Understanding the Key Players in the North Carolina Workers’ Compensation Process

January 30, 2010, by Michael A. DeMayo

Most first time North Carolina Workers’ Compensation claimants find themselves ovewhelmed by the Byzantine claims process. To make things easier for you, we’ve put together this quick guide to explain the basic players who deal with North Carolina Workers’ Compensation claims and injury management.

1. Employee

This is you. A worker who gets injured while executing a job related duty can be eligible for North Carolina Workers’ Compensation.

2. Employer

Your boss or your company is technically be known as the “employer.” If you work for yourself, and you have Self Employment Workers’ Compensation Insurance, you may be both the employee and the employer. Many employers are required by law to carry North Carolina Workers’ Compensation policies. These policies pay out to injured claimants; thus, the money does not come directly from the employers/company’s pockets. Another technical name for the employer is the “Insured.”

3. Insurance Company

The insurance company issues policies to employers to cover them in the event that an employee (such as you or a co-worker) gets injured on the job and requires money to pay for medical services, rehabilitation, and time off of work. Different states have different laws regarding Workers’ Comp Insurance Coverage. If you have specific questions regarding how North Carolina Workers’ Compensation Insurance companies must behave, speak with a veteran attorney or call the North Carolina Industrial Commission (NCIC).

4. Insurance Broker/Agent

A Broker or Agent acts as a liaison between the Insurance Company and the Employer. A broker typically tries to sell services to employers. The Broker can also act as a consultant and risk benefit analyst for employers.

5. Claims Administrator

A third party administrator, also known as a TPA, manages claims, adjusting them per settlement arrangements. Some insurance companies outsource their work to these independent agencies. TPAs also must act in accordance with North Carolina laws.

6. Doctor/Rehabilitation Specialist

The Physician and/or Rehab Specialist play critical roles in the injury management process. Obviously, if you are hurt on the job, a medical doctor must examine you and attest to your state and degree of injury before you can collect North Carolina Workers’ Compensation benefits.

7. Attorney

A North Carolina Workers’ Compensation Attorney can help you resolve questions you have regarding eligibility, benefits, settlement arrangements, insurance negotiations, and so forth. Most good attorneys will provide free, confidential consultations to answer your questions and concerns. Take advantage of this opportunity to learn more about the lawyer’s services, fee structure, track record, and credentials.

More Web Resources:

Third Party Administrator (TPA)

More about parties involved in workers compensation claims


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