Employees that have an on-the-job injury may be eligible for benefits – including medical care and income replacement – under workers’ compensation. The information on this web site is intended to help answer questions you may have regarding how the workers’ compensation process works.
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An injury happened at work. What do I do?
If the injury requires emergency medical care, immediately seek treatment at the nearest Emergency Room. After you are stabilized, you will receive any necessary additional medical care within the established medical provider panel. You should complete an incident report before the end of the shift of the day you had the injury and submit it to HR as soon as possible.
What do I record on my timecard?
On the day of your injury, the time spent waiting for and receiving medical care before the end of your shift should be recorded as worked time. If you are sent home, you will be paid as though you had worked a full shift. Your follow-up visits with an approved panel provider are also considered work time, provided they occur while you are actively at work at the Partnership.
Who pays for the cost of my medical care?
The cost of your medical care is paid through workers’ compensation when the treatment is authorized, provided by an approved provider, and the injury is accepted as a workers’ compensation claim. This means you would not be responsible for deductibles or co-pays for authorized treatment. If you receive a bill from a medical provider, please contact them to let them know that they need to bill the workers’ compensation claim underwritten by Erie Insurance instead of you (or your insurance).
If your injury requires medicine, you will be provided with a pharmacy card to cover the cost of the prescription. The card is specific to medications for your workers’ compensation injury and does not require any co-pays, just prior authorization. The name of the prescription company is “Key Scripts” and the card is accepted at most local pharmacies (ex. CVS, Walgreens, Wal-Mart).
If the injury is later determined not to be work related, the cost of medical care and medicine provided by the Emergency Department, Urgent Care, or other providers will be your responsibility. Contact HR at 910-826-3075 if you have questions regarding whether the services will be covered under your health plan.
Who determines whether the injury is covered by workers’ compensation?
Each incident report is electronically forwarded to the Partnership’s workers’ compensation underwriter Erie Insurance. Reports that indicate that either medical care was needed or where more information is needed to determine compensability are assigned to a Claims Specialist. Each specialist is a licensed adjuster who is experienced and knowledgeable regarding workers’ compensation. The specialist will interview you regarding the incident, relevant medical history, and relevant outside work activities to gather the necessary information to determine whether the injury can be covered under workers’ compensation. If the circumstances are very complex, the specialist may also consult with legal and/or medical counsel, and/or request to review the relevant medical records, and/or request additional information from HR. Once the review is completed, a decision is made regarding whether the injury is covered under workers’ compensation.
How long does it take to receive a determination?
Generally, first contact with you to obtain additional information regarding the incident is made within two business days of Erie’s receipt of the incident report and a determination regarding compensability is made at that time. If you are unavailable or if additional information is needed, the process will take longer. Please respond to a request for information from Erie Insurance as soon as possible.
Who lets me know the outcome of the review?
The specialist will let you know the outcome of the review. The informal process is to let you know by phone so that any necessary additional care can be directed appropriately (i.e. continued treatment with an approved provider). There is also a formal written notification process that is required by the state, this formal process is intensely form driven. The required forms are sent to you along with an explanation letter regarding the purpose of the forms.
What forms will Erie be sending and what do they mean?
One of the primary forms that is used is the “Form 18” which is the official workers’ compensation claim form for you to complete and file with the Industrial Commission within two years of the injury (or learning of an occupational disease). Erie will send a blank form to you indicating that this needs to be completed and sent by you to the Industrial Commission. The Partnership is not permitted to complete this form on your behalf and the Partnership incident report that you completed does not substitute for this form – your completion of this form preserves your right to pursue the claim; this is especially important if your claim is not accepted and you disagree with that decision.
The statute requires that you file this form with the Industrial Commission within 30 days of the accident to give the required written notice to the Partnership about your injury and within two years to establish your legal claim. Click here for a more detailed explanation provided by the ombudsman section of the NC Industrial Commission.
Another form Erie will be sending you is the “Form 19” which is the Partnership’s official report to the Industrial Commission of your injury. There is important information on the form regarding the injury, your average weekly wage, the length of time you have been at the Partnership, and more. Carefully review the information that Erie completed and sent to the Industrial Commission.
