Wondering if a workers comp claim can be reopened in NC? Read on to find out more information on if and when this can be done. The Bishop Law Firm represented workplace injury clients in North Carolina and we do not get paid unless you win. Give us a call today for a free case review, (919) 615-3095.

NC Workers’ Compensation Benefits

In North Carolina, state law provides medical compensation and wage loss benefits for non-fatal injuries and death benefits for fatal injuries. Medical compensation includes medical treatment and mileage reimbursement for treatment of your on the job injury. Lost Wage benefits provide monetary compensation due to your inability to earn wages because of your on the job injury. This benefit provides compensation based on the physical impairment of the injured body part as well.

There are four types of disability based compensation in which an injured worker may be entitled to receive based on North Carolina Law. The disability compensation benefits are:

  1. Temporary total disability compensation – Temporary total disability benefits (TTD) are the benefits owed to a NC workers’ compensation recipient when they are unable to work for a period of time that is more than 7 days. If an employee is awarded temporary total disability benefits, they will get 2/3 of their average weekly wage, not to exceed $1,254 (2023) per week under current law. The injured employee who is awarded TTD will also get their medical bills paid for by their employer’s insurance company. Generally, a worker getting TTD will return back to work at the discretion of their treating physician.
  2. Temporary partial disability compensation – Temporary partial disability benefits are for injured workers who are capable of returning to work, but not for the same wages they were working for pre-workplace injury. In this case, a worker may be entitled to 2/3 the difference between their pre and post-injury wages.
  3. Permanent partial disability compensation Permanent partial disability benefits (PPD) are assigned to workers who sustain a permanent injury and cannot return to the same work because of the injury. An injured worker who gets PPD is assigned a disability rating by a doctor which is a percentage of injury to that body part. The amount of compensation for the loss of use of a body part is defined by statute.
  4. Permanent total disability compensation – the worker must show that he/she is totally and permanently disabled from any occupation and thus will receive medical benefits and his/her weekly compensation for life.

Workers’ Compensation cases settle when the worker has reached maximum medical improvement. Maximum medical improvement means that the employee’s work injury will not improve even with further medical treatment. Settlements usually include a lump sum payment made to the injured employee prorated over the rest of their life. This proration is imperative for those pursuing Social Security Disability benefits to avoid an offset of their SSDI benefits. 

But, if your workers’ comp case has been settled for some time, but now you are experiencing physical difficulties resulting from the same on-the-job injury, don’t feel alone. Many NC injured workers find themselves in similar situations.

Can a Workers Comp Claim be reopened in NC?

In North Carolina, certain types of workers’ compensation settlements have a significant and unique feature which can be extremely beneficial to injured workers. According to North Carolina Workers’ Compensation Law, a workers’ compensation settlement can be re-opened if the settlement was not made by a clincher agreement.

Settlement agreements must be approved by the North Carolina Industrial Commission. If you look at your prior WC settlement does it say “ Compromised Settlement ” at the top or was it settled using NCIC Form 21 or Form 26? If you settled under Form 21 or 26, you can reopen if you meet the below time limitations.

Compromised (clincher) settlements are usually only reopened for fraud and other misrepresentations. Clincher agreements are considered to be a “full and final” settlement of your workers’ compensation claim against the employer (their workers’ compensation insurance carrier).

Reopening WC Form 21 and 26 Settlements

North Carolina law states settlement agreements are generally binding on the parties after they have been approved by the Industrial Commission. However, the language contained in N.C. General Statute §97-47 allows for a final award of the Industrial Commission to be re-opened, reviewed, or modified based on a change in the injured worker’s condition. The statute specifically states:

“Upon its own motion or upon the application of any party in interest on the grounds of a change in condition, the Industrial Commission may review any award, and on such review may make an award ending, diminishing, or increasing the compensation previously awarded…but no such review shall be made after two years from the date of the last payment of compensation pursuant to an award under this Article, except that in cases in which only medical or other treatment bills are paid, no such review shall be made after 12 months from the date of the last payment of bills for medical or other treatment, paid pursuant to this Article.”

It is important to understand that the statute has a two (2) year time limitation which requires that these “change of condition” claims be filed within the specified time frame. That means an injured worker may re-open a settled case within two years of when the last compensation payment was made. In “medical only” claims, the time limitation is for one (1) year after the last medical bill was paid. Form 18M will need to be filed with the N.C.I.C. to reopen your case.

Reopening a NC Workers Compensation Claim can be done, but injured workers must know how their original claim was settled and pay attention to the time limits. If you are an injured worker who is considering settlement of your workers’ compensation claim or have already settled your workers’ compensation claim based on a disability impairment rating, and have questions about future medical treatment, then contact a NC Workers Compensation Lawyer.

The Bishop Law Firm represents injured workers in RaleighCaryFayettevilleDurhamRocky Mount, WilsonSmithfieldLouisburgChapel Hill, Roanoke RapidsGreensboroWinston SalemGreenville and surrounding areas in North Carolina. We do not get paid unless we win your case and we offer free case reviews by phone, (919) 615-3095.