North Carolina Workers' Compensation Laws

The North Carolina Workers’ Compensation Act requires all employers with three or more employees to have workers’ compensation insurance coverage. Companies must either provide this coverage or qualify as self-insured employers to pay medical and disability benefits to their employees. Employers who must have insurance include:

• Sole proprietorships, unless the owner is the only employee
• LLCs and partnerships
• Corporations
• Agricultural agencies and farms, unless they have fewer than 10 full-time non-seasonal laborers
• State and local government agencies
• Any business where employees use or are in the presence of radioactive material

Providing workers’ comp insurance is an expected part of owning a business.

Exceptions to Workers’ Compensation Requirements

Sole proprietors are not required to have workers’ comp for themselves unless they have more than three employees. LLC and partnership members are not included in the “employee” count, so a partnership with three members and two employees does not need coverage. Corporate officers are included when determining whether the business needs workers’ comp, so a small corporation with five officers and four employees needs coverage, even if the officers opt out.

Other exceptions include:

• Some railroad employees, since railroad workers have a separate type of workers’ compensation coverage
• “Casual employees,” employees hired for work not in the usual course of trade for the employer, such as a day laborer hired to paint the lobby
• Farm or agricultural workers, in situations when fewer than ten full-time non-seasonal farm laborers are hired by an employer, as when extra workers are needed in the off-season
• Federal government employees working in the state of North Carolina and compensated by the federal government

Independent contractors are self-employed or freelance workers who are not considered regular employees of the company and not covered by workers’ compensation insurance. Employers may not avoid their responsibility to pay workers’ comp benefits by misclassifying actual employees as independent contractors. If the Industrial Commission finds that an employee was intentionally misclassified as an independent contractor based on an analysis of work-related factors, the employer may be subject to fines and penalties.

Workers’ Compensation Benefits

North Carolina’s workers’ comp benefits cover all “reasonable medical care” needed for a work-related injury or illness. If you are unable to work after an injury or occupational disease, you’ll receive partial wage replacement (about 67% of your average weekly wage) until you can return to full-time work. Let’s take a closer look at what workers’ comp may cover.

Medical Benefits

Workers’ compensation in North Carolina covers all authorized doctor visits, including surgery, hospital care, and rehabilitation. Medical bills are sent directly to the insurance company at no out-of-pocket cost to you. Your employer chooses the healthcare provider, but you can attempt to use one of your preference by petitioning the Industrial Commission and showing good cause.

Medical benefits include mental health treatment and chiropractic care. They also cover medical expenses like prescription drugs, equipment like crutches or braces, and mileage to and from the doctor or hospital in excess of 20 miles round trip.

Wage Replacement

If you can’t work for more than seven consecutive days, you’ll qualify for wage replacement. A seven-day waiting period applies before weekly payment checks arrive. If you’re unable to work for more than 21 days, you’ll receive the first seven days retroactively.

Wages are based on your average weekly wage for the previous year. If you have been working for at least a full year, your total earnings, including any overtime and bonuses, are added together and divided by 52 weeks. If you’ve worked less than a full year, your total earnings are divided by your actual number of weeks worked. The maximum payment in 2026 is $1446 per week, and the lowest allowable state payment is $30, unless your average weekly wage is less than that. In that case, you receive your full wage.

Temporary Partial Disability

Temporary partial disability means you can return to work with some limitations, such as reduced hours or longer breaks. If your employer can provide “light work,” you must accept it or risk losing your wage replacement benefits. Temporary benefits can last up to 500 weeks, or until you reach “maximum medical improvement.”

While you are on temporary partial disability, your medical benefits remain uninterrupted. You can continue medical treatment until your doctor feels you no longer need medical care.

Permanent Disability

If you reach “maximum medical improvement” and remain partially or wholly impaired, you may be declared permanently disabled. Permanent partial disability means total loss of part of the body, partial loss of use of part of the body, or an injury leading to an inability to earn the same wages in any employment as earned at the time of the injury. If you won’t be able to ever return to your former occupation, you’ll have access to vocational rehabilitation to help you find employment in a new position or job.

Permanent total disability means you’re no longer able to earn gainful employment due to the injury or illness caused by your work-related accident. Under North Carolina general statutes, this rating is limited to catastrophic brain damage, loss of both eyes, or major paralysis.

