North Carolina Workers Comp Claims: Eligibility, Filing and Appeals

In North Carolina, almost all employers with three or more employees are required to have Workers Compensation insurance, with a few specific exceptions. Employers may purchase insurance from a licensed carrier or become self insured. Some employers may also have the option to be placed in a self insured fund or placed in an assigned risk pool. The North Carolina Industrial Commission oversees Workers Compensation laws in the state of North Carolina. In recent years, workplace injuries and illnesses in the state have dropped from 4.0 injured workers for every 100 full time employees to 3.7 in 2007.

Common Covered Work Related Injuries

Accidental injuries, such as slip and fall injuries and “specific traumatic incidents” such as hernias or back injuries are covered under North Carolina Workers Compensation insurance. Occupational diseases are also covered. To be compensated, injuries must “arise out of and in the course and scope of” employment. Employees are not covered for injuries sustained while commuting to work, but they may be compensated for injuries sustained while driving for work related purposes.

How to File a North Carolina Workers Compensation Claim

Injured employees should report their injury to their employer and the North Carolina Industrial Commission within 30 days by submitting a completed Commission Form 18 - “Notice of Accident to Employer and Claim of Employee, Representative, or Dependent for Workers’ Compensation Benefits.” The employer should then submit Form 19 - “Employer’s Report of Employee’s Injury or Occupational Disease” to the Industrial Commission and to their insurer. If an employer does not report the injury, have two years to file a claim with the Industrial Commission by submitting Form 18 or 18B.

Workers Compensation Claim Denials

Denials must be made within 14 days of a claim, and the insurer must give an explanation for the denial. Common reasons for denial include insufficient information regarding the injury or failure to prove that the injury was caused by work related activity. Claims may also be denied if they are reported too late or if the proper paperwork is not filed.

Appealing a North Carolina Workers Compensation Denial

An employee should first attempt to resolve a claim denial through mediation. If this is unsuccessful, they may then request a formal hearing with the North Carolina Industrial Commission. A Request For Hearing Form 33 must be submitted within two years of the date of injury in order to appeal a claim. Further appeals may be made in the North Carolina Court of Appeals if necessary.

Collecting North Carolina Workers Compensation Benefits

Monetary lost wage benefits are usually paid weekly. The amount of monetary benefits depends on the type of injury and the employees’ average wage. Partial disabilities entitle employees to benefits equal to two thirds the difference between their post-injury and pre-injury average wages. Total disability gives employees two-thirds of their average weekly wage. Benefits do not start until an employee has missed seven days of work. Additional benefits of up to $20,000 may be made for disfigurement or organ damage. For injuries that occur after January 1, 2009 weekly compensation rate may not be less than $30 or more than $816.

Hiring a North Carolina Workers Compensation Lawyer

An experienced Workers Compensation lawyer should be consulted if there is a dispute in the amount of benefits, or when a claim has been wrongly denied. A lawyer will be able to assist an employee in following the specific legal procedures necessary in order to successfully dispute a claim. Lawyers may represent employees in mediations and formal court hearings. In North Carolina, it is illegal for a lawyer to accept a fee for any services connected to Workers' Compensation claims unless the fee is approved by the Industrial Commission.

North Carolina Workers Compensation Office Locations

North Carolina Workers Compensation Information Specialists Section
N.C. Industrial Commission
4333 Mail Service Center
Raleigh, NC 27699-4333
North Carolina Department of Commerce
Mailing Address:
4301 Mail Service Center
Raleigh, NC 27699-4301
Street Address:
301 North Wilmington Street
Raleigh, NC 27020-0571
(919) 733-4151

North Carolina Industrial Commission
Mailing Address:
4340 Mail Service Center
Raleigh, NC 27699-4340
Street Address:
Dobbs Building, 6^th Floor
430 North Salisbury Street
Raleigh, NC 27603-5937
(919) 807-2500

North Carolina Office of State Personnel
Third Floor, Administration Building
116 W. Jones Street
Raleigh, NC

North Carolina Office of State Personnel - Development Center
101 W. Peace St.
Raleigh, NC
(919)733-2474

North Carolina Office of State Personnel - Temporary Solutions
620 N. West Street, Suite 102
Raleigh, NC
(919)733-7927