| EMPLOYEE
COVERAGE |
All
North Carolina State Government employees are covered under the State Government
Workers' Compensation Program.This includes all agency and university employees
and officers. It also includes all State elected officials, members
of the General Assembly or those appointed by the Governor to serve on
a per diem, part-time or fee basis. It covers full-time employees,
part-time employees and temporary employees. |
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COVERAGE
DETERMINATION
GUIDELINES |
As
defined under the North Carolina Workers' Compensation Act an injury is
covered under workers' compensation if it was caused by an accident or
incident which arose out of and in the course of your employment.
The Workers' Compensation Act does not provide compensation for all injuries,
but for injuries by accident. An accident is defined in the law as
a separate event preceding and causing the injury. Unless there is
an accident, an injury received while performing the regular duties in
the usual and customary manner is not compensable.
There
are two exceptions to the "by accident" requirements of the law.
These are back injuries and hernias. If either of these injuries are caused
by a specific traumatic incident of the work assigned they are compensable
in the absence of an accident preceding the injury.
Certain
diseases termed "occupational diseases" are compensable under the North
Carolina Workers' Compensation Act. An occupational disease is any
disease which is proven to be due to causes and conditions which are characteristic
of a particular occupation or employment and the exposure is greater than
that of the general public outside of the employment. Diseases of
this nature are generally caused by a series of events of similar nature,
occurring regularly or at frequent intervals over a period of time in the
employment. Only those occupational diseases specifically designated
in the North Carolina Workers' Compensation Act are compensable.
All ordinary diseases of life to which the general public is equally exposed
are excluded. |
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| RESPONSIBILITY
OF EMPLOYEE |
Responsibility
for claiming compensation is on the injured employee. You must immediately
give notice of the accident to the employer or as soon as possible after
the accident occurs; in any event within 30 days or the employer may refuse
compensation. With reference to occupational disease, an employee
must give notice to the employer when the employee is first informed by
a competent medical authority of the nature and work-related cause of the
illness. A claim must be filed with the North Carolina Industrial
Commission (NCIC) by either the employee or the employer within two years
from the date or knowledge thereof; otherwise the claim is barred by law.
Generally
in State agencies, employees notify their immediate supervisor of an accident.
You can provide written notice to your employer that an accident with an
injury or diagnosis of a work-related illness has occurred in the manner
required by your agency. Typically, this will be in one of the following
three forms: |
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1.
Complete an NCIC Form 18. This form is also used to notify the NCIC
of a claim if the employer refuses to accept liability of a compensable
claim. This form may be obtained from your agency Workers’ Compensation
(WC) Administrator or from the NCIC.
2.
The State Government Workers' Compensation Program provides a form (SGWCP-2)
for you to describe the accident or injury and for selection of your leave
options if you lose time from work because of the injury. This form
may be obtained from your supervisor or agency WC Administrator.
3.
Your agency may have an developed internal form for you to use. This
form may be obtained from your supervisor or WC Administrator. |
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Upon
receipt of notice of the injury or illness, the employer then completes
an NCIC Form 19 which is the employer's report of injury.
You
are responsible to accept the medical treatment provided by the employer.
The employer should provide medical treatment for the injury or refer you
to a specific physician. If the employer fails to provide the necessary
medical treatment or physician referral for the injury, you may obtain
the necessary treatment from a physician or hospital of your own choice.
State agencies have specific procedures for their employees to follow for
the treatment of injuries, such as in-house treatment or a predetermined
list of physicians for you to visit. If your agency has specific
treatment procedures you should follow their guidelines. Once the
initial treating physician is established you cannot change treating physicians
for the injury unless a referral is approved by the employer or the NCIC. |
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