Workers Comp in North Carolina: Workers’ Compensation Benefits Guide

From the Wright Brothers’ flight at Kitty Hawk in 1903 to the birth of beloved brands like Pepsi and Krispy Kreme, North Carolina is a land of historic firsts. It’s also home to one of the largest advanced manufacturing workforces in the United States. Some of the state’s biggest employers include Atrium Health, Walmart, Inc. and Duke University. But if you’re among the 1 in 50 N.C. workers injured on the job every year, what can you do? In many cases, you can file a claim for workers’ comp. North Carolina workers’ compensation claims usually cover all medical costs and help cover lost wages if your accident makes you miss work.

Learn how the process works, what benefits are available if you qualify, how to appeal or find an attorney, and more helpful info below.

How Does Workers’ Comp Work in North Carolina? Key Takeaways

• All employers in the Tar Heel State with three or more employees must carry workers’ compensation insurance.
• Workers who get hurt or sickened on the job can file claims on this insurance policy to get free medical treatment and recover lost wages.
• You can file a North Carolina workers’ compensation claim as soon as your first day of employment if your employer has coverage.
• Only injured workers who must stay off the job for at least one week after a workplace accident can receive wage-loss benefits.
• It’s illegal for employers to fire employees who wish to file a workers’ comp claim for an accidental work injury.
• 2024 industry data shows working with a workers’ comp attorney can get you $7,700 to $12,400 more for your injury.

What is Workers’ Compensation?

Nearly every U.S. state requires most employers to purchase workers’ compensation insurance. This coverage pays for necessary medical treatment and compensation for lost wages until injured employees can return to work. This no-fault system benefits everyone, since it gives injured workers immediate access to necessary care and covers reasonable medical treatment costs. Wage-loss compensation equals two-thirds of your average weekly wage based on the last 12 months of job income.

When you file a claim, you’re not suing your employer. Instead, you are filing a claim with the insurance company that provides your employer with that policy coverage. And it doesn’t matter whose fault it is or why you got hurt at work, either. There’s no person or entity to “blame” for the work accident that hurt you.

Which Employers Must Carry Workers’ Compensation Insurance In North Carolina?

According to state law, most North Carolina businesses that hire three or more employees must have workers’ compensation coverage. That means if you have at least two other coworkers, your insurance coverage begins starting on your first day of employment. And that coverage automatically includes undocumented workers as well as part-time or temporary staffers. North Carolina National Guard and state militia members working on active duty under the governor’s direction also have coverage.

However, North Carolina workers’ compensation law also automatically exempts certain types of employees from this coverage requirement.

Automatic Coverage Exemptions Under the NC Workers’ Compensation Act

North Carolina General Statutes § 97-13 specifically excludes the following people from the above automatic insurance coverage requirements for employers and workers:

• Any company or individual selling agricultural products on a farm or producer’s behalf, whether they be in commission-only or salaried positions
• Casual employees
• Corporate officers
• Committee members, directors, and executive officers of any non-profit may not be covered, depending on their circumstances
• Domestic employees
• Farm laborers and agricultural workers with employers who hire fewer than 10 total full-time, non-seasonal employees
• Federal government employees (i.e., certain railroad workers, postal carriers)
• Independent contractors*
• Limited Liability Company (LLC) members
• Prisoners or inmates incarcerated by the state, in some cases
• Sole proprietorships (i.e., self-employed workers that hire no other employees or subcontractors)

Important: Exempted employees (sole proprietors, for example) may elect to purchase workers’ comp insurance for themselves, if they so choose.

*N.C. Gen. Stat. §97-19.1 stipulates that some trucking company owner-operators must carry workers’ compensation insurance, even if they’re independent contractors.

How to Confirm Your Employer Has Workers’ Compensation Coverage

Not sure if you work for an employer that has workers’ comp insurance coverage? You can use North Carolina’s online search tool to find out.

Penalties for North Carolina Employers That Fail to Purchase Workers’ Comp Insurance

Employers have three options for purchasing coverage:

1. From the private workers’ compensation insurance provider of your choosing.
2. Through the state’s assigned risk pool market, which the North Carolina Rate Bureau (NCRB) administers.
3. Applying for self-insurance status through the North Carolina Department of Insurance (DOI).

The North Carolina Workers’ Compensation Act § 97-94 levies a penalty for employers who fail to purchase insurance:

• $1 per employee per day fine if that the employer refuses or fails to secure coverage (with a minimum $50 daily penalty)
• $100 per day is the maximum fine for any employer, regardless of the total number of employees they hire

In addition, state law allows a Class H felony charge against any employers who willfully refuse to purchase coverage. If an employer neglects to purchase coverage as required, they may be guilty of a Class 1 misdemeanor.

