; disability claim nc
Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

disability claim nc

VIEWS: 32 PAGES: 2

  • pg 1
									6701 Carmel Rd., Suite 102 Charlotte, NC 28226 (704) 544-1718 Fax (704) 544-1719

KENNY COBLE ekcoble@wjlaw.net NEAL COLLINS nacollins@wjlaw.net

2515

NORTH CAROLINA WORKERS’ COMPENSATION
SCHEDULED INJURIES §97-31
BODILY LOSS Thumb ………. Finger – 1st…... Finger – 2nd….. Finger – 3rd….. Finger – 4th….. Toe – Great…. Toe – Other…. MAX WKS 75 45 40 25 20 35 10 BODILY LOSS Hand…………….. Arm……………… Foot……………… Leg……………..… Eye………………. Back………….. MAX WKS 200 240 144 200 120 300*

TIME PERIODS
WAITING PERIOD (§97-28)……………………………………….. WAITING PERIOD RECOVERABLE AFTER DISABILITY (§97-28)…… EMPLOYER’S FIRST REPORT OF INJURY (§97-92)………………… ADMIT OR DENY EMPLOYEE’S RIGHT TO COMPENSATION (§97-18) 7 days 21 days 5 days from knowledge of injury 14 days from notice of injury

PAYMENT WITHOUT PREJUDICE (§97-18) Payments may continue for 90 days from date Employer has written or actual notice of injury/death (may apply for extension). Must file form to deny before expiration of 90day period/extension or waive right to contest compensability of, and liability for, the claim.

STATUTE OF LIMITATIONS
*Loss of 75% or more of the back is Total Industrial Disability and compensated for 100% loss FILE INITIAL CLAIM (§97-24 AND §97-58)………………………………….... CHANGE OF CONDITION (§97-47)…………………………………………….. APPEAL TO THE FULL COMMISSION (§97-85)…………………………………. APPEAL TO THE NC COURT OF APPEALS (§97-86)………………………….…. 2 years 2 years 15 days 30 days

MAXIMUM COMPENSATION RATES
2000…….$588.00 2001…….$620.00 2002…….$654.00 2003…….$674.00 2004…….$688.00 2005…….$704.00 2006…….$730.00 2007…….$754.00 2008…….$786.00 2009……$816.00

HOW DO YOU COME UP WITH…
AVERAGE WEEKLY WAGE (AWW) Compute wages for 1 year prior to injury, then divide by 52. Omit any period of time during which employee missed more than 7 consecutive calendar days. If employee worked less than 1 year, divide wages by number of weeks actually worked. (§97-2(5)) TEMPORARY TOTAL DISABILITY (TTD) If disability exceeds 7 days, benefits of 66-2/3% of AWW not to exceed the maximum compensation rate for the year in which the injury occurred. (§97-29) TEMPORARY PARTIAL DISABILITY (TPD) 66-2/3% of the difference between the AWW before the injury and the amount able to earn after the injury for up to 300 weeks from the date of injury. (§97-30) TOTAL DISABILITY Compensation, including medical compensation, shall be paid for by the employer during the lifetime of the injured employee. (§97-29)

COMMONLY USED NCIC FORMS
Form 19 Form 21 Form 22 Form 24 Form 26 Employer’s Report of Injury to Employee Agreement for Compensation for Disability Employee’s Wage Statement Application to Terminate or Suspend Payment of Compensation Supplemental Memorandum of Agreement as to Payment of Compensation

DEATH BENEFITS
66-2/3% of the AWW of 400 weeks is paid to the employee’s dependants within 6 years of the accident or 2 years of the final determination of disability. Burial expenses of $3,500 are also allowed (§97-25). Rule 409 sets forth procedures for death claims.

MISCELLANEOUS MILEAGE
Claimant is entitled to Reimbursement for Travel if that travel is medically necessary and the mileage is 20 miles or more. The maximum fees set forth for travel to and from the place of medical attention are as follows: $0.485 per mile for travel $45.00 per night for lodging $25.00 per day for meals (maximum) These fees are subject to approval by the Industrial Commission. (§97-25)

Form 28 Return to Work Report Form 28B Report of Carrier/Admin. of Compensation and Medical Compensation Paid and Notice of Right to Additional Medical Compensation Form 28C Report of Carrier/Admin. of Compensation and Medical Compensation Paid Pursuant to a Compromise Settlement Agreement Form 28T Notice of Termination of Compensation (Trial RTW) Form 33 Request that Claim Be Assigned for Hearing Form 33R Response to Request that Claim Be Assigned for Hearing Form 60 Employer’s Admission of Employee’s Right to Compensation Form 61 Denial of Workers’ Compensation Claim Form 62 Notice of Reinstatement of Modification of Compensation Form 63 Notice to Employee of Payment of Compensation Without Prejudice Form 90 Report of Earnings

COMMUNICATION WITH MEDICAL PROVIDERS
The NCIC has recently approved a Workers’ Compensation Medical Status Questionnaire that may be submitted by an employer/insurer paying compensation for an admitted workers’ compensation claim to medical providers who have treated an employee for a work-related injury or condition. Medical providers are authorized by the N.C. General Statutes §97-25.6 to respond to these questions without an authorization from the employee. A copy of the Approved Workers’ Compensation Medical Status Questionnaire may be downloaded from the Industrial Commission’s website at http://www.comp.state.nc.us/ncic/pages/wcmsques.pdf.

Employee files Form 18 or 18B with Employer and NCIC

CSA filed for approval by NCIC

Employer files Form 19 (or Form 29 in case of death) with NCIC

NCIC assigns File Number; EDMS File created

Parties go to mediation to negotiate settlement

Employer files Form 61 Employer files Form 21 or 60 (Form 26 or 62 may subsequently be filed.) Claims Section approves Forms 21, 26/26D.

Employee pursues claim – Files Form 33; Employer responds with Form 33R

Dockets Section acknowledges Form 33/33R

Deputy Commissioner hears case and issues Opinions & Awards

Parties comply with Opinions & Awards Employer files Form 30. Claims Section approves Form 30 and completes Form 30D. Statistics Section updates system.

Employer files Form 28

Employer files Form 28B. Statistics Section acknowledges.

Dissatisfied party files Notice of Appeal and completes Form 44. Dockets Section schedules Full Commission hearing.

Trial return to work continues for up to 9 months.

Full Commission issues Opinions & Awards

Employer files Form 28T

Employer files Form 24 to be reviewed by Executive Secretary

WC Payments continue

Employer files Form 62; Employee files Form 28U. Disputed Form 28U reviewed by Executive Secretary upon request.

Parties comply with Opinions & Awards Dissatisfied party appeals to the NC Court of Appeals

Employee or Employer may appeal Executive Secretary’s decision by filing a Form 33 to request a hearing before a Deputy Commissioner


								
To top