North Carolina and South Carolina have rules governing workers’ compensation benefits and require most employers to offer them to employees hurt on-the-job. So, if you’ve been injured at work and are eligible for benefits, you are probably wondering, “How much should I be getting?”
I help injured workers fight for workers’ comp benefits every day, and I see firsthand how important these payments can be for helping them recover and for providing for their families’ daily needs.
Unfortunately, most insurers make more by paying out less. You may think you should be getting one amount, while your employer or the insurance company thinks you should be getting less. That’s why knowing the laws and how they are applied can make a significant difference when dealing with your employer or their insurance company about the type and amount of benefits you may be entitled to.
In this article, I will provide an overview of the three main types of benefits. Then, I will explain how to calculate workers’ comp benefits.
What Do Workers’ Comp Benefits Include?
There are three broad categories of workers’ compensation benefits in North and South Carolina to which you may be entitled:
Lost wages benefits, or wage replacement benefits, allow eligible injured workers to collect a portion of their wages (usually on a weekly basis) until they are able to return to work. Calculating potential weekly wage loss benefits correctly can be crucial if you are injured and unable to work.
Permanent impairment benefits may be available to you if you sustain permanent damage to parts of your body or your senses.
Medical care benefits generally cover all the medical treatment recommended by your workers’ comp doctor and can last indefinitely as long as you require ongoing care.
How Much Does Workers’ Comp Pay?
If you are eligible for workers’ comp, it generally pays your medical expenses (such as doctor bills, hospital bills, ambulance bills, and prescriptions) and your weekly wage loss payments (approximately 2/3 of your average weekly wage) while you are recovering and unable to return to work. If you have suffered permanent impairment from your work injury or illness, you may also be eligible for additional impairment benefits.
How Do You Calculate Your Average Weekly Wage?
In North and South Carolina, workers’ compensation lost wage benefits require the calculation of the eligible worker’s Average Weekly Wage (AWW).
You may need this for calculations moving forward because wage replacement benefits in North and South Carolina are generally 2/3 of the AWW (66.67%). Calculating AWW may seem straightforward, at least at a glance. However, there are five different ways to determine AWW by law, based on your individual work circumstances:
1. For Eligible Employees Who Have Worked for More Than One Year
Your Pre-Injury Annual Gross Pay / 52 Weeks = Your Average Weekly Wage (AWW)
Note: The above formula is for workers who have been employed for more than a year (52 weeks) and excludes any periods of seven or more days not worked. If the worker received a raise during the last 52 weeks, the AWW is calculated using that pay rate.
2. For Eligible Employees Who Have Worked for More Than One Year But Missed More Than Seven Consecutive Days in the Year Prior
Your Pre-Injury Annual Gross Pay / The Number of Weeks Worked in the Prior Year After You Remove Any Periods of Leave Greater than 7 Days = Your Average Weekly Wage (AWW)
3. For Eligible Employees Who Have Worked for Less Than One Year
Total Earnings During Employment / Number of Weeks Employed = Your Average Weekly Wage (AWW)
Note: This again excludes any period of seven or more days not worked.
4. For Eligible Employees Who Have Not Worked for Long Enough to Determine a Fair Wage
In the event that a worker has not been on the job long enough to reasonably calculate their AWW, the wages of a similar employee are used to represent the injured worker’s earnings with one of the two earlier formulas.
5. For Eligible Employees for Whom None of the Prior Formulas Will Work
If a worker’s AWW cannot reasonably be calculated with any of the four methods above, the AWW is set at the amount that most closely approximates what that worker would earn. For example, if you received a promotion and a raise in the year leading up to the accident, it may not be accurate to use your prior year wages to determine what you would have earned in the future. Instead, you may want to argue that this fifth category would apply.
For purposes of the calculations below, we’ll be using the first method.
What Are the Different Types of Workers’ Comp Disability Benefits, and How Do You Calculate Them?
In the following sections, I will provide more details about each benefit category and discuss how to calculate your workers’ comp benefits if you’re eligible.
Temporary Total Disability, a Type of Wage Loss Weekly Benefit
When a workplace injury temporarily and totally disables you, Temporary Total Disability (TTD) benefits are the law’s way of financially protecting you if you qualify. Whether or not you qualify depends on your particular circumstances.
The first seven days after your injury are a grace period. The law says that you will not receive any compensation during this time. Once that waiting period is over, qualifying employees are entitled to weekly benefits equal to two-thirds of their average weekly wage up to the maximum compensation rate set by the NCIC in North Carolina or the SCWCC in South Carolina.
