The Workers' Compensation Program for East Carolina University is administered by the Office of Environmental Health and Safety in accordance with the provisions of the North Carolina Workers' Compensation Act, the North Carolina Industrial Commission Rules and Regulations, and the North Carolina State Government Workers" Compe4nsation Manual. Workers' Compensation benefits are available to any full-time, part-time, or temporary employee who suffers an accidental injury or contracts an occupational disease within the meaning of the Workers' Compensation Act. The Office of Environmental Health and Safety is responsible to ensure that employees are informed of their entitled rights under the Workers' Act and to provide the medical care needed to help an injured employee reach maximum medical improvement and return to work as soon as possible and compensate the employee for any disability received from a compensable injury. A Workers' Compensation Administrator has been designated in the Office of Environmental health and Safety to be responsible for the effectiveness of processing and monitoring the workers' compensation claims. The University is responsible for accepting employer liability for the State and paying claims. On those cases that involve possible litigation issues, the University will contact the North Carolina Attorney General's Office who will defend all cases for the State before the Industrial Commission. East Carolina University is self-insured for Workers' Compensation.
The University must submit all reportable claims and valid medical and compensation payments to the North Carolina Industrial Commission for approval. Reportable claims include those injures when the employee misses at least one day of work or when medical costs exceed $2,000.00. The Industrial Commission is responsible for insuring that each employer administers the provisions of the Workers' Compensation Act.
It is the intent of East Carolina University to provide uniform and consistent application of the rules and regulations to be followed in processing workers' compensation claims and also ensure entitled benefits are provided to all affected employees. The program is periodically reviewed by the North Carolina Office of State Personnel Employee Safety and Health Division to measure and evaluate the effectiveness of the program and recommend changes to achieve optimum results.
Medical Benefits: Includes payment of all medical, surgical, hospital, nursing, sick travel, prescription drugs, and rehabilitation services prescribed by the authorized treating physician to give relief or effect a cure. Payments of all medical services is subject to the North Carolina Industrial Commission Fee Schedule. All medical services must be approved by the Office of Environmental Health and Safety prior to treatment except when emergency services are necessary (i.e., life threatening situations). If the employee is dissatisfied with the services rendered by providers selected by the University, the employee may request a change of physician but only when the employee can show reasonable cause to support a change.
Compensation Benefits: These benefits include temporary total benefits for time lost from work and permanent partial or permanent total disability compensation for any physical disability associated with the injury. During any temporary total disability period, if the employee is unable to work in excess of seven days due to the injury, they are entitled to sixty-six and two-thirds percent of their average weekly earnings subject to provisions of the North Carolina Workers' Compensation Act. During this seven day waiting period, the employee may use sick or vacation leave if available, or choose to go off the payroll with no pay. If the total lost worktime exceeds 21 days, the employee will also receive benefits for the initial seven day waiting period. The weekly benefit effective when the claim is submitted remains in effect for the life of the claim. The weekly rate of compensation cannot be more than $862.00 for injuries occurring after January 1, 2012.
Reporting the Injury
Responsibility for claiming compensation is on the injured employee. The employee must immediately give notice of the accident to their supervisor or as soon as possible after the accident occurs. All accidents should be reported no matter how minor they appear to be. The employee or supervisor then must immediately report the incident to the Office of Environmental Health and Safety. The University can refuse compensation if the incident is not reported in a timely manner.
Reporting Close Calls
A "close call" or "near miss" is an incident that does not result in injury or illness. Employees should report all "close calls" or "near misses" to their supervisor. Supervisors should then report these "close calls" or "near misses" to the Office of Environmental Health and Safety in order that appropriate measures be taken to circumvent future accidents. Accident prevention must be emphasized instead of reactionary measures to help prevent actual incidents.
Obtaining Medical Treatment
When the injury is reported to the Office of Environmental Health and Safety, they will schedule medical treatment with the ECU Prospective Health Physician or other qualified care provider. All medical treatment must be authorized by the Office of Environmental Health and Safety prior to treatment except when emergency services are necessary (i.e., life threatening situations). Also, the Office of Environmental Health and Safety must be contacted prior to having prescriptions filled and they must be filled at an authorized agency.
Injured employees must report directly to their medical appointments and return immediately to work upon the conclusion of the medical appointment. This means reporting directly to the appointment for an arrival time 10-15 minute prior to the scheduled appointment time. Upon completion of the appointment, the employee must report back directly to work unless other arrangements are approved by HE&S and the employee supervisor. For local Greenville medical appointments, employees should leave work 30 minutes prior to the appointment and return to work within 30 minutes of the conclusion of the appointment, while observing all traffic and safety rules.
The following forms must be forwarded to the Office of Environmental Health and Safety as soon as possible, but at least within 72 hours of the accident.
This information will be reviewed to determine if the claim is compensable. If a claim is denied, a letter detailing the reasons for denial will be sent to the employee.
The employee must complete, sign and date the Employee Statement of Injury, Workers' Compensation Program Guidelines, and Employee Authorization for the Release of Medical Information form.
The supervisor must complete, sign and date the NCIC Form 19 and the Supervisor Accident Investigation Form.
If a claim is compensable and medical bills exceed $2,000.00 and/or the employee has missed more than one day from work, NCIC Form 18 must also be submitted. This form will be mailed to the injured employee. If you have questions about the form you may contact an Industrial Commission at 1-800-688-8349.
