What are you actually entitled to after a workplace injury? How long will the checks keep coming? What happens if the insurance company decides to cut you off? These are the questions that keep injured workers in Jacksonville up at night, and getting clear answers shouldn’t require a law degree.
At Horton & Mendez, Injury & Car Accident Attorneys, our managing partners spent years on the insurance defense side of workers’ comp cases. We’ve seen how employers and insurers build strategies to reduce disability payouts. Now we use that experience to protect injured workers. Call our experienced Jacksonville workers’ compensation lawyers at 910-405-7751 for a free consultation. You pay nothing unless we win.
Types Of Workers’ Comp Disability Benefits In North Carolina
North Carolina’s Workers’ Compensation Act recognizes several categories of disability benefits. Understanding which type applies to your situation is the first step toward protecting your income.
Temporary total disability
Temporary total disability (TTD) covers the period when you’re completely unable to work while receiving medical treatment. If your injury keeps you out of work entirely while you heal, TTD benefits replace a portion of your lost wages.
Temporary partial disability
Temporary partial disability (TPD) applies when your recovery has progressed enough to return to some form of work, but you cannot perform your full duties or earn your pre-injury wages. TPD benefits fill part of that wage gap while you continue recovering.
Permanent partial disability
Permanent partial disability (PPD) applies to permanent damage or loss of use of a body part after you’ve reached maximum improvement from medical treatment and your condition has stabilized. Under North Carolina workers’ compensation law, a physician rates injuries by the percentage of impairment of the affected part, and the NC Industrial Commission uses that percentage to calculate your award.
Permanent total disability
Under N.C. Gen. Stat. § 97-29(d), permanent total disability requires specific qualifying conditions, including loss of both hands, both arms, both feet, both legs, both eyes (or any two of these), spinal injury with severe paralysis, severe brain or closed-head injury, or second- or third-degree burns covering 33% or more of the body. An employee who qualifies for permanent total disability under these criteria is entitled to lifetime compensation, including medical compensation, regardless of whether the employee has returned to work.
How Workers’ Comp Disability Benefits Are Calculated
For partial disability, North Carolina law provides weekly compensation equal to 66 2/3% of the difference between your average weekly wages before the injury and the wages you can earn afterward, subject to the annual maximum weekly benefit amount, up to 500 weeks.
For total disability, the same 66 2/3% rate applies to your full pre-injury average weekly wages. Your compensation rate stays the same over the duration of the claim. There are no cost-of-living increases.
Insurance carriers understand these calculations inside and out, and they’ll look for ways to deflate your average weekly wage or argue you’re capable of earning more than you actually can. Working with a lawyer who has handled these disputes from the carrier’s side gives you a distinct advantage.
How Long Do Workers’ Comp Disability Benefits Last
The duration of your benefits depends on the type of disability.
- Temporary total disability: Up to 500 weeks of payments.
- Temporary partial disability: Also capped at 500 weeks, with any weeks of TTD payments deducted from that total.
- Permanent partial disability: Based on the schedule of injuries in N.C. Gen. Stat. § 97-31. For example, the loss of a thumb provides 66 2/3% of average weekly wages for 75 weeks. Less-than-total loss is calculated proportionally.
- Permanent total disability: Lifetime benefits for qualifying injuries.
No compensation is due for the first seven days of lost time unless the disability exceeds 21 days. If it does, payment for those first seven days will be made retroactively.
What Maximum Medical Improvement Is And How It Affects Your Benefits
Maximum medical improvement (MMI) is the point at which your doctor determines your condition has improved as much as it will with continued treatment. A doctor may conclude a worker has reached MMI, meaning the worker’s medical condition has healed as much as possible with medical attention.
MMI is a turning point in your case. Once you reach it, your temporary disability benefits typically end, and your doctor assigns a permanent impairment rating. A Form 26A agreement may then be entered into to provide payment of permanent partial disability benefits based on that rating.
One tactic carriers rely on heavily: pushing for a premature MMI determination to shut down your temporary benefits ahead of schedule. We’ve watched this approach play out from the adjuster’s side of the table, and we know exactly how to challenge it.
What Happens When Your Disability Benefits Are Terminated
Your workers’ comp disability benefits can be terminated or suspended under certain circumstances. The employer or insurer may argue you’re capable of returning to suitable employment. Termination or suspension of compensation because the employee is capable of returning to suitable employment does not affect the employee’s entitlement to medical compensation.
You’re entitled to a second opinion on your impairment rating by a physician of your choice at the employer’s or insurance carrier’s expense. You also retain the right to reopen your case for further disability compensation within two years of the last payment.
If your benefits have been cut off, don’t accept the insurer’s decision as final. Call 910-405-7751 to talk with our team about your options.
Can You Receive Workers’ Comp Disability And Social Security Benefits At The Same Time
Yes, you can receive both workers’ compensation disability benefits and Social Security Disability Insurance (SSDI) at the same time. However, there’s an important catch.
Social Security regulations reduce SSDI benefits when the combined total of both workers’ compensation and SSDI exceeds 80% of the worker’s average current earnings before becoming disabled. This is called the “offset,” and it can significantly reduce your monthly income if your benefits aren’t structured properly.
Under N.C. Gen. Stat. § 97-29, when an employee receiving extended workers’ comp benefits also receives full Social Security retirement benefits, the employer may reduce the extended compensation by 100% of the employee’s retirement benefit.
Navigating these overlapping benefits is complicated. An experienced workers’ compensation lawyer can help you understand how programs interact and protect your total income.
How A Jacksonville Workers’ Compensation Lawyer Protects Your Disability Benefits
Insurance carriers dedicate entire departments to controlling how much they pay for disability claims. You deserve representation from someone who understands their internal processes. At Horton & Mendez, our managing attorneys built their careers in insurance defense before switching sides. With 65+ years of combined experience, we bring an insider’s perspective to every case we handle.
When you work with us, we:
- Review your medical records to ensure your impairment rating is accurate.
- Challenge premature MMI determinations.
- Fight back against wrongful termination of benefits.
- Help coordinate your workers’ comp disability and SSDI benefits to maximize your total recovery.
- Handle all communication with the insurance company so you can concentrate on recovery.
Our Jacksonville office at 507 New Bridge Street, Unit 700, serves injured workers throughout the area. We also maintain offices in Wilmington, Gastonia, Apex, Winston-Salem, Cornelius, and Monroe for convenient access across the state.
Frequently Asked Questions About Workers’ Comp Disability
Who qualifies for workers’ comp disability benefits in Jacksonville, NC?
Any employee in North Carolina who suffers a work-related injury or occupational disease and is unable to earn their pre-injury wages may qualify. Workers’ compensation operates on a no-fault basis, so benefits don’t depend on proving someone else caused your injury.
How much will I receive in workers’ comp disability benefits?
Benefits are typically 66 2/3% of your average weekly wages, subject to an annual maximum set by the NC Industrial Commission. Your specific amount depends on your pre-injury earnings.
What should I do if my workers’ comp disability benefits are denied?
If a claim is denied, you may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing. Before you go through that process alone, call a workers’ compensation lawyer who can build the strongest case on your behalf.
Get Help From Experienced Jacksonville Workers’ Compensation Lawyers
Fighting for disability benefits while recovering from a serious injury is exhausting. At Horton & Mendez, we spent years learning the insurance industry’s denial strategies from the inside. Now every bit of that knowledge works in your favor.
Call 910-405-7751 today for a free consultation. We’re available at our Jacksonville office or any of our locations across North Carolina. There’s no fee unless we secure compensation for you.