Insured or not, North Carolina law holds employers responsible for the cost of an injured worker’s medical treatment and lost wages. But buying this required coverage also gives employers access to liability insurance, which can cover legal expenses in cases where employees blame their employer for their injuries.

What Types of North Carolina Workers’ Compensation Benefits Are Available to Injured Employees?

North Carolina law offers several different types of workers’ compensation benefits after a work-related accident. Approved claims always cover your medical expenses, but some employees also receive weekly payments to help cover lost wages.

If you cannot return to your old job after your accident but can keep working, you may also qualify for vocational rehabilitation. These include things like job-placement and retraining services, adult education classes, and other related services. Your employer’s insurance provider covers any costs if you’re deemed eligible for vocational rehab services from the state.

Medical Benefits

North Carolina workers’ comp insurance offers medical benefits to cover the cost of approved work-related injuries and illnesses. This includes paying for reasonable medical treatment expenses related to your workplace injury, such as:

• Doctor’s visits
• Hospital stays
• Medical imaging (i.e., x-rays, MRIs, CT scans)
• Mileage reimbursement, provided the round-trip distance is more than 20 miles
• Prescription drugs and over-the-counter medications
• Physical therapy
• Surgery

Wage Replacement Benefits

Workers’ comp in North Carolina only pays for lost wages after the seven-day required waiting period ends. That means your first week off is usually unpaid unless you miss at least 21 days due to your workplace injury. Once you’re unable to work for more than three weeks in a row, you’ll get reimbursed for that first week off.

The longest wage replacement benefits can last from North Carolina workman’s comp is 500 weeks. Payments usually come in weekly installments, but may qualify for a lump-sum settlement if you can meet certain requirements.

Temporary Total Disability (TTD) Benefits

If the doctor keeps you off the job after your work-related injury or illness, you may get temporary total disability benefits. TTD income from your North Carolina workers’ compensation insurance carrier equal two-thirds of your average weekly wage (AWW). All workers’ comp benefits are subject to annual minimum and maximum amounts set by the North Carolina Industrial Commission.

That said, you must miss a minimum of seven days of work before you’ll qualify for TTD payments. Subsection 97-29 of the North Carolina General Statutes says that you can get temporary total disability for no more than 500 weeks total. You’ll get these benefits paid in weekly installments until you can safely return to work.

Temporary Partial Disability (TPD) Benefits

If your doctor says you can return to work but with certain restrictions, you may become eligible for temporary partial disability. According to N.C. Gen. Stat. § 97-30, TPD benefits pay two-thirds the difference between your pre-and post-injury work wages. You can receive temporary disability benefits from workers’ comp until you:

• Return to normal job duties while earning the same pay as you did before your workplace injury, or
• Reach Maximum Medical Improvement (MMI) according to your doctor, or
• Receive temporary partial disability payments for 500 weeks, the maximum time limit allowed under state law.

Permanent Partial Disability (PPD) Impairment Ratings and Disfiguring Injuries

Once you reach MMI, your doctor assesses you for the presence of a disfiguring or permanent “scheduled injury.” In plain English, this means you have a “total loss of function” in one or more body parts. And MMI simply means that your doctor doesn’t think you can heal any further with additional medical treatment.

Scheduled injuries qualify for PPD benefits equal to two-thirds of your Average Weekly Wage (AWW) for an assigned number of weeks per body part.

If you lose the ability to use or a doctor surgically removes a body part, N.C. Gen. Stat. § 97-31 defines your payout in the following terms:

Affected Body Part	Weeks of PPD Income You’re Owed
Back (i.e., at least 75% loss of use)	300 weeks
Eye	120 weeks
Arm	240 weeks
Leg	200 weeks
Hearing loss in both ears	150 weeks
Both hands, feet, eyes, legs, arms, or any two of those things combined	eligible for total permanent disability benefits instead
Hand	200 weeks
Foot	144 weeks
85%-100% vision loss in one eye	120 weeks
Hearing loss in one ear only	70 weeks
Thumb	75 weeks
Index finger (pointer finger)	45 weeks
Middle finger	40 weeks
Ring finger	25 weeks
Little finger	20 weeks
Loss of half a thumb or any finger	50% of the time period specified for a total loss
Multiple fingers lost/amputated	20-200 weeks
Big toe	35 weeks
Any other toe	10 weeks
Partial toe loss (any toe)	5-17 weeks
Multiple toes lost	10-35 weeks

North Carolina law sets the maximum PPD settlement amounts as follows:

• $10,000 for any disfiguring injury to a body part not listed in the chart above
• $20,000 for a serious disfigurement that affects either your head or face (i.e., extensive burns) or losing any important organ

Permanent Total Disability (PTD) Benefits

If you can no longer work after your workplace accident in any job, you may still be eligible for PTD benefits.

