How to report a worker's compensation claim
The State of North Carolina maintains Worker's Compensation coverage for all employees of the Division. This coverage is provided through a self-funded program and is administered by CorVel, Inc. of Charlotte. The Worker's Compensation Act establishes three conditions that MUST be met for an injury or illness to be considered compensable. These conditions are that the employee must suffer a personal injury by accident, that the injury must arise out of, and, in the course of employment with the State. This means the injured party must be an employee of the State at the time of the incident and the employee must be performing a job duty at the time of the incident, so intentional injuries are not covered.
The Office of State Human Resources has developed a Worker's Compensation Handbook that is useful for employees to review. The handbook provides information on each employee's rights and responsibilities under the program.
If one (1) or more persons are hospitalized, an employee death occurs, an employee suffers an amputation, or loses an eye call your human resources office or Safety Director immediately upon notifying a supervisor.
In all other cases follow the reporting process as shown below when an employee is injured while performing his or her duties.
Immediately following the incident:
Employee must report the incident to his/her supervisor.
life threatening injury, contact the local EMS.
non-life threatening injury, the supervisor is to:
1. Select "Workers Compensation in 'Select a Network' dropdown list, then
2. Inform the provider that an injured employee is on the way to the medical facility and that case is a Worker's Compensation case. If a preferred medical provider is not available, send employee to a local medical facility.
3. Provide employee two (2) copies of the Medical Authorization and Pharmacy form (supervisors may sign this form), employee is to distribute the above copies as follows:
Within 24 hours following the incident:
The NCIC 19 form can be initially sent to your Department WC coordinator office via email, but must be followed by a signed copy via interoffice mail, scan/email or fax.
Incident Follow-up and employee return to work
The supervisor must maintain contact with the employee while the employee is away from work and/or recuperating from the injury.
Upon employee return to work, the employee must provide to the supervisor:
The Supervisor must keep the human resources office informed of any days away from work and any work restrictions placed on the employee by the attending physician.
If the attending physician indicates job restrictions, these must be accommodated for the period of time indicated. For information on the DEQ return to work program, click here or contact your human resources office.
If the employee has out of pocket expenses for prescriptions, reimbursement is to be made on NCIC form 25P (Excel file) and then submitted to the your human resources office.
The maximum weekly benefit for any claim effective January 1, 2013 is $884.00.