North Carolina Workers’ Compensation Benefits: TTD, TPD, PPD and Medical

What Medical Benefits Does North Carolina Workers’ Comp Cover?

The first and often the largest benefit is medical compensation. N.C. Gen. Stat. § 97-25 puts it in one sentence: “Medical compensation shall be provided by the employer.” N.C. Gen. Stat. § 97-2(19) defines it broadly: “medical, surgical, hospital, nursing, and rehabilitative services,” including attendant care, vocational rehabilitation, medicines and sick travel, “as may reasonably be required to effect a cure or give relief.” There is no waiting period for medical care. Providers are paid on the Commission’s fee schedule and, under N.C. Gen. Stat. § 97-90, cannot bill you the balance while the claim is accepted or still being decided; travel of 20 miles or more round trip is reimbursed at the IRS standard mileage rate on the Form 25T.

The trade-off is control: in an accepted claim the insurer directs your care and chooses the doctor. The statute gives you two ways to push back. Under § 97-25(b) you can request a second opinion examination in writing; if the employer does not agree within 14 calendar days, the Commission can order one at the employer’s expense. Under § 97-25(c) the Commission can approve a doctor of your own choosing if you show the change is “reasonably necessary to effect a cure, provide relief, or lessen the period of disability,” and it may give less weight to a provider you saw before asking for authorization in writing, so ask first. The insurer’s tool is the independent medical examination: under N.C. Gen. Stat. § 97-27 you must attend one requested by the employer or ordered by the Commission, even in a denied claim; you may have your own physician present; the employer must give you the report within 10 business days; and refusing suspends compensation. Refusing treatment the Commission has ordered does the same under § 97-25(d).

How Much Does Temporary Total Disability Pay In North Carolina?

Temporary total disability, usually shortened to TTD, is the weekly check you receive while you are completely unable to earn wages because of the injury. N.C. Gen. Stat. § 97-29(a) sets the rate at “sixty-six and two-thirds percent (66⅔%) of his average weekly wages,” not more than the maximum established each year and “nor less than thirty dollars ($30.00) per week.” The average weekly wage comes from N.C. Gen. Stat. § 97-2(5): your earnings in the 52 weeks before the injury divided by 52, with adjustments if you lost more than seven consecutive days that year, worked for the employer less than a year, or have a wage history that needs a fairer method.

The maximum is the figure people search for as the “NC Industrial Commission maximum compensation rate.” It is recomputed every July 1 from the state’s average weekly insured wage multiplied by 1.10, rounded to the nearest two dollars, and applies to injuries on and after the following January 1. The Commission’s rule is that the cap for your entire claim is the rate for the year you were injured.

How Long Does Workers’ Comp Last In North Carolina?

For most injuries the outer limit on wage benefits is 500 weeks. Under § 97-29(b) an employee “shall not be entitled to compensation pursuant to this subsection greater than 500 weeks from the date of first disability” unless the employee qualifies for extended compensation. Extended compensation under § 97-29(c) is a high bar: you may apply only after 425 weeks have passed since the date of first disability, and you must prove by a preponderance of the evidence “a total loss of wage-earning capacity,” defined as “the complete elimination of the capacity to earn any wages.” Once you reach full Social Security retirement age, the employer may offset 100% of your retirement benefit against extended compensation.

Lifetime benefits exist only for permanent total disability, and § 97-29(d) limits that to four categories: the loss of both hands, both arms, both feet, both legs, both eyes, or any two of them; a spinal injury involving severe paralysis of both arms, both legs or the trunk; a severe brain or closed head injury; and second- or third-degree burns to 33% or more of the total body surface. Outside those categories, no one should promise you benefits for life.

Two more clocks matter. Weekly benefits under § 97-29 or § 97-30 and a scheduled permanent partial award under § 97-31 cannot be collected for the same injury at the same time, but the employee may “select the statutory compensation which provides the more favorable remedy.” And after benefits end, N.C. Gen. Stat. § 97-47 lets the Commission reopen an award for a change of condition, but not “after two years from the date of the last payment of compensation” under the award, or after 12 months from the last medical bill where only medical was paid.

