Raleigh Estate Planning and Corporate Law Attorneys

Workers' Compensation

What Are the Workers’ Compensation Insurance Requirements for North Carolina Employers?

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Workers’ compensation claims have a twofold purpose: to compensate employees who suffer work-related injuries and to protect employers from being sued by their injured employees. For this reason, North Carolina requires most businesses with three or more employees to obtain workers’ compensation insurance. Here, we discuss the general worker’s compensation requirements for North Carolina employers and how COVID-19 might impact employee claims.

General Requirements for Employers

The North Carolina Workers’ Compensation Act (North Carolina General Statutes §97-94) generally requires all businesses in the state (whether they operate as corporations, sole proprietorships, LLCs, or partnerships) with three or more employees to obtain worker’s compensation insurance. Certain exemptions apply, including for businesses that employ:

  • “casual” employees (those whose work is casual and not part of the regular trade or business);
  • domestic servants working in a household;
  • farm laborers when there are fewer than ten full-time, non-seasonal workers;
  • employees of certain railroads; and
  • North Carolina federal government employees.

Who Does NOT Count as an “Employee” for Workers’ Compensation Purposes?

Whether a business employs three or more employees is not as straightforward as it might sound. The following groups of individuals generally do not need to be covered by workers’ compensation insurance:

  • Business owners, such as partners in a partnership, do not necessarily count as employees.
  • Corporate officers may elect to be excluded from coverage (however, they will still be counted as employees when determining whether a business has three or more employees, even if they opt-out of coverage).
  • Finally, with some exceptions, independent contractors generally do not qualify as employees.

How Much Does Workers’ Compensation Coverage Cost Employers?

The cost of workers’ compensation insurance coverage will vary depending on the number of employees a business employs and the type of jobs its employees perform. The North Carolina Rate Bureau is a non-profit organization that sets “class codes” and “base premium rates” for workers’ compensation, which will determine the total cost of workers’ compensation for a business.

These figures vary and reflect how dangerous a job is compared to another type of job (with high-risk jobs carrying higher base rates than lower-risk jobs). Depending on an employee’s class code and base premium rate, the North Carolina Rate Bureau will set a rate for its workers’ compensation premiums, which businesses must follow.

North Carolina workers’ compensation insurers usually offer discounts to employers. These discounts will vary based on the insurer but can include discounts for a drug-free workplace; for businesses that are part of a professional, trade or industry group; and for businesses that implement certain safety or fall prevention programs. 

COVID-19 and Workers’ Compensation in North Carolina

For the foreseeable future, COVID-19 appears to be here to stay, and businesses across the State continue to be affected by it. While most businesses will undoubtedly be impacted by COVID-19 in one way or another, many business owners likely wonder how it will affect their workers’ compensation claims. Most notably: Will employees be able to file workers’ compensation claims for having contracted COVID-19?

Unfortunately, the short answer is that we simply do not know. It is unclear whether these claims will be compensable under North Carolina law. While it appears more likely that they will be denied, to understand why this issue is so complex, it helps to review the laws surrounding workers’ compensation claims.

Coverage for Workers’ Compensation Injuries

Coverage for workers’ compensation injuries is divided as follows:

  • Injuries that occurred because of an accident or specific trauma (e.g., a slip-and-fall at work); and
  • Injuries caused by an “occupational disease.”

Potential COVID-19 claims would likely have to be filed as “occupational disease” claims. The North Carolina statutes define an occupational disease as either one of the specific diseases enumerated in the Act (which does not include COVID-19), or any disease acquired while working at a job that placed the person more at risk for getting the disease than the general public.

Thus, if the general public is equally exposed to the disease outside of the place of employment, the disease is not considered an occupational disease and therefore would not be covered by workers’ compensation.

Establishing Eligibility for a COVID-19 Workers’ Compensation Claim

To be eligible for benefits, an employee must show that he or she contracted COVID-19 from exposure on the job and, because of the job, he or she was at a greater risk than the general public. It might be that some frontline workers, such as healthcare workers, would be able to show that they were at higher risk of exposure to the virus than the general public. Likewise, it is possible that others, such as grocery store clerks, could show the same.

What becomes more challenging to prove, however, is causation, that is, a link between the employee’s job and the resulting COVID-19 infection. Even if it were likely that the employee contracted the virus while on the job, (such as while working at a hospital or treating patients infected with COVID), it would be very hard to prove this, as the disease could have just as easily been contracted outside of work. In other words, proving causation is extremely difficult, if not virtually impossible.

