The State Government Workers’ Compensation Program was established in 1985 and is administered by the Office of State Personnel. The purpose of the program is to ensure that all eligible employees who experience a work related injury or illness receive appropriate medical care and equitable benefits as provided under the Workers’ Compensation Act and the Workers’ Compensation section of the State Personnel Policy.
The North Carolina Workers’ Compensation Act provides benefits to state of NC government employees who receive an injury by accident while in the normal course of job duty. Please refer to the North Carolina State Government Workers’ Compensation Employee Handbook for further definition.
Who is Eligible?
All full-time, part-time and temporary North Carolina State University employees are covered by the North Carolina Workers’ Compensation Act. While medical care procedures vary between Student and Post-Doctoral employees and regular NC State employees, all are provided with equal benefits and follow the same claims process.
What Do I Do If I Get Hurt At Work?
In the case of a life-threatening emergency, immediately contact Campus Police (919-513-3333) to dispatch emergency services, or 911, if outside the Raleigh area.
In the case of a non-life threatening emergency, notify a supervisor or manager immediately. The supervisor or manager will assess the situation, help arrange for proper medical care and begin the injury reporting process. It is important to report a work-related injury, accident or illness immediately, no matter how insignificant the incident may seem, as oftentimes those that get overlooked turn into larger medical problems.
The responsibility for claiming compensation is upon the injured employee. All incidents must be reported within 30 days of the occurrence unless reasonable excuse is made to the satisfaction of the Industrial Commission for not giving such notice, and the Commission is satisfied that the employer has not been prejudiced thereby. The injured employee must complete the Employee Statement and Use of Leave Options forms and submit it immediately to his/her supervisor.
It is the responsibility of an employee’s supervisor to schedule appropriate medical care. Before visiting an authorized medical care facility, the supervisor will provide the employee with the Medical Authorization and Attending Physician’s Form. The attending physician must complete this form, and the employee is to return the form along with any other medical notes or documentation to his/her supervisor after the visit.
Note: Employees are required to return to work immediately following the medical appointment to update the supervisor on the employee’s status.
Note: Employees are obligated to accept any suitable employment provided it within capabilities. Refusal to accept suitable employment may result in termination of compensation and may result in dismissal.
What Are The Supervisor Responsibilities?
The first responsibility of the supervisor is to direct the employee to the appropriate medical care. Employees who work in the Raleigh-area are to be directed to one of the four Authorized Medical Facilities by completing and giving the employee the Supervisor’s Medical Treatment Authorization Form. Employees who do not work at NC State’s Raleigh facilities or surrounding area should be directed to the nearest Urgent Care Center using the same form. Hospital Emergency Rooms should only be used for extreme injuries and for after-hours treatment that cannot wait until the Urgent Care opens. The Department may be charged for the inappropriate use of a Hospital Emergency Room.
Raleigh-area employees should receive their Prescriptions from their authorized workers’ compensation health care provider through the Student Health Center.
It is also the supervisor’s responsibility is to assess the incident and assist the employee in seeking proper medical care or necessary treatment for any work-related injury. The supervisor must then complete the First Report of Incident.
Supervisors should maintain open lines of communication both with the employee as well as the Leave Coordinator, particularly if light duty restrictions apply or the incident resulted in lost time from work.
The injured employee’s transition back to work is managed by several, including the supervisor, physician, Leave Coordinator and Human Resources Representative. Flexibility in providing light or modified duties as recommended by the treating physician will support a smooth return to full time job duties for the employee. A supervisor who anticipates a gradual transition back to work after an injury should contact the Leave Coordinator as soon as possible.
The Workers’ Compensation Procedures Booklet provides more information for supervisors.
Who Provides Medical Treatment?
NC State faculty and staff are to visit one of four approved health care facilities.
Student employees and Post-Doctoral Students must visit Student Health Services in the event a work-related accident or injury occurs. If after hours, then the student, employee or Post-Doctoral student should visit one of the four approved health care facilities.
Authorized Medical Facilities
- WakeMed Urgent Care
601 Oberlin Drive
Raleigh, NC 27605
- Next Care Urgent Care
1110 Kildaire Farm Road
Cary, NC 27511
- PostDoc/Student workers only
Student Health Services
2815 Cates Avenue
- RX Urgent Care
3100 Blue Ridge Road Ste. 100
Raleigh NC 27612
How Do I Schedule A Doctor’s Appointment?
For both student and regular faculty and staff, additional health care needed by specialists will be coordinated between the University Leave Coordinator, the initial treating physician and CCMSI Corporation, third party administrator for Workers’ Compensation claims. An employee should consult with either CCMSI or the WC Administrator to facilitate health care with a specialist.
Are Prescription Drugs Covered?
When the authorized treating physician prescribes medication, prescriptions may be filled at no cost, by most major pharmacies such as Wal-Mart, Kerr Drugs, Eckerd, or CVS. CCMSI internally manages the prescription drug plan for the Workers’ Compensation program. CCMSI will provide the pharmacist with the required authorization to fill the prescription.