In July 1999, the state of NC began using a third party administrator (TPA) to manage cases which have medical bills exceeding $2,000.00 and/or the employee has missed more than one day from work. The TPA is an insurance-like organization who manages more difficult cases. Injured employees and the supervisor will be notified of the change in case management. The medical treatment will be seamless - employees will continue to receive medical attention from the Office of Prospective Health.
Communication with Employee
The employee must provide their supervisor with a doctor's note regarding their work status following each doctor's visit. A copy of this note should also be provided to the Office of Environmental Health and Safety. When an employee is on Workers' Compensation Leave, they must communicate with their supervisor and the Office of Environmental Health and Safety on at least a weekly basis. Compensation checks must be picked up from the Office of Environmental Health and Safety by the injured employee. Checks will be mailed only in special circumstances.
Transportation to Medical Treatment
the supervisor should arrange form transportation to the initial visit when the employee is unable to drive. Following the initial visit, the employee will be responsible for transportation to all prescribed medical treatment.
Injured employees must report directly to their medical appointments and return immediately to work upon the conclusion of the medical appointment. This means reporting directly to the appointment of ran arrival time 10-15 minutes prior to the scheduled appointment time. Upon completion of the appointment, the employee must report directly back to work unless other arrangements are approved by HE&S and the employee supervisor. For local Greenville medical appointments, employees should leave work 30 minutes prior to the appointment and return to work within 30 minutes of the conclusion of the appointment, while observing all traffic and safety rules.
Compliance with Physician's Orders
The employee must attend all medical appointments at the scheduled time. Cancellation of an appointment requires authorization from the Office of Environmental Health and Safety and only for valid reasons. The employee must accept all medical treatment provide by the authorized physician. They must also follow all restrictions placed on them by the physician. This applies to activities away from work as well. Not following the physician's orders is considered noncompliance, and may result in employer requesting stop payment of compensation and implementing dismissal procedures.
If the employee receives medical treatment, no leave is charged to the day of the injury if the treating physician instructs the employee not to return tot work. The employee shall obtain a written statement from the physician indicating that the employee must not return to work and present the statement to the supervisor. The employee is not charged time for doctor visits or other prescribed medical treatment. There is a seven day waiting period before compensation benefits are awarded. During this period, the employee may use sick or vacation leave, if available, or elect to go off the payroll with no pay. After seven days, the employee receives 2/3 regular compensation until returned to work by the treating physician.
Return to Work
When an employee placed on workers' compensation leave has been released to return to work by the treating physician, there are three possible return to work situations.
- The employee has reached maximum medical improvement and has been released to return to work by their treating physician; the employee returns to the original or similar position held prior to the injury.
- The employee has not reached maximum medical improvement, but is ready to return to limited or transitional work with the approval of the treating physician. All temporary transitional work is subject to the availability of such work.
- The employee has reached maximum medical improvement and has been released by the treating physician, but has received a disability that prohibits employment in the previous position. The University will attempt to place the employee in another position that is suitable to the employee's capacity to work which is both meaningful and productive. If a suitable position is not available with the University, the employee will be referred to the Office of State Personnel for re-employment assistance and possible return to work in another State agency.
In some cases the extent of disability may be such that vocational rehabilitation will be necessary. If so, the University will make the necessary arrangements wit the North Carolina Division of Vocational Rehabilitation for such training that may be necessary to assist the employee to obtain suitable employment consistent with their performance capabilities.
Retaliation and Dismissal Policy
The Workers' Compensation Act prevents employers from firing or demoting in retaliation for pursuing remedies under the Act. However, if an employee, who has been on workers' compensation leave, has reached maximum medical improvement and has been released to return to work by the treating physician refuses suitable employment in keeping with his/her capacity, the employer shall request stop payment of compensation and implement dismissal procedures.
Continuation of Benefits
When an employee is placed on workers' compensation leave, they are taken off the State's regular payroll and placed in leave without pay - workers' compensation leave status. There are no deductions made from the weekly workers' compensation benefits. Payroll deductions made from regular pay is the employees' responsibility to take care of while on workers' compensation leave. While on workers' compensation leave, the employee is eligible for continuation of the following benefits: Vacation/sick leave, individual hospitalization insurances (premiums for dependent coverage must be paid directly by employee), and performance increases. The employee does not receive retirement service credit while on workers' compensation leave (credits can be purchased for the period of time out on approved leave of absence).
Closing a Claim
Claims are generally closed when the employee reaches maximum medical improvement and/or returns to work. Claims that involve only medical benefits are closed when the last medical bill is paid. Claims that involve compensation are closed when the last compensation payment is paid. A letter will be sent to the employee notifying them when the claim has been closed. If there is a significant change in condition within 2 years from date of last payment, a request to reopen the claim must be made in writing directly to the North Carolina Industrial Commission.
Questions regarding workers' compensation claims should be directed to the Workers' Compensation Administrator with the Office of Environmental Health and Safety. If questions are not answered to your satisfaction, you may call the North Carolina Industrial Commission at 1-800-688-8349 or 919-733-0345. Assistance is available to unrepresented claimants, employers, and other parties to enable them to protect their rights. In addition, the North Carolina Industrial Commission can answer questions pertaining to all aspects of Workers' Compensation.