One of the most challenging aspects of North Carolina workers' (workmans') comp law is coordination with other health and disability benefits. These include public benefits, such as Social Security and Medicare, as well as private benefits like health insurance and short and long-term disability. The failure to properly coordinate with other programs can have dramatic consequences.
N.C. Workers' Compensation and Social Security
Seriously injured workers may be eligible for Social Security disability benefits in addition to workers compensation benefits. Employees can receive both. The amount of the Social Security benefit is based on the amount the employee has paid into the program. The total maximum benefit (Social Security plus workers' comp) is determined by a complex formula. Workers' Comp will pay first, then Social Security will kick in an amount up to the maximum benefit. Another advantage to applying for Social Security is that beneficiaries are generally eligible for Medicare after two years on Social Security disability.
N.C. Workers' Compensation and Medicare
Disabled workers may be eligible for Medicare benefits as well as workers' compensation. Medicare will not pay medical expenses related to a workers' compensation injury, but may pay for other uninsured medical expenses. Under certain circumstances Medicare requires that its interests be protected in the settlement of a workers' compensation case. In these situations Medicare requires that a certain sum of money be Òset-asideÓ by the employee to be spent on medical treatment for the workers' compensation injury before Medicare will step in and provide further benefits. Determining when and how these Medicare set-asides must be established is one of the most troubling issues facing North Carolina workers' compensation attorneys today.
N.C. Workers' Compensation and Private Health Plans
An injured employee should not allow an employer to push their workers' comp injury off onto health insurance. This could adversely affect the workers' comp claim and even contribute to a complete loss of benefits. Health plans will frequently attempt to recover money they spend on medical services that are related to a workers' comp injury. Whether this is allowed depends on the language of the particular health plan or policy. Many large employers have established health plans under a provision in federal law known as ERISA. These plans add an additional level of complexity to the question of reimbursement and must be carefully considered. An injured employee should not allow their health coverage to lapse because workers' compensation will only pay for services related to the particular injury.
N.C. Workers' Compensation and Short and Long-Term Disability Plans
Injured employees frequently are forced to rely on short or long-term disability plans when a workers' comp claim is denied. These disability plans may be entitled to reimbursement, especially if the plan is entirely paid for by the employer.