What Is Temporary Partial Disability?

Temporary partial disability, or TPD, is for the worker who is back at work but earning less because of the injury: reduced hours, a lighter job, a lower rate. N.C. Gen. Stat. § 97-30 pays “sixty-six and two-thirds percent (66 2/3%) of the difference between his average weekly wages before the injury and the average weekly wages which he is able to earn thereafter,” subject to the same annual maximum as TTD. An illustration only: a worker who earned $900 a week before the injury and now earns $600 on light duty has a $300 gap, and TPD pays two-thirds of it, $200 a week, on top of the new wages.

The limit is 500 weeks of payments, and any weeks of total disability already paid under § 97-29 are deducted from those 500; TTD and TPD share one budget. TPD is also the benefit that continues during a trial return to work under § 97-32.1, which is why a light-duty job that pays less should never mean your claim simply stops. That mechanism is explained on the return to work page.

How Does Permanent Partial Disability Work Under The § 97-31 Schedule?

When you reach maximum medical improvement, the point where further treatment is not expected to improve the condition, the treating physician assigns an impairment rating, a percentage of loss of use, to the injured body part. N.C. Gen. Stat. § 97-31 turns that rating into money. The statute lists body parts and assigns each a number of weeks; compensation for a total loss is 66⅔% of the average weekly wage for that many weeks, “in lieu of all other compensation, including disfigurement,” paid in addition to the benefits already received during the healing period. Partial loss of use is paid as the same proportion of those weeks, and total loss of use counts as loss of the member.

Who Gets Death Benefits, And How Much?

When a compensable injury or occupational disease causes death within six years, or within two years of the final determination of disability, whichever is later, N.C. Gen. Stat. § 97-38 requires the employer to pay the dependents weekly compensation of 66⅔% of the worker’s average weekly wage, subject to the same annual maximum and the $30 minimum, plus “burial expenses not exceeding ten thousand dollars ($10,000).” Persons wholly dependent on the worker share the benefit “share and share alike to the exclusion of all other persons.”

Death benefits are paid “for a period of 500 weeks from the date of the death of the employee.” Two exceptions extend them: a widow or widower who was unable to support herself or himself because of physical or mental disability as of the date of death continues to receive payments for life or until remarriage, and a dependent child’s payments continue until the child turns 18. Families with a death claim often also have a claim against a negligent third party, explained on our North Carolina wrongful death page.

What Other Benefits Can An Injured Worker Claim?

Vocational rehabilitation. Under N.C. Gen. Stat. § 97-32.2 the employer may engage vocational rehabilitation services at any point in a claim, and the employee may request them, “including education and retraining in the North Carolina community college or university systems,” if the employee has not returned to work or has returned earning less than 75% of the pre-injury average weekly wage while receiving TPD. The cost is borne by the employer the same way medical compensation is. Refusing vocational rehabilitation the Commission has ordered bars further compensation until the refusal ends.

Settlements. Many claims end in a lump-sum compromise settlement, commonly nicknamed a clincher, which must be filed with and approved by the Industrial Commission as fair and just before it binds anyone. Attorney fees in a workers’ compensation claim are likewise subject to Commission approval under § 97-90.

No-fault, with narrow exceptions. None of these benefits depends on who caused the accident. Workers’ compensation is no-fault. North Carolina’s contributory negligence rule, which bars an ordinary injury claim over even 1% of fault, does not apply to a Chapter 97 claim; the only fault-based bars are in N.C. Gen. Stat. § 97-12, which denies compensation for an injury proximately caused by the worker’s intoxication, a non-prescribed controlled substance or a willful intent to injure, and puts the burden of proof on the party claiming the bar. The same section adjusts benefits 10% either way for a willful safety-rule breach by the worker or a willful statutory violation by the employer.