Being injured at work is stressful. Finding the money to pay for medical bills shouldn’t be, but many workers who have never engaged with the system before find themselves wondering, “What medical treatment is covered under North Carolina workers’ compensation?” The answer can be crucial for your recovery.
How the Workers’ Compensation System Operates in NC
Workers’ compensation insurance is a program established to provide for employees who get injured at work or come down with occupational illnesses. The program should pay for medical care, along with two-thirds of the employee’s lost wages while they heal. The workers’ comp system is overseen by the North Carolina Industrial Commission.
The system works relatively well and gets put to good use frequently. In 2023, roughly 68,600 cases were filed. Of those, 40,900 were relatively severe injuries that required days away from work, work restrictions, or a job transfer. The remaining 27,700 cases filed with the Industrial Commission did not require days away from work.
Without workers’ compensation benefits, these injured employees would have been left to pay for their medical costs themselves. Instead, thanks to North Carolina workers’ compensation laws, they got access to the medical care they needed for free.
Types of Medical Care Covered by Workers’ Comp in NC
Under Chapter 97 of North Carolina’s General Statutes, injured employees are entitled to have all their medical care related to their workplace injuries paid for by workers’ compensation insurance. Medical care can include any treatments that work to cure the injury or illness, offer relief from pain, or lessen the worker’s disability. Workers pay no deductibles or co-pays. The types of medical care covered by workers’ compensation can include:
- Initial treatment: Workers’ compensation will pay for all the initial doctor visits, hospital stays, diagnostic tests, surgeries, and medications required to treat the initial injury or illness.
- Ongoing therapy: If the worker needs ongoing care, workers’ compensation benefits will also cover ongoing therapies, like physical therapy and occupational therapy.
- Pain management: Many injuries cause ongoing discomfort. When that’s the case, workers’ comp will pay for pain management treatments, which can include injections, medications, and other therapies.
To be covered by workers’ compensation, these treatments must be provided by an approved doctor.
Difficulties With Getting Access to Treatment in NC
It’s often the case that workers’ compensation insurance companies refuse initial claims filed by employees or deem necessary treatments unnecessary. When that happens, you have the right to request a hearing with the North Carolina Industrial Commission. Injured workers are also entitled to get second opinions regarding their conditions.
If injured workers go for two years or more without pursuing benefits, they may lose their right to seek workers’ compensation benefits at all. At that point, their workers’ comp cases will be dismissed.
Permanent Disability Ratings
Most of the time, workers’ compensation benefits are temporary. They last until the injured worker has recovered from their injuries or illness and can then either return to their job or find other gainful employment. In some cases, though, people become permanently disabled. When that happens, they will receive permanent disability ratings. If you’re having issues with receiving a permanent disability rating, consult a workers’ compensation attorney.
Who Chooses the Doctors?
Deciding who chooses the doctors is one of the most contentious issues in North Carolina’s workers’ compensation system. In general, the employer gets the first choice of who treats an employee’s injury or illness. The employer can require the injured worker to attend independent medical examinations with the physician of their choice, and employees who refuse to attend can risk losing their benefits.
Workers can request changes in their authorized treating physicians if they can show that the change is necessary to reduce pain, cure the injury, or return to work. They can also request second opinions from outside physicians.
FAQs
What Does Workers’ Comp Cover in NC?
In NC, workers’ comp:
- Covers medical expenses for all work-related injuries and illnesses.
- Provides partial wage replacement for lost income.
- Provides vocational rehabilitation benefits in some cases.
If a worker dies from their occupational illness or injury, their dependents may also be eligible to receive death benefits. A skilled workers’ comp attorney can provide guidance for your unique circumstances.
What Benefits Are Not Covered Under Workers’ Compensation?
The benefits that are not covered under workers’ compensation include payment for injuries that:
- Occur during an employee’s commute to and from work.
- Result from a worker’s intoxication.
- Were caused by horseplay.
Workers’ compensation does not cover preexisting conditions, nor does it cover injuries or illnesses that occur because of activities that take place outside work.
What Should You Not Say to a Workers’ Comp Adjuster?
What you should not say to a workers’ comp adjuster includes comments downplaying the severity of your injuries or providing false details about the incident. You should also avoid admitting fault for your injury. While workers’ comp benefits don’t require you to prove fault, some circumstances may exempt you from benefit eligibility, such as being drunk at work or engaging in horseplay that leads to injury.
What Does Workers’ Comp Pay in NC?
In NC, workers’ comp:
- Pays for medical expenses related to workplace injuries.
- Provides disability benefits to the tune of two-thirds of an average week’s paycheck.
- Gives injured workers access to vocational rehabilitation programs if necessary to get them back into a state of gainful employment.
Workers’ comp also pays out death benefits if an injured worker dies from their occupational injury or illness.
Hire a Workers’ Compensation Lawyer
Knowing what medical treatment is covered under North Carolina workers’ compensation is an important part of your recovery process. Now, it’s time to hire a workers’ compensation lawyer who can help you get the benefits you’re due. Ayers, Ayers & Dressler focuses exclusively on personal injury, workers’ comp, and Social Security Disability law. Our team has successfully taken on countless workers’ compensation cases. We can do the same with yours, too. Contact us today.
