Learn which medical treatments are covered under North Carolina’s workers’ comp and how to apply
From emergency room visits to ongoing physical therapy, workers’ compensation is designed to cover a range of medical treatments, ensuring that injured workers receive the necessary care without bearing the financial burden.
But who exactly qualifies for these benefits? And what steps must be taken to ensure that your medical needs and rights are fully addressed?
The reality is that navigating the maze of workers’ compensation can be a daunting task, particularly when you’re coping with a serious injury or illness and unsure about your next steps. This article aims to shed light on the types of medical benefits available and answer common questions about the steps involved in claiming your financial support.
If you’ve recently suffered a work-related injury, illness or disease and need help filing a workers’ comp claim or simply need some advice, reach out to the knowledgeable work injury attorneys at Wilder Pantazis Law Group to schedule a free consultation to learn more about your rights.
What kinds of injuries and illnesses qualify for medical benefits under workers’ comp?
Under North Carolina law, any injury, illness or disease that arises out of or in the course of employment qualifies for workers’ comp benefits. This means that as long as the condition is related to the work you performed or due to your work environment, it should be covered.
These include conditions like:
- Black lung disease
- Occupational asthma
- Hearing loss (due to chemicals or noise)
- Chemical poisoning
- Chronic obstructive pulmonary disease (COPD)
- Repetitive strain injuries like carpal tunnel syndrome
- Infectious diseases contracted by health care workers
Additionally, work-related injuries, illnesses and diseases are covered regardless of fault, so you don’t have to prove that anyone was negligent to qualify for benefits. In most cases, you even qualify for benefits if you caused the accident that led to your injuries.
What medical benefits am I entitled to after a work injury in North Carolina?
If you suffer a work-related injury or illness, you’re generally entitled to the following types of medical benefits under workers’ compensation:
- Hospital stays and doctor visits. You are covered for all necessary appointments with health care professionals to treat your injury or illness resulting from your job.
- Surgical procedures. If surgery is required as a direct consequence of your workplace injury, workers’ compensation will pay for these operations.
- Dental services. Any dental work needed due to a work-related injury, including repairs, extractions or reconstructions, is included.
- Prescription medications. All necessary medications prescribed by your treating physician for the work-related injury are paid for.
- Diagnostic tests and X-rays. Necessary diagnostic procedures, including MRIs, CT scans and X-rays, that are required to evaluate your injury are covered.
- Physical therapy. Rehabilitation services such as physical therapy are covered if they’re part of your recovery plan.
- Chiropractic care. Employees may receive up to 20 chiropractic sessions if deemed medically necessary. Approval is needed for further treatment beyond this.
- Medical equipment. Any medical devices or equipment prescribed to aid in recovery or compensate for the loss of function are covered, such as wheelchairs or crutches.
- Prosthetic devices. The cost of artificial limbs or other prosthetic devices is included if they’re necessary due to the work injury.
- Mileage or travel expenses for medical appointments. Transportation costs for getting to and from treatment or medical evaluations can be reimbursed.
- Coverage for ongoing care related to the work injury or illness. Long-term treatment costs, including follow-up visits and maintenance care for chronic conditions resulting from the workplace incident, are also covered.
Each of these benefits is designed to ensure that workers who are injured on the job in North Carolina can receive the medical care they need without having to bear the financial burden themselves.
How do I know if I’m eligible for medical benefits after a work injury in NC?
In North Carolina, the right to workers’ compensation medical benefits is limited to individuals whose employers are required to carry workers’ compensation insurance and who are classified as employees rather than independent contractors.
Employees of businesses with mandatory coverage
Most businesses in North Carolina with 3 or more employees are legally mandated to have workers’ compensation coverage. If you are an employee of such a business, you should be eligible for medical benefits after an on-the-job injury or illness.
If you want to verify that your employer has coverage, you can use this online search tool provided by the North Carolina Industrial Commission or contact their office directly.
Exclusion of independent contractors
Generally, independent contractors are not eligible for workers’ compensation medical benefits under North Carolina law. The distinction between an employee and an independent contractor can sometimes be complex and is determined by various factors, such as the degree of control the employer has over the worker, the permanency of the relationship, and the method of payment, among others.
