What You Need to Know About Disability Benefits in North Carolina

Understand the differences between workers’ compensation, Social Security and North Carolina disability benefits—and how they all interact

Nobody is immune to getting hurt at work. While certain professions like construction and manufacturing tend to result in higher rates of occupational injury compared to office jobs, workers in all types of industries can experience a work-related injury or illness that results in temporary or permanent disability.

In North Carolina, injured individuals who have to take some time off work to recover or who suffer permanent impairment after getting injured at work are entitled to certain disability benefits, depending on the extent of the damage. The type and amount of benefits you can be paid vary widely, which is why it’s important to have an in-depth understanding of when disability is paid in North Carolina as well as for how long and how much you’re owed.

The nation’s biggest benefit programs for individuals with disabilities are Social Security and workers’ compensation. Though these disability programs provide a vital safety net for injured workers, they differ in several important ways.

With so many different disability programs, eligibility requirements and deadlines, it’s no wonder that many injured workers get confused about what compensation they are entitled to. At Wilder Law Group, we help individuals and families in North Carolina cut through all the bureaucratic red tape to secure their maximum compensation. Schedule your free consultation with one of our work injury or disability attorneys in Charlotte today to take the next step.

In the meantime, continue reading for a basic overview of the disability compensation programs available to injured workers in North Carolina.

Workers’ compensation disability

When it comes to North Carolina’s workers’ compensation system, wage replacement benefits are generally paid if an employee has been disabled due to a job-related injury or illness. Workers are eligible for workers’ compensation disability benefits starting on Day 1 of their employment.

The concept of what constitutes a “disability” under workers’ compensation can get quite complicated in a technical sense, but it’s generally when a worker’s wage-earning ability has fully or partially diminished. In North Carolina, the burden of proof is on the injured employee to prove their disability. They also must prove that their disability happened in the course and scope of employment.

If there is a disagreement between the employer and the employee about the entitlement to wage replacement benefits or the amount to be paid in the form of benefits, the Industrial Commission will weigh in on the matter. If the employee wants their case to be heard by the Industrial Commission, they should consult with an experienced worker’s compensation attorney who is Board Certified.

There are 4 types of disability benefits offered through worker’s compensation in North Carolina

The types of benefits you are eligible for will depend on the period the disability is set to last (permanent or temporary) and the severity of the disability (partial or total).

What are temporary disability (TTD and TPD) benefits?

When a work-related injury temporarily inhibits an individual’s ability to work, they may be owed temporary disability (wage loss) benefits. Temporary disability benefits are considered either total (TPD) or partial (TPD) depending on whether the injury fully prevents the employee from working or only reduces what they are able to do at work.

If a worker is only partially disabled, they may be able to return to work in “suitable employment.” What conditions qualify as suitable employment varies from case to case, which is why you should enlist help from a knowledgeable attorney.

After a 7-day waiting period, the injured worker can start receiving TTD or TPD benefits. If the disability lasts for 21 days or longer, then the injured worker will be compensated for the lost wages from the 7-day waiting period. If the worker reaches maximum medical improvement in 20 days or less, they will not get paid for the 7-day waiting period.

For all temporary disability benefits, injured workers will be paid two-thirds of their average weekly wage. This weekly payment can continue for up to 500 weeks maximum for cases that arise after June 24, 2011 (up to 300 weeks maximum for cases before that date).

What are permanent disability (PTD and PPD) benefits?

When a work-related injury is so catastrophic that it totally or partially inhibits a person’s ability to ever work full-time again, then they may qualify for permanent disability benefits under the workers’ compensation system.

Permanent partial disabilities may be classified as either “scheduled” injuries (an impairment to one of the body parts listed in the schedule contained in N.C.G.S. 97-31) or “unscheduled” injuries (an impairment that is not listed in the schedule). PPD benefits are calculated by multiplying the impairment rating percentage given by the authorized treating physician by the workers’ compensation rate and the number of weeks assigned to the injured body part.

Permanent total disabilities, on the other hand, are only paid in limited circumstances when the employee has suffered the loss of:

Both hands, arms, feet, legs, eyes, or any combination of any 2 of these listed body parts;
Spinal injury involving severe paralysis of both arms, both legs, or the trunk;
Certain severe brain or closed head injuries; or
Second-degree or third-degree burns to 33 percent or more of the total body surface.

Social Security disability

Unlike workers’ compensation, Social Security disability benefits are only paid to workers who have a substantial work history. In addition, workers’ compensation only covers short-term and long-term disabilities that arise out of and in the course of employment; whereas Social Security disability benefits are paid to anyone with a long-term impairment, regardless of where the injury occurred (in the workplace or outside of the workplace).

Generally, Social Security disability pays more for wage-replacement benefits than workers’ compensation. According to the SSA, Social Security disability benefits paid nearly twice what workers’ compensation paid in 2002.

There are 2 main disability programs available through Social Security: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Both SSDI and SSI offer monetary benefits through the Social Security Administration (SSA) for people who are disabled. However, the eligibility requirements for each program vary.

SSDI vs SSI: what’s the difference?