These seven days do not need to be consecutive, but they must be days you would have worked. Once your seven-day period is up, you may be eligible to receive benefits. If your disability lasts more than 21 working days in North Carolina and 14 days in South Carolina, you may be eligible to retroactively receive compensation for those first seven days.
The circumstances surrounding how and why you potentially receive Temporary Total Disability (TTD) can be among the most significant disputes in workers’ compensation cases. Having an attorney on your side to help build your case and negotiate with your employer or their insurance company can significantly increase your odds of success.
Calculating Temporary Total Disability (TTD) Compensation and Duration of Benefits
To calculate TTD, you follow these two steps to determine your AWW and your potential compensation rate:
Your Pre-Injury Annual Gross Pay / 52 Weeks = Your AWW
Your AWW x .6667 = Your Compensation Rate*
*If eligible, as long as it does not exceed the maximum compensation rate set by the NCIC in NC or the SCWCC in SC.
Generally, the maximum duration of TTD benefits is 500 weeks. There are exceptions, however, and you should consult with an attorney to find out if these exceptions apply to you.
Temporary Partial Disability, a Type of Wage Loss Weekly Benefit
Temporary Partial Disability (TPD) is a workers’ compensation lost wage benefit that seeks to bridge the gap between what an eligible worker earned prior to being injured, and what they’re able to earn while recovering from that injury.
For example, you’ve returned to a job, but you’re not functioning or earning at the same rate you were prior to the injury – whether you’re simply not able to do as much work, or you’ve been placed in a job that pays less but that you can perform despite the injury.
You can typically receive TPD compensation in North and South Carolina after returning to work, even if you received TTD compensation before returning. The seven-day waiting period is the same for TPD as it is for possible TTD compensation.
Calculating Possible TPD Compensation and Duration of Benefits
Your Pre-Injury Annual Gross Pay / 52 Weeks = Your AWW
Your Post-Injury Gross Pay / Weeks in Pay Period = Your Post-Injury Weekly Wage
Your AWW – Your Post-Injury Weekly Wage = Difference in Wage
Difference in Wage x .6667 = Your TPD Compensation Rate*
*If eligible, as long as it does not exceed the maximum compensation rate set by the North Carolina Industrial Commission or the South Carolina Workers’ Compensation Commission.
Generally, the maximum duration of potential TPD benefits is 500 weeks in North Carolina and 340 weeks in South Carolina. There may be exceptions, however, and you should consult with an attorney to find out if these exceptions apply to you.
Permanent Partial Disability, a Permanent Impairment Benefit
Permanent Partial Disability (PPD) is a permanent impairment benefit you may be entitled to when you sustain permanent damage to parts of your body or your senses. Maybe you can continue to work, but your capacity for work is permanently reduced due to the injury.
Once you reach Maximum Medical Improvement (MMI) for your injury, your treating physician will determine the level of disability and may assign what is called a PPD rating, also known as a permanent impairment rating. It is important to know that you may have the right to request a second opinion on your impairment rating.
In North Carolina, you can generally seek that opinion from a provider of your choosing at the insurer’s expense. It is important to be strategic in picking the right provider for the requested evaluation as some insurance companies may steer you towards a provider they think will provide a less favorable opinion for you on your impairment.
Calculating PPD Compensation and Duration of Benefits
Calculating Permanent Partial Disability benefits is done through the use of a schedule defined in §97-31 of the North Carolina Workers’ Compensation Act and Section 42-9-30 under South Carolina Workers’ Compensation Law. These schedules set out a value for specific parts of the body.
To calculate possible compensation, you can use the following formula:
PPD Impairment Rating x Your Compensation Rate x Weeks Assigned in the Schedule = Potential PPD Compensation
If you are entitled to and choose to accept Permanent Partial Disability benefits, you are not necessarily closing your case although it may make it more challenging to obtain certain benefits in the future. Typically, you still have two years from the date you receive payment to file a claim for “change in condition” should your condition worsen over time or require additional medical treatment.
Permanent and Total Disability, a Type of Wage Loss Weekly Benefit
When you’re injured in such a way that you can no longer work after reaching Maximum Medical Improvement (MMI), you may be entitled to Permanent and Total Disability compensation. These benefits are for injuries that often completely destroy quality of life as well as render a person unable to earn a wage. These injuries can also deteriorate over time, causing other conditions to develop.