Currently, unless legislation is passed that defines COVID-19 as an occupational disease, it appears likely that an employer will be in the position to deny such claims in North Carolina. However, this is an unfamiliar terrain, and the coming months are likely to bring more clarity.

Workers’ Compensation Claims During Uncertain Times

While the costs associated with a workers’ compensation policy will vary depending on the size and nature of your business, owners of small, medium-sized, or large businesses should be aware of their obligations. At this time, it remains unclear whether COVID-19 claims will be covered under workers’ compensation insurance, but business owners should make sure they are fully in compliance with the laws regardless of what changes may be on the horizon.

North Carolina’s Response to the Opioid Crisis Continues to Build Steam

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As the nation struggles to deal with the staggering human and economic costs associated with the crises of opioid addiction and misuse, North Carolina is on the vanguard of the response.

The centerpiece of this effort is the Strengthen Opioid Misuse Prevention Act, more commonly referred to as the STOP Act.  Passed unanimously by both houses of the General Assembly on June 28, 2017 and signed into law by Governor Cooper on June 29, 2017, the STOP Act limits first time prescriptions for most opioids to no more than 5 days for acute pain, and 7 days for post-surgical pain.  It will require medical providers to check North Carolina’s Controlled Substance Reporting System database (CSRS) to confirm that the patient is not receiving inappropriate medications from other sources, and will require electronic prescriptions for such drugs by 2020.  The STOP Act also strengthens the CSRS, including provisions requiring pharmacies to report opioid transactions more quickly, and expands the availability of the opioid antagonist naloxone, in an effort to reduce the harm from opioid overdose.  But, recognizing the value of opioids in the correct settings, the STOP Act does not apply to medications administered in an inpatient setting, nor does it prevent follow up prescriptions for longer terms when medically appropriate.

In concert with the STOP Act, other efforts to confront the opioid crisis include the North Carolina Department of Health and Human Services’ Prescription Drug Abuse Advisory Committee, and the North Carolina Industrial Commission’s Opioid Task Force, which seeks to recommend rules and guidelines addressing the use of opioids in the context of workers’ compensation claims.

For more information on how North Carolina is addressing the opioid crisis, you may want to review the state’s Opioid Action Plan:  https://www.ncdhhs.gov/opioids

Select NC Industrial Commission Filings Now Require An Attorney

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As of Monday, September 18, 2017 the North Carolina Industrial Commission will no longer allow adjusters to file or respond to the below documents, as the North Carolina State Bar has determined that it constitutes the unlicensed practice of law.  Therefore, if you wish to file or respond to any of the below documents, an attorney will have to be retained in order to do so:

  • Form 24 Application to Terminate or Suspend Benefits
  • Motion to Compel Cooperation with Medical Treatment or Vocational Rehabilitation
  • Response to Form 23 Application to Reinstate Benefits
  • Response to Form 18M, Form 28U
  • Response to any Motions filed by Plaintiff or Plaintiff’s Attorney, including a Motion to Compel Medical Treatment, Motion to Compel Rule 607 or Discovery Responses, Motion to Compel Second Opinion.

Please contact any of our workers’ compensation attorneys if you have any questions.

NC Supreme Court Reaches Verdict In Wilkes v. City of Greenville

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On Friday, June 9, 2017, the North Carolina Supreme Court reached its decision in the Wilkes v. City of Greenville case, and the ramifications of the decision will have the most impact on workers’ compensation claims since the Reform Act of June 24, 2011.

At issue in the Wilkes case was the causation presumption. It has long been Defendants’ position that only the body parts specifically identified on a Form 60 or 63 are compensable, and it is Plaintiff’s burden of proving that other symptoms, conditions and/or injuries to other body parts are related to the original accident. The North Carolina Supreme Court in the Wilkes decision has struck down such an argument, holding that in admittedly compensable accidents, Plaintiffs are entitled to a rebuttable presumption that additional medical treatment for any symptoms, conditions or injuries is related to the work accident.

We encourage you to contact one of our attorneys to schedule a meeting or seminar to discuss the impact of the Wilkes decision on your current claims and your handling of future claims.

Kristine L. Prati Defends Appeal To Full Commission

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Kristine L. Prati successfully defended an appeal brought by the employee to the Full Commission requesting reinstatement of indemnity benefits. In the Opinion and Award filed on August 15, 2016, the Full Commission agreed with the prior ruling of the Deputy Commissioner and refused to award ongoing temporary total disability benefits as the employee failed to prove that he was disabled.