The major difference between the SSI and SSDI eligibility. Generally, SSDI is only available to workers with a certain number of work credits. SSI, on the other hand, is a need-based disability program that offers benefits to those who have not worked before or lack enough credits to be eligible for SSDI.

What’s more, compared to SSI, the approval rates for the SSDI are high for a number of possible reasons. For starters, Social Security Disability Insurance applicants generally have better coverage and higher income than SSI applicants. What’s more, SSDI applicants are more likely to consult a doctor because they may be experiencing varying medical issues. Findings by medical examiners are highly credible forms of evidence in an SSDI application, especially when the applicant has a long work history.

What is SSDI?

The Social Security Disability Insurance program is funded through payroll taxes. The recipients are “insured” since they have worked for some time, and they have contributed to the Social Security trust fund in the form of Social Security taxes. The amount of SSDI benefits you will be paid depend, in part, on how much you earned prior to being disabled.

To qualify for the SSDI program, you must meet the following requirements:

Have worked in jobs covered by Social Security
Have a medical condition that meets Social Security’s definition of disability
Have a certain number of “work credits”
Be less than 65 years old.

If you’re still receiving SSDI when you reach the age of full retirement (67 for individuals born in 1960 or later), then your disability benefits will be automatically converted to retirement benefits. The amount you will be paid will remain the same.

Before you start receiving any SSDI benefits, you may have to wait for at least 5 months. After this 5-month waiting period has come to an end, the Social Security Administration will start issuing benefits depending on your pre-injury earnings.

What is SSI?

SSI, which stands for Supplemental Security Income, is a need-based program that provides benefits to certain individuals depending on their assets and income. As with SSDI, this program is funded by American taxpayers, but not from the Social Security trust fund. Unlike SSDI, SSI is not dependent on your work history.

The main eligibility criteria for SSI is your financial need. To be eligible for the program, your income, assets and resources must total less than $2,000. For a couple, the limit is $3,000. In addition, you must be:

Age 65 or older
Blind; or
Disabled

What conditions qualify for disability benefits under SSI?

For injured workers who are below the age of 18, they may be considered “disabled” and eligible for SSI benefits if they have a physical or mental impairment that causes “marked and severe” functional limitations that:

Can be expected to result in death, or
Has lasted or can be expected to continuously last for 12 months (1 year) or longer.

For adult injured workers (at least 18 years old), you may be eligible for SSI benefits if you have a physical or mental impairment that results in an inability to perform “substantial gainful activity” that:

Can be expected to result in death, or
Has lasted or can be expected to continuously last for 12 months (1 year) or longer.

Additional Social Security disability programs

In addition to SSDI and SSI, other disability programs available through Social Security include:

Disabled Widows and Widowers Benefits (DWB) — sometimes called “survivors’ benefits”
Disabled Adult Child Benefits (DAC)
Special benefits for people who are blind

North Carolina disability benefits

In addition to workers’ compensation and Social Security disability, public employees in North Carolina—such as teachers, police officers, government workers and other state employees—can become members of the Teachers’ and State Employees’ Retirement System (TSERS) or the Optional Retirement Program (ORP. Under the Disability Income Plan of North Carolina (DIPNC), these employees may be provided monthly wage replacement benefits if they become disabled while employed by the state of North Carolina.

Disability benefits may be provided through:

Short-term disability
Extended short-term disability
Long-term disability

Eligibility requirements differ for each of these programs, which is why it’s beneficial to consult with an attorney who is experienced in North Carolina’s disability benefits program to understand your rights.

See our Quick Reference Guide below for an overview of eligibility, deadlines, forms required and other rules.

How to obtain North Carolina disability benefits

As a North Carolina disability benefit recipient, there are several requirements that you must follow to obtain and maintain your benefits. The following Disability Quick Reference Guide identifies the steps and materials needed throughout the process.

It is important that you complete the forms in their entirety, or respond to requests from the North Carolina Retirement Systems so that your disability benefits are processed in a timely manner, and to guard against any interruption of disability benefits.

