Extending Workers' Compensation Benefits
Wage replacement benefits under workers’ compensation are governed by the particular laws of each state for individuals injured during the course of their job duties. In North Carolina, workers’ compensation can provide medical bill payment and temporary and/or permanent wage replacement benefits depending on the extent of the injured worker’s injuries.
However, wage replacement benefits will only continue for certain amounts of time depending on how quickly the injured worker heals and subject to other duration caps set by state law. Only qualifying individuals who apply for an extension of benefits through the North Carolina Industrial Commission will be able to continue receiving benefits past the statutory time limits. It is important to be aware of both the time period limits and extension qualifications to ensure that you are not foreclosed from receiving the full amount of benefits you deserve.Temporary Wage Replacement Benefits
- Temporary full wage replacement benefits apply when the worker is temporarily disabled to the point where they cannot work at all for at least a week. A weekly benefit of two-thirds the worker’s average weekly wages will become available after the first week. If the disability continues for three weeks, then the employer must retroactively pay for the first week as well.
- Temporary partial benefits apply when the person is able to return to some type of paid work (sometimes after a healing period during which they receive temporary full benefits), but are unable to earn the same average weekly wages as before the work accident, either due to decreased hours or a change in job title. During this period, temporary partial benefits through workers’ comp provide an injured worker with two-thirds of the difference between their average weekly wages before the accident and current wages.
For either type of temporary wage replacement for accidents occurring after June 24, 2011, the benefit will be available for up to 500 weeks. There used be no time limit on temporary benefits under workers’ comp, but a recent change in law has set this cap. The employer can petition the North Carolina Industrial Commission to show that you are capable at some point of returning to some type of suitable employment. Having an experienced workers’ comp attorney to help appeal this process can be important to continue temporary benefits.
If the worker is still fully disabled 425 weeks after their injury, they should apply for an extension beyond the 500-week limit. The employee must be able to prove to the Industrial Commission by a preponderance of the evidence (or that it is more likely than not) that they have sustained a total loss of earning capacity.Permanent Wage Replacement Benefits
- Permanent partial benefits apply when the worker has healed as much as their doctors project that they can but the worker still suffers from permanent disability to a body part(s). N.C.G.S. 97-31 provides specific time periods for the duration of permanent disability based on the body part affected. For example, loss of use of a thumb receives 75 weeks of benefits; loss of use of an arm, 240 weeks. The statute (law) is written presuming total loss of use for each body part. If the worker suffers only a partial loss of use to a body part, their recovery duration will be calculated in proportion to the disability percentage their doctor or doctors assign to that body part. For example, if you are deemed to have lost a third of the functionality in your arm, you may recover “permanent” partial benefits for one-third of 240 weeks, or 80 weeks. See “Rates and Durations for Permanent Partial Disability” for more information. Note that this is the only category of workers’ comp benefits for which a person can recover regardless of whether or not they had to miss any work because of the injury—a permanent injury to one of the body parts listed in the 97-31 schedule is presumed to be disabling.
- Accepting a permanent partial disability payment based on your disability rating also starts the clock running on a two-year time limit under N.C.G.S. 97-47 to file for a change in condition. Otherwise, if you accept a ratings-based payment for permanent disability and your condition worsens afterwards, you can miss out on the right to other permanent benefits in the future.
- Permanent full benefits provide lifetime benefits to injured workers who meet certain strict criteria. A worker can be eligible for these lifetime payments if they suffered total loss of both arms, legs, hands, feet, or eyes (or two of any of these); spinal injury that involved severe paralysis in the trunk of their body or both arms or legs; second or third-degree burns to a third of the body; or a severe brain/closed head injury that results in severe disturbance to cognitive function or a neurological disorder. The employer has a right at any point to prove to the Industrial Commission that the worker is capable of returning to some suitable employment, at which point wage replacement benefits will cease but medical payments will continue.
If you have questions about extending your workers’ comp claim, it is important to speak with a workers’ comp attorney to ensure that the proper procedure is followed. Contact Arnold & Smith, PLLC today for a consultation with one of our dedicated workers’ comp attorneys.