Who Decides If I’m Disabled in a North Carolina Workers’ Compensation Claim?

In most cases, your treating physician is the party who decides if you are disabled in a North Carolina workers’ compensation claim. Your physician will evaluate your condition and determine the extent to which the injury impacts your ability to return to work. This determination forms the basis for the type of benefits you can receive and how long. 

Understanding how North Carolina workers’ compensation law determines your eligibility for benefits is essential to ensuring you get the benefits you deserve for your workplace injury or illness. This decision can also determine the amount of benefits you qualify to receive. 

How Your Physician Determines If You Are Disabled

After sustaining a workplace injury or illness, you will need medical treatment. Your physician will use the guidelines set forth by the North Carolina Industrial Commission (NCIC) to evaluate your injury and make an impairment evaluation. Although these reference guidelines can help a doctor determine the level of impairment, the NCIC leaves sole discretion for deciding on the treating physician. 

The NCIC offers guidance on many specific types of injuries, including: 

• The lower extremities, including the hip, knee, and ankle
• The upper extremities, including wrists, elbows, and shoulders
• The cervical, thoracic, and lumbar spine
• The pelvis
• Amputations
• Loss of vision or hearing
• Loss of permanent teeth 
• Occupational diseases 

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North Carolina Workers’ Compensation Impairment Ratings

In addition, the guide provides detailed guidance as to the percentage of impairment in particular scenarios. For example, if you suffer a knee injury, the degree of limitation to your range of motion receives a specific percentage of impairment, also known as an impairment rating. 

Your impairment rating is a crucial element of your claim for workers’ compensation benefits in North Carolina. Your impairment rating, as decided by your treating physician, will determine whether you qualify for: 

• Temporary Partial Disability (TPD): Provides benefits to cover the difference in your income if you can work, but in a lesser capacity than before the accident.
• Temporary Total Disability (TTD): Provides benefits if you cannot work in any capacity due to the nature of your injuries after the workplace accident.
• Permanent Partial Disability (PPD): Provides compensation when you suffer an injury that will permanently impair a specific part of your body. 
• Permanent Total Disability (PTD): Provides lifelong compensation if you will never return to work due to the nature and severity of your specific injury. 

In the North Carolina workers’ compensation system, your ability to return to work determines your disability rating. Additionally, the NCIC may use additional considerations when deciding if you can receive benefits for permanent disabilities, as outlined in G.S. § 97-29. 

What Are Scheduled Injuries in North Carolina Workers Compensation?

Some injuries are so severe that the North Carolina Workers’ Compensation Act automatically considers them disabling. These are known as scheduled injuries and include: 

• Loss of limb
• Loss of hearing 
• Loss of vision 
• Serious bodily disfigurement

In addition to outlining specific injuries, G.S. § 97-31 also contains detailed information relating to: 

• The type of workers’ compensation disability benefits you can receive
• How long you can receive compensation
• How much money you can receive

If you suffer from one of the injuries outlined in this statute, the NCIC considers you disabled for your North Carolina workers’ compensation claim. Your physician will provide you with a treatment plan and documentation to include in your claim for benefits. 

Can My Employer Decide If I Am Disabled in a North Carolina Workers’ Compensation Claim?

Your employer cannot decide if your injury meets the criteria for eligibility for worker’s compensation benefits. While your employer or its workers’ compensation insurance carrier can deny your initial claim for benefits, they do not decide on qualification of incapacity. 

Only a qualified, licensed North Carolina physician can decide if your injury meets the requirements for disability and the level to which the injury impairs you.

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Contact Our Workers’ Compensation Lawyers for Help With Your Claim  

If you need help seeking benefits after a workplace injury, Farmer & Morris Law, PLLC, can help. We can work with you to navigate the often-complex process of getting the benefits you deserve under North Carolina’s workers’ compensation system. In addition, we can work with your treating physician to ensure you receive an accurate disability rating and qualify for the type and duration of benefits you deserve. 

Call us at (828) 286-3866 to learn more about who decides if you’re disabled in a North Carolina workers’ compensation claim.

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