Death Benefits

If an employee dies on the job or from a work-related injury or illness, death benefits become available to their eligible dependents. Death benefits from workers’ comp in North Carolina will usually include:

• Up to $10,000 for funeral and burial expenses
• Cash benefits paid in weekly installments to eligible survivors, such as a dependent spouse or child (until they reach age 18)

Understanding the Workers’ Comp North Carolina Claims Process

1. Notify your employer about your work-related injury or illness immediately and ask for medical care.

Injured workers in NC need to see an authorized healthcare provider after a workplace accident. Seeing a doctor without getting written permission to do so from the North Carolina Industrial Commission could put your claim at risk. In simple terms, your employer’s insurance company could potentially refuse to pay those medical bills. And if that does happen, you definitely need to speak with a workman’s comp attorney.

Important: State law says employees must report work injuries to employers within 30 days to protect their rights to workers’ compensation. To fully meet this requirement, be sure to report your work-related accident orally and in writing to your supervisor.

If your employer has no designated doctor, head to the nearest ER or your family physician for medical treatment. Be sure to tell whomever treats you that your injury or illness is work-related and your employer’s contact information.

Pro Tip: You cannot receive workers’ comp in North Carolina unless you have medical bills resulting from your workplace injury.

2. Fill out, sign, and file Form 18 with the North Carolina Industrial Commission to start your claim.

You must complete and file Form 18 to have a valid workers’ compensation claim for benefits. Be sure to submit Form 18 electronically (along with any supporting documents from your doctor or employer) directly with the Industrial Commission.

3. Your employer must report your work-related injury or illness to their insurance carrier as soon as they’re aware.

Employers must also tell the Industrial Commission within 5 days if your accident forces you to miss more than one day of work. They will complete this step by filing Form 19 electronically with the Industrial Commission. However, if you can return to your job duties right away, you will only receive medical benefits.

4. If approved, your first payment for lost wages can start as soon as the 14th day after your employer receives notice of your injury.

You must miss at least a week of work before you’ll qualify for lost wage benefits, but your employer’s insurer should cover all medical treatment.

5. Denied claim? You can still appeal and dispute the insurance carrier’s decision.

Any injured employee who wishes to appeal a claim denial can do so by filing a request for a hearing with the Industrial Commission. You can file Form 33, Request That Claim be Assigned for Hearing, directly with the commission. The Commission automatically refers all disputes on North Carolina workers’ compensation claims for mediation. Mediation services cost $150 per hour, plus another $150 to the mediator overseeing your conference with the employer’s insurance company.

Important: Injured workers with attorneys representing their appeals may have other means to resolve disputes other than mediation.

Need Workers Comp? North Carolina Attorneys Can Review Your Claim for Free

Several factors can lead to an unfortunate claim denial, like an employer improperly classifying you as a contractor. Or finding out you have a qualifying repetitive stress injury from your own doctor, not an authorized provider. Even if you failed an on-the-spot drug test after your accident, you may still be eligible for workman’s comp.

Why not speak with a nearby attorney for free about your case? It’s a fast, easy, and free way to protect your rights and maximize any workers’ comp benefits you’re owed.

All workers’ compensation attorneys in our network offer free, no-obligation consultations to individuals who qualify. Click the button below now to get started:

FAQs for North Carolina Workers’ Compensation Claims

Q: Is it legal for my employer to drug test me after a work accident?

A: In most cases, yes. But failing a test doesn’t automatically disqualify you from receiving workers’ compensation benefits. An attorney can review your case and advise you correctly based on your unique circumstances and local laws.

Q: Can I reopen my claim after I receive a settlement payment on my workers’ compensation case?

A: No. Once your employer pays a lump-sum settlement, then your case is officially closed. North Carolina law states that your employer is no longer responsible for any additional costs related to your claim. This is typically known as a compromise settlement agreement, and it usually applies if you’re seriously injured and need long-term medical care.

Q: How long do I have to file my claim paperwork if I have something like carpal tunnel or need rotator cuff surgery? I’ve been working in pain for years!

A: The North Carolina statute of limitations for workers’ compensation claims is two years from your injury date. For an occupational illness, the two-year filing deadline also applies. So, your deadline would be two years from the date your doctor diagnosed your repetitive stress injury.

Q: Will they deport me if I’m an undocumented worker who needs workers’ comp benefits for a job injury?

A: It’s important to speak with an attorney who understands how to protect your rights in such cases. However, state law says you’re entitled to the same benefits as any eligible lawful resident alien or U.S. citizen worker.

Q: Can future employers see whether I’ve gotten workers’ comp in the past at a different company and then use that to deny me jobs?

A: No. Employers cannot access that portion of your employment history until after they make you a job offer and you accept it. At that point, you might have a case for employment discrimination if they suddenly took back your offer with no explanation.

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