The State is a self-insured employer, which means that agencies do not purchase coverage for workers' compensation, but pay expenditures as they occur.  The State has contracted with a Third Party Administrator (TPA) to handle the workers' compensation claims of most employees.  The TPA is responsible for all compensation and medical bill payments through a workers' compensation fund established by State agencies and universities and administered by the Office of the State Controller, in cooperation with the Office of State Personnel.

The Workers' Compensation law provides medical benefits and disability compensation including a weekly compensation benefit for time lost.  The  weekly benefit is equal to 66 2/3% of the employee's average weekly earnings up to a maximum established by the Industrial Commission each year.  When an employee is injured, he/she must go on workers' compensation leave and receive workers' compensation weekly benefits after the waiting period required by statute (G.S. 97-28).
 

WHO IS COVERED UNDER THE STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM?

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.

WHAT BENEFITS ARE PROVIDED UNDER  THE WORKERS' COMPENSATION PROGRAM?

The law provides medical and disability compensation including a weekly compensation benefit for time lost from work which is 66 2/3% of the employee's average weekly wage up to a maximum established annually by the North Carolina Industrial Commission.  There is a seven calendar day waiting period where no compensation for lost time will be allowed.  During this time, employees may elect to go on leave without pay or use any sick or vacation leave accrued prior to the injury.  An explanation of leave options and continuation of other benefits may be found in the Workers' Compensation Leave section of the State Personnel Policy.
 

WHO ADMINISTERS THE WORKERS' COMPENSATION FOR MY AGENCY?

Agencies are responsible for administering their own programs, including funding medical treatment and compensation for loss of wages for employees experiencing a work related injury or occupational illness. A Third Party Administrator (TPA) contracted by the state, handles the individual workers' compensation cases for the University System, the Judicial Branch, the Legislative Branch, all agencies under the Executive Branch (with the exception of the Department of Transportation) and several Boards and Commissions.  The TPA currently responsible for handling those workers' compensation claims is Key Risk Management Services, Inc. located in Greensboro, North Carolina.
 

WHAT SHOULD AN EMPLOYEE DO IN THE EVENT OF A WORK RELATED INJURY OR ILLNESS?

An employee who is injured on the job or contracts an occupational disease as defined in the Workers' Compensation Act must notify his or her supervisor immediately and complete the proper forms as soon as possible.  An explanation of workers' compensation coverage, including the employees' entitlements, rights and duties may be found in the North Carolina State Government Workers' Compensation Employee Handbook, a copy of which may be obtained from the agency Workers' Compensation Administrator.

WHAT ARE THE RESPONSIBILITIES OF THE SUPERVISOR WHEN AN EMPLOYEE IS INJURED ON THE JOB OR DIAGNOSED WITH AN OCCUPATIONAL ILLNESS?

The supervisor has the responsibility of ensuring that the employee receives medical treatment immediately and notifying the agency Workers' Compensation Administrator, or designee, as soon as possible in order to begin the process of administering the claim.  The supervisor should be aware of where to direct the employee for medical treatment (unless it is a life threatening emergency). The agency Workers' Compensation Administrator will provide the name of the selected  physician from the Preferred Provider Network listing, unless the agency utilizes an in-house medical treatment facility.

ACCIDENT ~ An unlooked for and untoward event which is not expected or designed by the injured employee; a result produced by a fortuitous cause.  An accident results in an interruption in the normal work routine caused by the accident.
 

COMPENSATION ~ The monetary relief for loss of wages due to work related injury; also, payment for disability ratings given when disabling injuries occur.  Types of compensation paid to employees covered by the Act are:

• Compensation for disability dependent upon extent of  injury.
• Compensation in stipulated amounts for  loss of some part of the body.
• Compensation for death.
• Compensation for bodily disfigurement.
   

DISABILITY ~ Incapacity because of an accidental injury to earn wages which the employee was receiving at the time of the injury in the same or any other employment.  The types of disability are:

•      Permanent Partial Disability - Any injury which results in the complete loss or loss of use of any member or part of the body.  A disability rating, stated in percentage, is given by the treating physician when the employee has reached maximum medical improvement.

•      Permanent Total Disability - Any injury other than death which results in the complete and permanent total incapacity of the employee from following any gainful occupation.

•     Temporary Partial Disability - Any injury or disability which renders the employee able to work but at a lesser rate of earnings than that of his average weekly wage of his occupation at the time of the accident.

•     Temporary Total Disability - Any disability which renders the injured employee unable to perform a regularly established job on one or more calendar days following the day of injury.

FIRST AID TREATMENT ~ One-time treatment and subsequent observation of minor scratches, cuts, burns, splinters, etc., which do not ordinarily require medical care.
 

INJURY ~ Injury and personal injury shall mean only those injuries caused by accident arising out of and in the course of the employment.  With respect to back injuries and hernias, however, injury shall mean those which arise out of and in the course of the work assigned resulting directly from a specific traumatic incident.
 

LOST WORKDAY ~ Any day for which the employee is unable to earn or is not paid a full day's wage as a result of the injury or illness.  These days are counted on a calendar basis and are used to determine when an employee may begin to draw compensation.
 

MEDICAL-ONLY CLAIMS ~ Those claims which have medical cost that does not exceed $2,000.00 and there is one day or less of time lost from work.  These claims are accumulated by the agency and totals are submitted to the Industrial Commission once a year.