Permanent total disability can result in lifetime payments or lump-sum settlements. In cases where an injury is this severe, the worker and their family should consider consulting a workers’ compensation attorney to discuss their best course of action.

Death Benefits

Death benefits provide the worker’s survivors with financial support and help cover burial expenses. Weekly wage replacement payments are calculated at two-thirds of the worker’s average weekly wage, similar to the worker’s lost wages. Spouses may receive benefits for life or until remarriage. Minor children can receive benefits until they reach the age of 18.

Funeral and burial expenses are covered up to $10,000. The employer must cover all medical bills related to the worker’s final treatment. The family should have no outstanding costs.

How To File a Workers’ Compensation Claim

If you’re injured on the job, your first step should be to report the injury to your employer in writing. This is something all injured workers should do, even if they’re treated at the on-site nurse’s office or transported from the office. You must file an official report for workers’ comp coverage, which also ensures your boss is informed of the incident.

If your job requires you to see a specific healthcare provider, do so. For injuries that required emergency medical treatment, visit the company doctor after you leave the ER.

Step two is to tell the treating physician or nurse that your injury is work-related. Give them your employer’s name and address. The treating healthcare provider must complete certain documents and bill workers’ compensation for the treatment.

Step Three requires you to notify your employer in writing within 30 days of the injury. This should state that you were injured on the job and received medical treatment. Your employer has a limited amount of time to file their own documents regarding your claim, so do this sooner rather than later.

Your work injury notice should include the date of the accident, where it happened, and as many details as you can recall. If you can’t do it yourself, have a friend or family member write it for you. Keep a copy for yourself.

Following the doctor’s instructions carefully is part of step four. Whether they tell you to return to work immediately or stay away until they clear you, get it in writing. Make sure to fully understand any instructions or directives a physician gives you before leaving their office.

You must give notice to your employer within 30 days of the date of your injury and have up to two years to file a claim. If you miss either of these deadlines, your claim could be denied. Ff that happens, you could lose your right to file a workers’ compensation case for this injury.

What if My Claim Is Denied?

Your claim can be denied for many reasons. The most common reason for claim denial is missing a filing deadline. In some cases, a missed deadline can be extended. If you receive a claim denial letter, contact a workers’ compensation lawyer. They can review the denial letter with you and determine the actual cause of the denial.

Some common reasons for denials include:

• Missing or unclear medical evidence: The second most common reason for denials is a lack of supporting evidence. The doctor may have failed to attach important documentation, or you could have misread what was needed. In some cases, required forms may not have been completed.
• Lack of connection between your job and your injury: It may have been unclear how your injury was related to your employment. The reviewer could have lacked evidence that showed how the accident caused your particular injury or illness.
• Pre-existing conditions: Insurance companies may claim you had a pre-existing condition unrelated to your job injury. Insurers can’t deny coverage for pre-existing conditions if you can show that your accident aggravated the problem. Make sure your employer knows about any pre-existing conditions you may have, as claiming one after an injury or aggravation is extremely difficult.
• Injured outside of work: Insurance companies likely won’t pay if there’s a question about whether the injury happened at work or was due to a third party’s liability. In this case, your attorney may need to file a personal injury claim on your behalf.

The appeals process goes through the NCIC. You must file a “Notice of Accident” form and a Request for Hearing form. Your attorney can explain the process for these documents and what they must include. In most cases, you can’t submit new evidence with this request. It’s strictly a review of the original claim.

NCIC has mandatory mediation before the case goes to a hearing. You may have your attorney represent you. The goal of mediation is to resolve your case before it goes to a hearing.

If you can’t come to a settlement agreement at mediation, you’ll have a hearing with the Deputy Commissioner. The Commission will issue a ruling on your claim. Your attorney can present evidence in this case, but usually not new evidence. You may appeal to the NCIC and the state Court of Appeals. If you need to appeal a denial of your claim, consider speaking with a North Carolina workers’ compensation attorney.

Get Legal Advice From a North Carolina Workers’ Compensation Attorney

After a workplace injury, you may find yourself buried in paperwork and facing questions. Although workers’ comp is a “no-fault” system, you still need to explain how you were hurt and the impact it has on your life. A North Carolina workers’ compensation attorney can help you resolve these questions and deal with the paperwork while you recover from your injuries.