Workers' Compensation Bulletin

Information Regarding the North Carolina Workers’ Compensation Act

Meredith R. Henderson, Executive Secretary
Ashley M. Moore, Chief Deputy Commissioner & Director of Claims Administration
Emily M. Baucom, Clerk of the Industrial Commission
Kevin V. Howell, Dispute Resolution Coordinator
Lauren Halbert White, Director of Compliance Division
Samuel Constance, Chief of Criminal Investigations & Employee Classification Division

Please Note:

This bulletin provides general information only. It is not a legal reference. 

Also, an Information Specialist can provide further information about Industrial Commission forms, policies, and procedures. However, an Information Specialist cannot provide legal advice. 

If you need information about a specific case, please provide:

• the name of the injured employee,
• the Commission file number, and
• the name of the employer and date of injury, if known.

Injured employees may wish to consult with an attorney. For assistance locating an attorney who is familiar with workers’ compensation law, employees may contact the North Carolina Bar Association’s Lawyer Referral Service at ncbar.org/public-resources/lawyer-referral-service or at (800) 662-7660 and (919) 677-8574. The Lawyer Referral Service will provide the name of an attorney willing to discuss the case. Be sure to mention workers’ compensation when requesting a referral.

Industrial Commission Forms

All Industrial Commission forms can be found on the Commission’s website free of charge. Paper copies of forms may be obtained free of charge by contacting an Information Specialist. 

Electronic Filing

All documents filed with the Commission in workers’ compensation cases by represented parties shall be submitted electronically. Any document filed with the Commission which requires contemporaneous payment of a processing fee pursuant to Rule 11 NCAC 23E .0203 shall not be deemed filed until the fee has been paid in full. 

The electronic filing requirements do not apply to claimants, medical providers, or non-insured employers without legal representation. Claimants, medical providers, and non-insured employers without legal representation may file documents with the Commission via the Electronic Document Filing Portal (EDFP), email, U.S. Mail, private courier service, or hand delivery. The rule governing Electronic Filings is 11 NCAC 23A .0108. 

Employers' Obligation to Obtain and Maintain Coverage

A business covered by the North Carolina Workers’ Compensation Act, Chapter 97 of the North Carolina General Statutes, is required by law to obtain workers’ compensation insurance or qualify as a self-insured employer. In general, all businesses employing three or more employees on a regular basis are covered by the Act. Certain groups are exempt from the provisions of the Act, and these exemptions are set forth in N.C. Gen. Stat. §97-13. Employers of one or more employees who are employed in activities which involve the use or presence of radiation are required to have coverage.

Corporate officers are counted in determining whether the corporation has three or more employees. However, corporate officers may specifically exclude themselves from coverage under a workers' compensation policy. Corporate officers of certain non-profit corporations that do not receive any compensation for their work are not covered under the Act, but they count towards the total number of employees. Sole proprietors, partners, and members of limited liability companies are not automatically counted as employees, but they may elect to include coverage for themselves under their workers' compensation policy. Principal contractors must obtain a certificate of coverage from their subcontractors to avoid liability for injuries suffered by a subcontractor's employees.

How To Obtain Workers' Compensation Coverage

If you are subject to the Act, you are required to carry workers' compensation insurance. To obtain workers' compensation insurance, contact an insurance agent about your coverage needs and the types of coverage available to you.

How Your Workers' Compensation Insurance Premiums Are Set

The North Carolina Rate Bureau, (919) 783-9790, sets rates for specific types of employment and bases premiums on each $100.00 of payroll. Policies are written annually, and premiums may increase if there is an injury and may decrease if there are no injury claims. Premiums also increase or decrease based upon the number of employees and payroll.

Injuries Covered

Employees are entitled to benefits if, while carrying out activities for the benefit of their employer, they sustain an “injury by accident” or contract an “occupational disease.” 

An “accident” is an interruption of the normal work routine where there is some unusual or unforeseen event, other than the injury itself. In cases involving injuries to the neck and back, as well as in hernia cases, a “specific traumatic incident” (which may include normal work activities) qualifies as an “accident.” All injuries must arise out of and be in the course of the covered employment to be compensable.