If a pharmacy is unable to obtain the necessary authorization such as after normal business hours or during a weekend, the employee may pay for the prescription and file for a reimbursement by sending the original copy of the receipt to the University WC Administrator. CCMSI can be reached by phone, at 888-596-8771 or email firstname.lastname@example.org.
You may contact the Tmesys Pharmacy Help Desk at 1-800-964-2531. Employees should have the pharmacist enter the RX Bin, RXPCN and group member ID#. Format for the group member ID# is the date of injury and SSN combined as YYMMDD123456789. Tmesys is the PBM for the employee.
What If I Can’t Return To Work Right Away?
An employee may choose to use sick or vacation leave, or go on Leave Without Pay during the 7-calendar-day waiting period. The law provides medical and disability compensation including a weekly benefit for lost workdays after a 7-calendar-day waiting period. A weekly benefit equal to 66 2/3% of the employee’s average weekly earnings up to a maximum established by the North Carolina Industrial Commission is payable to the employee. Compensation begins on the eighth calendar day of lost work time and if the lost time goes beyond 21 calendar days, the employee is entitled to receive compensation for the first 7 calendar days.
The weekly benefit may be supplemented by using sick or vacation leave, earned prior to the injury, in accordance with the Supplemental Leave Schedule set by the State Personnel Commission.
If the doctor states the employee should not return to normal work duties, the statement must be reflected on the medical documentation. If an employee does not return as scheduled, the absence is considered unauthorized unless prior to the absence the employee provides the supervisor with a written updated medical status from the authorized treating physician allowing the time off.
Occasionally, a doctor will order work restrictions. In this case, a supervisor should make every effort to reasonably accommodate the limitations and the employee should comply with the doctor’s recommendations. A supervisor who anticipates a gradual transition back to work after an injury should contact the Leave Coordinatoras soon as possible.
Note: Employees are obligated to accept any suitable employment provided it is within capabilities. Refusal to accept suitable employment may result in termination of compensation and may result in dismissal.
What Happens to My Benefits?
While on Leave Without Pay – Workers’ Compensation status, there will be no benefit deductions taken from the weekly workers’ compensation pay. Workers’ Compensation wages are mailed directly to the employee by CCMSI.
State Health Plan coverage may continue while on Workers’ Compensation. The employer’s monthly contribution continues to be paid by the University; however, the employee must pay premiums for dependent coverage to the Payroll Office, 919-515-4350.
Retirement Service Credit
Retirement contributions stop while on workers’ compensation leave. An employee who is a member of the State Retirement System may purchase credit for the period of time on an approved leave.
Annual and sick leave continue to accrue while covered by Workers’ Compensation and are credited for use upon the employee’s return to work. If an employee does not return to work, vacation and sick leave accumulated during the first twelve months of leave should be paid in a lump sum along with other unused vacation credit. The payout of the vacation leave may exceed the 240 hours normally allowed.
Salary will be computed based on the last salary plus any legislative increases to which the employee is entitled upon reinstatement. Any performance increases that would have been granted had the employee been at work may also be included in the reinstatement salary, or it may be given on any payment date following reinstatement.
Employees continue to receive longevity credit and, if eligible, receive annual payments.
Depending upon the benefit plan, coverage may continue through direct pay to the vendor or Payroll. Please contact the Leave Coordinator for further information.
Who Manages Workers’ Compensation Claims?
The University Leave Coordinator establishes the procedures and processes to ensure injured employees receive the appropriate level of care and compensation in accordance with the Workers’ Compensation Act. CCMSI is the Third-Party Administrator (TPA) responsible for the overall administration of workers’ compensation claims for the State of North Carolina. CCMSI, in conjunction with the University Leave Coordinator, is responsible for accepting or denying liability for NC State, and is also responsible for monitoring and processing all workers’ compensation claims. Additionally, CCMSI pays medical benefits and compensation in accordance with the North Carolina Workers’ Compensation Act. The University and CCMSI try to provide the best possible medical care for injured employees to help them reach maximum medical improvement and return to work as soon as possible.
Payment of medical bills is not an indication of the University’s acceptance of liability for the claim. If you receive a bill from the medical facility, please contact the facility to make sure they are billing CCMSI correctly. You may contact the Leave Coordinator for further assistance, 919-515-2151.
If a claim is denied, the employee will be notified as soon as possible, pending receipt of medical documentation, if necessary. To petition further, a written notice of claim must be filed with the North Carolina Industrial Commission, 4319 Mail Services Center, Raleigh, NC 27699-4319. The notice should include:
- Employee’s name, address, and Social Security number
- The employer’s name
- The date and nature of the injury
All information should be provided using a Form 18, provided by NC State University.
Guiding Policies and Other Resources
Office of State Human Resources
- Workers’ Compensation Administration
- NC State Government Workers’ Compensation Employee Handbook
- Supplemental Leave Schedule
- Employee Statement
- Use of Leave Options
- First Report of Incident
- Supervisor’s Medical Treatment Authorization Form