If your employment status or the nature of your employer’s coverage is unclear, it could affect your eligibility for medical benefits. It’s important to review your work arrangement and consult with a workers’ compensation attorney if there are any uncertainties about your classification as an employee or the workers’ compensation insurance status of your employer.
What do I need to do to file a workers’ comp claim for medical expenses in NC?
To file a workers’ compensation claim for medical expenses in North Carolina, you need to follow these steps:
- Notify your employer. Within 30 days of your injury or the discovery of your occupational disease or illness, inform your employer about the incident. This notification should be in writing and should detail the incident and the nature of your injury.
- Seek medical treatment. Obtain the necessary medical care for your injuries. Remember that for non-emergencies, this care must be from a provider authorized by your employer or their workers’ compensation insurance.
- Complete the necessary paperwork. Fill out Form 18 (Notice of Accident to Employer and Claim of Employee, Representative, or Dependent) and submit it to the North Carolina Industrial Commission (NCIC). This should be filed as soon as possible, but no longer than 2 years after the date of injury or discovery of the illness or disease.
- Follow doctor’s orders. To ensure continued eligibility for benefits, comply with the treatment plan prescribed by your authorized medical provider.
- Monitor your claim. Stay in contact with your employer or their workers’ comp insurance representative to monitor the status of your claim and provide any additional information needed.
Remember, if there are any disputes or if you need assistance at any point in the process, you should consult with a workers’ compensation attorney who can guide you through the intricacies of the system and advocate on your behalf.
Am I allowed to choose my own doctor after a work injury?
In North Carolina, the choice of a health care provider for a work-related injury is generally directed by your employer or their workers’ compensation insurer. However, you are typically allowed to select a doctor from a panel of physicians provided by your employer.
Additionally, if you wish to change doctors at any point or request a second opinion, you must get approval from the North Carolina Industrial Commission.
Remember that in urgent situations requiring immediate medical intervention, you have the right to visit the nearest emergency department. However, once the emergency treatment is provided and you’re stabilized, the ongoing treatment should be transferred to an approved health care provider.
Will I receive any medical bills for treatment covered under workers’ comp?
In North Carolina, if your injury is covered under workers’ compensation, you should not receive any medical bills for treatments that are authorized under this coverage. All bills should be sent directly to your employer’s workers’ compensation insurance carrier for payment.
If you do receive a bill, it’s important to contact your employer or the insurance carrier to resolve the issue.
What is a “medical only” claim?
A “medical only” claim in North Carolina refers to a workers’ compensation claim where the injured worker has not missed more than 1 day of work, suffered disfigurement or impairment, or incurred more than $4,000 in medical expenses.
For such claims, employers or insurance carriers are not mandated to submit a claim to the North Carolina Industrial Commission, which means an official file number is not generated. This means that if an injured worker needs to resolve a dispute or request a hearing, they must file a Form 18 to establish an Industrial Commission file number to begin the process.
How do I get reimbursed for travel expenses for medical appointments?
In North Carolina, workers’ compensation covers travel expenses for medical appointments if the round-trip mileage exceeds 20 miles. You can get reimbursed for these expenses at the IRS’s standard mileage rate, along with any tolls you’ve paid.
If an overnight stay is medically necessary, you’re also entitled to lodging and meal expenses at the rates set for state employees. Additionally, necessary expenses for parking or hired vehicles will be reimbursed at the actual cost.
To claim these travel expenses, you must fill out and submit Form 25T to your employer’s workers’ comp insurer.
Get help from an experienced North Carolina work injury attorney
If you’re navigating the complexities of a workers’ compensation claim in Charlotte and seeking your rightful medical benefits, don’t risk going it alone.
With more than 85 years of combined experience, the dedicated team at Wilder Pantazis Law Group is poised to assist you every step of the way, ensuring your rights are protected and your claim is handled effectively.
Reach out for a free consultation, and let us advocate for the support and compensation you deserve.
N.C. Industrial Commission Home Page. (n.d.). Www.ic.nc.gov. Retrieved November 3, 2023, from https://www.ic.nc.gov/index.html