This can be the worst case scenario for any injured worker. These injuries result in high medical and care costs, burden families, and can be financially shattering without help like these benefits.
To be eligible for Permanent and Total Disability benefits, at least one of these four conditions must be present:
- The worker must have lost any combination of two of the following: hands, arms, feet, legs, eyes. For example, the worker may have lost both hands, or one foot and one eye. (Note: South Carolina’s law also includes shoulders and hips.)
- The worker must have suffered a spinal injury resulting in paralysis of the upper, lower, trunk, or whole body.
- The worker must have suffered a severe head injury or brain damage resulting in permanent disability.
- The worker must have suffered second or third degree burns to at least one third of the body.
Calculating Possible Total and Permanent Disability Compensation and Duration of Benefits
Your Pre-Injury Gross Pay / Weeks in Pay Period = Your AWW
Your AWW x .6667 = Your Compensation Rate*
*If eligible, as long as it does not exceed the maximum compensation rate set by the North Carolina Industrial Commission or the South Carolina Workers’ Compensation Commission.
Total and Permanent Disability compensation is paid for life.
Medical Care – Protecting Your Rights and Your Health
With healthcare as expensive as it is, medical costs relating to your workplace injury could easily be many times what you earn. If you are approved for medical care for your injury, it should cover your medical costs, such as diagnostics, physician and specialist costs, and medications.
If the insurance company deems treatment unnecessary, you can file a motion with the NCIC or the SCWCC to try and compel treatment. You may also be able to receive a pre-authorized medication account to help offset out-of-pocket costs.
Unfortunately, the physician will be chosen by the insurance company. But your attorney can help you request a different physician if you do not agree with the care plan provided.
Medical care is yet another workers’ comp matter that may seem straightforward but actually leaves a great deal of room for debate or interpretation. Consult with a dedicated workers’ compensation lawyer to help you understand your rights, your options, and all that you may be entitled to receive.
Are There Additional Benefits Under Workers’ Compensation in North and South Carolina?
Yes, there are other workers’ compensation benefits that an attorney can help you seek after a work injury or illness. Here are a few of the benefits that I always consider when working with my clients.
Vocational Rehabilitation Benefits
In North and South Carolina, injured workers who cannot return to their former employment or are returned to a lower paying job may be entitled to vocational rehabilitation at the expense of their employers.
Vocational rehabilitation benefits may include:
- on-the-job training
- transferable skills analysis and testing
- resume, interviewing, and job application services
- job search assistance
- education and tuition payment for retraining
- and more
Disfigurement Benefits
Disfigurement may or may not affect your ability to “do work,” but it certainly affects you as a person and can affect your ability to earn by making you less able to perform certain jobs.
Disfigurement payments are at the discretion of the North Carolina Industrial Commission or the South Carolina Workers’ Compensation Commission. The disfigurement must be serious, permanent, observable, and affect your ability to earn wages. A potential disfigurement award depends on the breadth of the injury and what part(s) of the body are affected.
Note: Disfigurement compensation is separate from disability benefit payments – if a worker lost a limb and received disability compensation, the worker cannot “double dip” and claim disfigurement as well.
Workplace Wrongful Death Benefits
When a workplace accident or illness results in death, families must deal with the tragic loss of a loved one while also dealing with the absence of that person’s wages, support, and presence. North and South Carolina law provide multiple potential benefits for families of workers who are killed on the job. To learn more about the benefits survivors may be entitled to, refer to our workplace wrongful death page.
Hurt on the Job? That’s a Job for Us
Your employer’s insurance company likely makes more by paying you less, and some adjusters may behave very badly in protecting their corporation’s interests. Don’t take chances with the insurance company or your employer – even if you and your employer have always been on good terms. We can handle your case for you while you focus on your recovery.
An experienced attorney on your side can significantly increase your odds of getting maximum compensation.
At my firm, we have several former insurance defense attorneys and adjusters on the team, and we leverage that inside knowledge to take on the insurance company for you. Since our firm began, we’ve recovered more than $1.8 billion total for more than 65,000 people.2
My firm was also named to the 2024 Best Lawyers in America “Best Law Firms” list, our 9th consecutive year being honored. And we’re proud to have earned a Tier 1 ranking (the highest) for workers’ compensation law.4
Are you owed more than you’re getting? Call us at 1-866-900-7078 or contact us online today for a free case evaluation.