Businesses complying with the Act and their employees may not be sued in the general courts of justice by employees for work-related injuries, except for intentional assaults and conditions that are found to be so grossly unsafe as to make injury substantially certain.

Occupational Disease

If the occupational disease is a listed disease in the Workers’ Compensation Act, the employee must also prove that there is a causal relationship between the employment and the listed disease. If the occupational disease is not a listed disease in the Workers’ Compensation Act, the employee must prove that the employment exposed him or her to a greater risk of contracting the disease than the public generally and that there is a causal relationship between the employment and the disease. Where an employee is exposed to the same injurious agent at the place of business of more than one employer, the claim should be filed with the employer on whose premises he or she was last injuriously exposed.

Employers' Obligation to Record and Report Injuries

A business covered by the North Carolina Workers' Comepnsation Act, Chapter 97 of the North CArolina General Statutes, is required by law to obtain workers' compensation insurance or quality as a self-injured employer. Every employer shall keep a record of all injuries, fatal or otherwise, and all work-related injuries, fatal or otherwise, shall be reported to the Commission on a Form 19 if the injury results in more than $4,000.00 in medical expenses or more than one day’s lost time from work. A copy of a completed Form 19, with "Important Information For Employee" on the back, must be furnished to the employee or his or her survivors. In addition, the employer is required to provide a Form 18 for use by the employee with the copy of the Form 19.

Giving Notice to Employer

Pursuant to N.C. Gen. Stat. §97-22, an injured employee shall give the employer written notice of a workplace accident “immediately. . . or as soon thereafter as practicable,” but no later than 30 days after the accident or else compensation may not be payable.   Pursuant to N.C. Gen. Stat. §97-58(b), the report and notice requirements set forth in N.C. Gen. Stat. §97-22 also apply in occupational disease claims (except for cases of asbestosis, silicosis, or lead poisoning), and the 30 days for giving written notice in an occupational disease claim begins to run on the date the employee was advised by competent medical authority that the employee has the occupational disease.

Filing Claims

Subject to certain exceptions, an employee loses the right to claim compensation unless a claim is filed with the commission within two years after the injury by accident (or, in cases of an occupational disease, within two years after death, disability, or disablement and being advised by competent medical authority that the employee has an occupationally related disease, whichever occurs last), or within two years after the last payment of medical compensation when no other compensation has been paid.

The Commission’s Form 18 (or Form 18B for lung disease claims) may be used by an employee to file a workers’ compensation claim. If a claim is not filed on a Form 18 or Form 18B, the employee will be asked to complete the appropriate form. Note that the filing of a Form 19 by the employer or carrier does not constitute a filing of a claim on behalf of an employee.

Denial of a Claim

Pursuant to N.C. Gen. Stat. 97-18 and Rule 11 NCAC 23A .0601, if the employer or insurer denies an employee’s right to compensation, the employer or insurer shall notify the Commission within 14 days after the employer or insurer has written or actual notice of the employee’s injury or death, or within such reasonable additional time as the Commission may allow. The employer or insurer also shall advise the employee in writing of its refusal to pay compensation on a form prescribed by the Commission, and the notification of the denial shall include a detailed statement of the grounds on which the right to compensation is denied. An employee whose claim has been denied has a right to request a hearing, and the hearing request should be made by filing a Form 33. 

Communication with Medical Providers

Pursuant to N.C. Gen. Stat. §97-25.6(c)(1), an employer is entitled, without the express authorization of the employee, to obtain the employee’s medical records containing “relevant medical information” from the employee’s health care providers. “Relevant medical information” means any medical record, report, or information that is any of the following: 

1. Restricted to the particular evaluation, diagnosis, or treatment of the injury or disease for which compensation, including medical compensation, is sought;
2. Reasonably related to the injury or disease for which the employee claims compensation; or
3. Related to an assessment of the employee’s ability to return to work as a result of the particular injury or disease. 

