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Workers' Compensation FAQs
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Q. Who is required to provide workers' compensation coverage?
AnswerA.
In general, any employer who employs three or more employees on a regular basis is covered by the North Carolina Workers Compensation Act. Exceptions include agricultural employments with fewer than ten regular employees, some sawmill and logging operations, and domestic employees.
If a business is subject to the Act, then it must carry workers' compensation insurance. Businesses may obtain the benefits and protections of the Workers' Compensation Act by purchasing compensation insurance, by being self-insured, or by joining a self-insurance pool. |
Q. What Injuries/Illnesses are covered by the workers comp system?
AnswerA.
In general, employees are entitled to benefits if, while carrying out activities for the benefit of their employer, they suffer: - an injury by accident,
- a "specific traumatic incident," resulting in a hernia or back injury, or
- an "occupational disease."
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Q. What is an “occupational disease”?
AnswerA.
The North Carolina Courts have issued decisions defining an “occupational disease.” Generally, an employee is entitled to benefits for disability due to a condition to which the employment significantly contributed, or if the employment was a significant factor in causing the disease's development, and if the employment exposed the worker to a greater risk of contracting the disease than the public generally.
Where an employee is exposed to the same injurious agent at the place of business of more than one employer, the claim should be filed with the employer on whose premises he was last injuriously exposed.
Asbestosis and silicosis are examples of potential occupational diseases. |
Q. What must an employee do when an injury occurs?
Answer A.
In general, an injured employee must report the injury to the employer within 30 days. There are exceptions including for some occupational diseases.
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Q. How do I file a notice of claim?
Answer A.
Notice can be given by providing a completed copy of the Commission's Form 18 to the employer and the Commission.
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Q. When am I barred from making a claim?
Answer A.
In general an employee loses the right to claim compensation unless he or she files a claim with the North Carolina Industrial Commission within 2 years after the accident. There are exceptions. In the case of occupational diseases, the employee should file a claim within 2 years of being advised by a doctor or other medical authority that he or she has an occupational disease related to his or her occupation.
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Q. Do all work-related injuries need to be reported?
Answer A.
All work-related injuries requiring medical attention (other than first aid) should be reported by the employer to its insurance company or administrator, who will report the injury to the Industrial Commission on Form 19 if the injury results in more than $2000 in medical expenses or more than one day's lost time from work.
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Q. What should I do if my employer fails or refuses to report an injury?
Answer A.
The employee in general should file a claim (Form 18 or 18B) within two years of the accident with the Industrial Commission.
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Q. What happens when the employer refuses to acknowledge the claim?
AnswerA.
When liability is denied, the Commission, claimant, his or her attorney, if any, and all known providers of health care must be promptly notified of the reason for such denial. The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the denial of liability.
If a claim is denied, in general the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing. |
Q. When can medical providers bill me?
Answer A.
In the case of an ongoing claim, medical providers may bill the employee only after it has finally been determined that it is not a compensable workers' compensation claim.
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Wallace & Graham, P.A. 525 North Main Street
Salisbury NC 28144
Toll Free: 1-800-849-5291
Local: 704-633-5244
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