If your injury is not accepted as compensable, you will also receive a “Form 61.” This form will detail the exact reason your injury (claim) is not covered under workers’ compensation. If you disagree with this decision, you can always contact the specialist. There is also a formal review process that you may request with the NC Industrial Commission by completing a “Form 33” and sending it to them. The Industrial Commission will review the circumstances and determine whether the claim meets the criteria to be accepted.
Below is the link to these forms as well as most of the NC Industrial Commission forms: www.comp.state.nc.us/ncic/pages/forms.htm
Who should I contact if I have questions about the decision or the forms?
You are welcome to contact the specialist that Erie assigned to you.
In addition, the Workers’ Compensation Board is the state’s administrative agency responsible for administering all workers’ compensation claims in the state. An ombudsman at the Board is available to you at no charge who can help answer questions regarding claims and to help you through the process of appealing a decision if you do not agree with it.
The NC Industrial Commission Ombudsman is available Monday – Friday from 8:00 a.m. to 5:00 p.m. at (919) 807-2501 or (800) 688-8349.
My personal doctor is familiar with my medical history. Can I get treatment from him or her instead?
No. Only treatment that is authorized and provided by an approved medical provider is paid through workers’ compensation. Also, the Partnership’s health plans don’t provide coverage for work injuries. This means that if you go to your own doctor, you may be responsible for the cost of the care provided.
I need medical treatment for my job injury, but I am also receiving treatment for a non-work related health condition. How does that work?
Only the treatment for the job related injury is covered under workers’ compensation; the cost of medical care for non-work related injuries would continue to be your responsibility (or the responsibility of your health plan if applicable). Where possible, the physician treating your work injury will separate out care that is provided for your work injury and refer you back to your regular physician for treatment of any non-work related health condition.
How long can I receive medical care through workers’ compensation?
Medical care for compensable injuries generally continues for up to two years after your last medical or indemnity compensation (for example, a weekly wage replacement). In addition, you may submit a Form 18M to the Industrial Commission to request an extension of this two year period. In the request, you would need to show “substantial risk of the necessity of future medical treatment.” The form would need to be submitted to the Industrial Commission before the end of the two year period.
An injury happened at work. What do I do?
If the injury requires emergency medical care, immediately seek treatment at the nearest Emergency Room. After you are stabilized, you will receive any necessary additional medical care within the established medical provider panel. You should complete an incident report before the end of the shift of the day you had the injury and submit it to HR as soon as possible.
What do I record on my timecard?
On the day of your injury, the time spent waiting for and receiving medical care before the end of your shift should be recorded as worked time. If you are sent home, you will be paid as though you had worked a full shift. Your follow-up visits with an approved panel provider are also considered work time, provided they occur while you are actively at work at the Partnership.
Who pays for the cost of my medical care?
The cost of your medical care is paid through workers’ compensation when the treatment is authorized, provided by an approved provider, and the injury is accepted as a workers’ compensation claim. This means you would not be responsible for deductibles or co-pays for authorized treatment. If you receive a bill from a medical provider, please contact them to let them know that they need to bill the workers’ compensation claim underwritten by Erie Insurance instead of you (or your insurance).
If your injury requires medicine, you will be provided with a pharmacy card to cover the cost of the prescription. The card is specific to medications for your workers’ compensation injury and does not require any co-pays, just prior authorization. The name of the prescription company is “Key Scripts” and the card is accepted at most local pharmacies (ex. CVS, Walgreens, Wal-Mart).
If the injury is later determined not to be work related, the cost of medical care and medicine provided by the Emergency Department, Urgent Care, or other providers will be your responsibility. Contact HR at 910-826-3075 if you have questions regarding whether the services will be covered under your health plan.
Who determines whether the injury is covered by workers’ compensation?
Each incident report is electronically forwarded to the Partnership’s workers’ compensation underwriter Erie Insurance. Reports that indicate that either medical care was needed or where more information is needed to determine compensability are assigned to a Claims Specialist. Each specialist is a licensed adjuster who is experienced and knowledgeable regarding workers’ compensation. The specialist will interview you regarding the incident, relevant medical history, and relevant outside work activities to gather the necessary information to determine whether the injury can be covered under workers’ compensation. If the circumstances are very complex, the specialist may also consult with legal and/or medical counsel, and/or request to review the relevant medical records, and/or request additional information from HR. Once the review is completed, a decision is made regarding whether the injury is covered under workers’ compensation.