In a claim in which the employer is not paying medical compensation to a health care provider from whom the medical records are sought, or in a claim denied pursuant to N.C. Gen. Stat. §97-18(c), the employer shall provide the employee with contemporaneous written notice of the request for the employee’s medical records. 

In all claims, upon the request of an employee, the employer shall provide the employee with a copy of any records received in response to a request within 30 days of receipt by the employer.

N.C. Gen. Stat. §97-25.6(c)(2) governs the conditions under which an employer may communicate in writing with an employee’s authorized health care provider without the express authorization of the employee. The employee must be provided with contemporaneous written notice of the written communication to obtain relevant medical information not available in the employee’s medical records. Under this provision, the employer may request the following additional information: 

1. The diagnosis of the employee’s condition;
2. The appropriate course of treatment;
3. The anticipated time that the employee will be out of work;
4. The relationship, if any, of the employee’s condition to the employment;
5. Work restrictions resulting from the condition, including whether the employee is able to return to the employee’s employment with the employer of injury as provided in an attached job description;
6. The kind of work for which the employee may be eligible;
7. The anticipated time the employee will be restricted; and
8. Any permanent impairment as a result of the condition. 

The employer shall provide a copy of the health care provider’s response to the employee within 10 business days of its receipt.

N.C. Gen. Stat. §97-25.6(c)(3) governs the conditions and procedure under which an employer may communicate with an employee’s authorized health care provider by oral communication to obtain relevant medical information not contained in the employee’s medical records, not available through written communication, and not otherwise available to the employer. The employer must give the employee prior notice of the purpose of the intended oral communication and an opportunity for the employee to participate in the oral communication at a mutually convenient time for the employer, employee, and health care provider. If the employee does not exercise his or her right to participate in the oral communication, the employer shall provide the employee with a summary of the oral communication within 10 business days of the oral communication.

N.C. Gen. Stat. §97-25.6(d) governs the conditions and procedure under which an employer may submit additional relevant medical information not already contained in the employee’s medical records to an employee’s authorized health care provider and communicate in writing with the authorized health care provider about the additional relevant medical information. The employer shall first notify the employee in writing that the employer intends to communicate additional relevant medical information about the employee to the health care provider and this notice shall include both the employer’s proposed written communication to the health care provider and the additional relevant medical information. The employee has 10 business days from the postmark or verifiable facsimile or electronic mail either to consent or object to the proposed communication. If the employee consents or fails to timely object, the employer may submit the additional information directly to the health care provider. If the employee timely objects, the employee also may request a protective order from the Commission to prevent the proposed communication, in which case the employer shall refrain from sending the proposed communication to the health care provider until the Commission has ruled on the protective order.

Medical Fee Schedule

Industrial Commission Medical Fee Schedule

Agreements to Pay Compensation

All agreements to pay compensation must be approved by the Commission. The most common forms of agreements are the Form 26A and the Compromise Settlement Agreement (or “clincher”).

A Form 26A agreement may be entered into after the end of the healing period to provide for payment of permanent partial disability benefits based upon a doctor’s evaluation, or “rating,” of any remaining physical permanent impairment. 

The employee is entitled to a single second opinion limited solely to the percentage of an impairment rating by a physician of his or her choice at the employer or insurance carrier’s expense when the physician approved by the employer or insurance carrier has rated and/or released the employee. 

The employee retains the right to reopen the case for further disability compensation within two years of the last payment of disability compensation if the employee can show that there has been a compensable change in the condition that resulted from the compensable injury. 

A Compromise Settlement Agreement, or “clincher,” is a voluntary complete and final settlement of the claim that provides payment of a negotiated amount for disability and medical compensation that the employee claims to be due.

Attorney Fees

The Industrial Commission must approve all attorney fees paid to an employee’s attorney under the Workers’ Compensation Act. Upon approval by the Commission as reasonable, the fees will be deducted from the compensation due to the employee and paid directly to the employee’s attorney by the employer, carrier, or third-party administrator.