The Ins and Outs of Weekly North Carolina Workers' Compensation Checks
Below you will find a Hardison & Cochran Podcast episode on the topic of Weekly Workers’ Compensation Checks in North Carolina. The transcript of the episode is also below for those who would simply like to read and not listen. To listen or read transcripts from other podcasts from Hardison & Cochran, please visit our Podcast Page.
Episode #10 North Carolina Workers’ Compensation Checks
Bill Campbell: [00:01:22] All right Ben, We’re going to talk about worker’s comp checks today. The first question, and I know many people, you talked to many clients or potential clients about this, is these checks when they’re coming. How are they calculated? What formula is used to calculate how much somebody is going to get or how much these checks are going to be written for?
Ben Cochran: [00:01:44] In North Carolina, the amount that is used to calculate a temporary total disability check or a lost wage check. What you do is you take into consideration the individual’s average weekly wage. Now in North Carolina average weekly wage can be calculated several different ways.
The easiest and most predominant is if an individual employee has worked for this employer for 52 weeks. If they worked for 52 weeks then you simply are able to take the average of those 52 weeks as the average weekly wage. So that’s the most common method is to look at their wage history if it’s sufficient enough if it’s 52 weeks you encapsulate 52 weeks. If it’s less than 52 weeks, but sufficient enough, you can still calculate that using pretty much a week by week calculation.
This is all set up it’s pursuant to statute. There’s a particular enumeration that you look at in order to calculate the average weekly wage. When you say OK this is a person’s average weekly wage over the past 52 weeks in North Carolina for temporary total disability purposes it’s two thirds the average weekly wake.
So it is 66 and two thirds percent of your average weekly wage that you’re entitled to for workers compensation benefits. That is what’s called your “compensation rate.” So the amount that you’ll receive when you’re unable to work is two thirds of your average weekly wage.
Bill Campbell: [00:03:23] If you’re receiving a check. Who is this check coming from? Is it coming from the insurance company or the employer who’s sending it out?
Ben Cochran: [00:03:30] When An individual is receiving Temporary Total Disability benefits, it is being dispersed by the insurance company. When they disperse these funds they will utilize Industrial Commission forms in order to recognize them with the Industrial Commission. So once they begin payments pursuant to statute, they must file an appropriate form.
There’s two different forms that are utilized by the insurance company to show or acknowledge that they are paying out of work benefits. The first one is a form 60, which means that they have admitted the employee’s right to compensation and they are going to pay pursuant to the disability the average weekly wage with the comp rate established on that particular form. So that form will identify when the disability began and how much it will be for. That is a form 60 filed with the Industrial Commission.
The alternate form that utilized in this particular situation is called a Form 63. Now, the form 63 is a particular form that can be used by the insurance company to delineate that they’re going to provide benefits, but they’re going to reserve the right to terminate those benefits at a later time if they elect to do so.
Now there are certain parameters within the statute and noted on the form as to when, if they fail, to properly terminate those benefits that that form 63 becomes an admission to compensibility. Very similar to the form 60.
Bill Campbell: [00:05:12] And these checks, are they actual, you know, when you talk about somebody getting a check or it’s payday or whatever. Some guy says “I got my check today.” Are these actual paper checks or can they be deposited direct deposit into a checking or savings account. How does that work?
Ben Cochran: [00:05:28] In Workers’ Compensation in the state of North Carolina, in my practice and based upon my experience 99% of temporary total disability checks are going to be paper checks. The predominant reason for that is because checks are distributed more likely than not on a week by week basis.
There are often certain situations where the insurance company knows that an individual, due to the nature of their injuries, are going to be out of work for a significant period of time. So that be the case sometimes they put it on what’s called “autopay” where they can go in their system and they could say to put this out for weeks at a time and then I’ll come back and fix it in the system and update it. It’s still going to be a paper check, but they can put it on auto pay so that it goes out on the same day every week to the injured employee.
They usually do that at most and a four week interval and then they come back and reassess the claim. It is a paper check. It’s sent a weekly. On the check, it gives you a pay period so it lets you know the benefits that you are receiving, the amount that you’re receiving as well as to what pay period it covers. So it has been rare circumstances that I have dealt with within my practice that somebody receives a direct deposit check based upon temporary total disability benefits.
And the primary reason for that is if somebody goes to their doctor and they get released to go back to work the insurance company wants to be able to terminate the check so that they’re not going to overpay the employee. .
Bill Campbell: [00:07:14] Since it’s on a schedule and they’re all paper obviously they’re coming via mail, and you know sometimes mail is early sometimes mail is late, what happens if a check is a day or two late and what happens if it’s really late going into two weeks. Is there any kind of recourse for the injured employee if their funds show up a week or two late?
Ben Cochran: [00:07:38] What I tell my clients is that if you are receiving ongoing benefits from workers’ compensation to the payment of a temporary total disability check. Generally, you are going to see that check come within a day of the same day each week.
So we usually tell our folks if you don’t get it on a Tuesday and you don’t have it by your mail run on a Wednesday, you need to call us. Because that way we can find out and make sure that you haven’t fallen off autopay or that the adjuster has not failed to input you into the system. So that is what we tell folks.
Unfortunately, it’s very common that you do have circumstances where they change within one to two days. And it really depends on the nature of the claim, how often that individual’s going back and forth to the doctor, whether or not the injured employee is close to maximum medical improvement and are they close to returning back to work?
All of those different circumstances really come into how closely the insurance company is watching as to how long they are going to have to pay that check. Because the sooner they can stop that check the sooner they have great control over the case. So they like to terminate that check as quickly as they can. But what about those cases that you’re talking about that are 10 to 14 days late? Pursuant to statute, late payment penalties can be assessed 14 days after the benefits become due and payable.
So unfortunately you checks got to be behind two weeks before you’re entitled to a penalty to be assessed and requested. So if I have a client that’s two weeks behind, 14 days behind, what we’ll do once those 14 days accure we file a motion with the Industrial Commission for late payment penalties. The late payment penalty is 10 percent of all those benefits that were due and payable but not paid within 14 days. .
Bill Campbell: [00:09:45] When you represent in someone and they’re getting a check each week, you know usually that’s four times a month, do you ever take any, those checks come to them and it’s all their money right. You don take any of that money for representation?
Bill Campbell: [00:10:01] When an injured employee contacts us and hires us our contract specifically governs what type of benefits we obtain in regards to entitles us to a overall fee. So our fee is based upon any benefits that we obtain or recover for you. In a situation where someone contacts us and they’re already receiving Temporary Total Disability benefits or it’s early enough on their claim to where they know they’re going to receive benefits.
We do not take their weekly benefits. The individual’s weekly benefits, those are benefits that they were going to be entitled to, and so we didn’t obtain those benefits for them, so we do not take a weekly check that they’re already receiving and we don’t take a percentage of a weekly check that they’re already receiving.
The periods of time to where we are able to receive a percentage of a weekly check, those are situations to where number one the person was not receiving a weekly check and the defendants had specifically said, this person is not entitled to a weekly check. And through some means of litigation through the Industrial Commission we have been able to get the injured employee awarded a check.
At those particular times the Industrial Commission will award us a fee because we were able to obtain that recovery for the injured employee. So if it’s a circumstance to where the individual has a denied claim they’re not receiving any benefits or their disability is denied and they’re not receiving any weekly benefits and were able to prosecute the matter through the Industrial Commission.
Those are the particular times that where if because of our services that individual is receiving weekly compensation. Then at that point the Industrial Commission will award us 25 percent of the weekly benefits because but for our services that injured employee wouldn’t be receiving anything.