conditions that arise from your initial injury. For example, if you suffer an upper back injury that causes an arm injury, you could also receive coverage for your arm injury.
- Home modifications: In some cases, benefits can cover home modifications associated with your work injury-related treatment. Modifications can include an adjustable bed, grab bars, and door openers. However, this can often depend on the severity of your injury and the length of your recovery time.
- Chiropractic care: North Carolina recognizes chiropractic care as a reasonable medical treatment for workers’ compensation. However, if your recovery involves more than 20 chiropractic visits, your chiropractor will need additional authorization from your employer or their insurance provider.
- Travel costs associated with medical care: Whether your injury leaves you unable to drive or you need medical care in a different city, benefits can cover reasonable transportation costs to and from medical appointments.
- Vocational rehabilitation: Sometimes, your injury may prevent you from doing your old job. Or you may want to do your old job again but need some retraining after your injury. Either way, workers’ compensation can usually cover vocational rehabilitation costs. Treatment can involve working with a vocational rehabilitation specialist who can help you create a return-to-work plan. Plans can include retraining for your current job, training for a different position within your company, or training for a new job in another field.
- Temporary total disability: Also known as a temporary total compensation rate, temporary total disability typically pays injured workers around 66 2/3% of their average weekly wage until they return to work. Wage caps are set annually by the North Carolina Industrial Commission. The rate cap for 2022 is $1,184.
Workers’ comp can also cover permanent disability and death benefits for fatal workplace incidents. A spouse or underage child’s eligibility for death benefits and the amount they can receive often depend on the circumstances.
Coverage disputes can and still happen
When you receive wage replacement and medical coverage to help you get back on your feet, you can return to your job fully recovered and ready to work.
However, you can face challenges trying to obtain benefits, especially if your employer or their insurance provider tries to deny your claim. If that happens, there are ways you can advocate for yourself to get what you need. Or you can reach out to an experienced workers’ compensation lawyer. Give us a call, and we’ll walk you through your options.