How long does it take to receive a determination?
Generally, first contact with you to obtain additional information regarding the incident is made within two business days of Erie’s receipt of the incident report and a determination regarding compensability is made at that time. If you are unavailable or if additional information is needed, the process will take longer. Please respond to a request for information from Erie Insurance as soon as possible.
Who lets me know the outcome of the review?
The specialist will let you know the outcome of the review. The informal process is to let you know by phone so that any necessary additional care can be directed appropriately (i.e. continued treatment with an approved provider). There is also a formal written notification process that is required by the state, this formal process is intensely form driven. The required forms are sent to you along with an explanation letter regarding the purpose of the forms.
What forms will Erie be sending and what do they mean?
One of the primary forms that is used is the “Form 18” which is the official workers’ compensation claim form for you to complete and file with the Industrial Commission within two years of the injury (or learning of an occupational disease). Erie will send a blank form to you indicating that this needs to be completed and sent by you to the Industrial Commission. The Partnership is not permitted to complete this form on your behalf and the Partnership incident report that you completed does not substitute for this form – your completion of this form preserves your right to pursue the claim; this is especially important if your claim is not accepted and you disagree with that decision.
The statute requires that you file this form with the Industrial Commission within 30 days of the accident to give the required written notice to the Partnership about your injury and within two years to establish your legal claim. Click here for a more detailed explanation provided by the ombudsman section of the NC Industrial Commission.
Another form Erie will be sending you is the “Form 19” which is the Partnership’s official report to the Industrial Commission of your injury. There is important information on the form regarding the injury, your average weekly wage, the length of time you have been at the Partnership, and more. Carefully review the information that Erie completed and sent to the Industrial Commission.
If your injury is not accepted as compensable, you will also receive a “Form 61.” This form will detail the exact reason your injury (claim) is not covered under workers’ compensation. If you disagree with this decision, you can always contact the specialist. There is also a formal review process that you may request with the NC Industrial Commission by completing a “Form 33” and sending it to them. The Industrial Commission will review the circumstances and determine whether the claim meets the criteria to be accepted.
Below is the link to these forms as well as most of the NC Industrial Commission forms: www.comp.state.nc.us/ncic/pages/forms.htm
Who should I contact if I have questions about the decision or the forms?
You are welcome to contact the specialist that Erie assigned to you.
In addition, the Workers’ Compensation Board is the state’s administrative agency responsible for administering all workers’ compensation claims in the state. An ombudsman at the Board is available to you at no charge who can help answer questions regarding claims and to help you through the process of appealing a decision if you do not agree with it.
The NC Industrial Commission Ombudsman is available Monday – Friday from 8:00 a.m. to 5:00 p.m. at (919) 807-2501 or (800) 688-8349.
My personal doctor is familiar with my medical history. Can I get treatment from him or her instead?
No. Only treatment that is authorized and provided by an approved medical provider is paid through workers’ compensation. Also, the Partnership’s health plans don’t provide coverage for work injuries. This means that if you go to your own doctor, you may be responsible for the cost of the care provided.
I need medical treatment for my job injury, but I am also receiving treatment for a non-work related health condition. How does that work?
Only the treatment for the job related injury is covered under workers’ compensation; the cost of medical care for non-work related injuries would continue to be your responsibility (or the responsibility of your health plan if applicable). Where possible, the physician treating your work injury will separate out care that is provided for your work injury and refer you back to your regular physician for treatment of any non-work related health condition.
How long can I receive medical care through workers’ compensation?
Medical care for compensable injuries generally continues for up to two years after your last medical or indemnity compensation (for example, a weekly wage replacement). In addition, you may submit a Form 18M to the Industrial Commission to request an extension of this two year period. In the request, you would need to show “substantial risk of the necessity of future medical treatment.” The form would need to be submitted to the Industrial Commission before the end of the two year period.