North Carolina Disability Benefits A Quick Reference Guide
	Short-Term/Preliminary Long-Term Disability	Extended Short-Term Disability	Long-Term Disability	State Disability
Who is eligible?	1-year membership earned within the 36 months preceding disability. The doctor must certify disability on or prior to the last day worked, or on exhausted leave. The injury can be a temporary or permanent disability.	1-year membership earned within the last 36 months prior to the end of short-term disability. The doctor must certify disability on or prior to the last day worked, or on exhausted leave. The employee must be temporarily disabled. The employee must go through short-term disability period.	5-year membership earned within the 96 months prior to the end of the short-term disability period. The doctor must certify disability on or prior to the last day worked, or on exhausted leave. The employee must be permanently disabled. Members cannot be eligible for unreduced service retirement.	The member must be vested as of July 1, 1982 or January 1, 1988. The doctor must certify disability on or prior to the last day worked, or on exhausted leave. The employee must be permanently disabled. If eligible for service retirement, the member must be vested as of July 1, 1982 for state disability.
When to apply (deadline)?	NONE	NONE	Within 180 days from the end of short-term disability or temporary total workers’ compensation (TTD).	NONE Note: Effective retirement date is in accordance with filing requirements.
How are benefits calculated?	Based on 50 percent of the worker’s salary as of the last day worked, reduced by certain offsets. The monthly maximum benefit is $3,000.	Based on 50 percent of the worker’s salary as of the last day worked, reduced by certain offsets. The monthly maximum benefit is $3,000.	Based on 65 percent of the worker’s salary as of the last day worked, reduced by certain offsets. The monthly maximum benefit is $3,900. The monthly minimum is $10.	Based on average financial compensation (AFC), accrual factor, total creditable service and projected service.
How long are benefits paid?	Maximum of 365 days (1 year) after a 60-day waiting period. Benefits are paid by the employer with proper certification from the doctor (Form 703 monthly certification unless preliminary long-term determination).	Maximum of 365 days (1 year) as approved by the Medical Board (paid by N.C. Retirement Systems).	Until the member is eligible for an unreduced service retirement or otherwise no longer meets requirements for benefits. There is a limit of 36 payments if the member is not vested prior to August 1, 2007, unless receiving Social Security disability benefits.	Lifetime, per G.S. §135-5(c)
What’s the application process?	Applicant completes Form 700 (Requesting Short-Term Benefits Through the Disability Income Plan of North Carolina) Employer completes Form 701 (Requesting Employer Information Required for Member Disability Income Plan Benefits) Licensed physician completes Form 7A ( Medical Report for Eligibility Review) Applicant and licensed physician complete Form 703 (Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review) Employer provides a job description Applicant provides supporting medical documentation within 6 months	Applicant completes Form 700 (Requesting Short-Term Benefits Through the Disability Income Plan of North Carolina) Applicant completes Form 704 (Requesting Additional Benefits Through the Disability Income Plan of North Carolina) Licensed physician completes Form 7A ( Medical Report for Eligibility Review) Employer completes Form 711 (Determining and Recording Short-Term Disability Benefits) Employer provides a job description Submit a copy of Form 701 Submit a copy of Form 703 if the member was not approved for short-term disability through the Retirement Systems Division	Applicant completes Form 700 (Requesting Short-Term Benefits Through the Disability Income Plan of North Carolina) Applicant completes Form 704 (Requesting Additional Benefits Through the Disability Income Plan of North Carolina) Licensed physician completes Form 7A ( Medical Report for Eligibility Review) Employer completes Form 711 (Determining and Recording Short-Term Disability Benefits) Submit a copy of Form 701 Applicant completes Form 703 (Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review) Employer provides job description (if member was approved for short-term disability through the Retirement Systems Division, then the Division should already have these documents)	Applicant completes Form 7 (Requesting Disability Retirement Benefits) Licensed physician completes Form 7A ( Medical Report for Eligibility Review) Employer provides a job description
What benefits are offset?	Temporary total disability (TTD) benefits through workers’ compensation Veterans Administration (same disability) Excess earnings (the amount a member earns over the earnable allowance)	Temporary total disability (TTD) benefits through workers’ compensation Veterans Administration (same disability) Excess earnings (the amount a member earns over the earnable allowance)	Social Security benefits (36-month hypothetical Social Security offset if vested prior to August 1, 2007) Temporary total disability (TTD) benefits through workers’ compensation Railroad retirement Veterans Administration (same disability) Excess earnings (the amount a member earns over the earnable allowance)	Excess earnings (the amount a member earns over the earnable allowance)
How often is the earnable allowance?	Monthly (up to the amount of short-term benefit)	Monthly (up to the amount of extended short-term benefit)	Monthly (difference between 100% salary and adjusted gross long-term before any offsets)	Annually
How often are re-exams (determined by Medical Board)?	NONE	NONE	Reviewed yearly (at the discretion of the Medical Board)	Reviewed yearly (at the discretion of the Medical Board)

Can I get multiple types of disability benefits at the same time?

It depends.

It is possible to get SSDI and workers’ compensation at the same time, but only if you’re permanently disabled. What’s more, your benefits may be “offset” (or reduced) based on what other disability benefits you are receiving.

According to the SSA, your Social Security Disability Insurance (SSDI) benefits can be reduced if you are simultaneously getting workers’ compensation benefits until the total amount you receive is no more than 80 percent of the amount you earned while fully employed (pre-injury).

For example, let’s say Allen became disabled while working at a Charlotte manufacturing plant. Prior to his disability, he was earning $4,000 per month, on average. Through Social Security, Allen is able to collect $2,200 per month in SSDI benefits. At the same time, he is earning $2,000 per month through his employer’s workers’ compensation program, giving him a total of $4,200 per month in total disability benefits—more than he made before his disability. Due to the 80 percent Social Security offset rule, Allen’s SSDI benefits would be reduced by $1,000 so that his total disability benefits are $3,200 (80 percent of his average monthly earnings of $4,000).

As you can see, the interaction between workers’ compensation, Social Security and North Carolina disability benefits can be intricately complex. To find out when the rules conflict and calculate your potential “offset,” don’t hesitate to consult with an experienced disability benefits attorney near you. If you live and work in North Carolina, reach out to Wilder Law Group for answers. Your first consultation is free.

Guide to Disability Benefits in North Carolina