Workers’ Compensation The Comingling of Benefits PANC Spring Conference 2018

WC Benefit Payments Benefit Payments FY16 FY17 Medical $23.4 Million Disability $27.3 Million $31.6 Million Other $ 3.8 Million $ 4.2 Million Total $54.5 Million $63.6 Million

Average WC Benefits Paid Per Day FY16 FY17 $214,451 $254,226

Disability Income Plan of NC Health Insurance Benefits What Benefits? Disability Income Plan of NC Health Insurance Benefits Retirement Benefits Medicare Benefits

Disability Income Benefits – Fact Specific Type of Injury? Can’t “Strong Arm” Must Meet the Eligibility Requirement Employees with at least one year of contributing membership service with the Teachers and State Employee’s Retirement (TSERS) System earned within 36 calendar months preceding the disability are eligible for short-term disability benefits.

Short Term Disability Benefits Provide Paperwork to Employee as soon as possible FMLA Requirement -12 Weeks 30 Days 60 Day Waiting Period Employee Must make Application Employee does not need to exhaust all of their accrued leave benefits before applying for short-term disability benefits. In lieu of STD, employees may elect to continue to exhaust any accumulated leave. May exhaust leave time during the waiting period – does not change the date of disability After a waiting period of 60 continuous calendar days from the onset of a disability, an eligible employee may receive monthly short-term benefits equal to 50% of 1/12th of annual base of compensation

Why Provide Disability Paperwork? Employer can establish the dates of the Short-term period Compensation If necessary, adjust the employee’s service Employee does not receive non-contributory service credit for the short-term period when in receipt of workers’ compensation (Employees may apply to purchase service credit if they return or are approved for long term disability) Employee will receive non-contributing service credits for short-term disability only if employee is in receipt of a short-term benefit Short-Term monthly benefits are offset by any workers’ compensation temporary total disability (TTD) payments for the same or related disability Once Employer pays 365 days of benefits, the last 6 months of benefits paid can be requested back from the State Retirement System

Death Benefits NCGS 97-38. Employee dependents are eligible to receive death benefits, should an employee die from a compensable injury or occupational disease (500 weeks). Burial Expenses up to $10,000. NCGS 97-37 Employee is entitled to compensation for an accepted injury for which they were entitled to payments, and dies from any other cause than the injury for which employee was entitled to compensation, payment of the unpaid balance shall be made to dependents, next of kin. Employee dependents are also eligible to receive the disability death benefit when injured employee has been in receipt of workers’ compensation benefits throughout the entire short- term period ( as long as all other requirements are met).

Extended Short-Term Disability Benefits Up to 365 additional days after the last day of the short-term disability. Is it reasonable to extend short-term disability to an employee receiving workers’ compensation benefits?

Long-Term Disability Benefits After short-term disability benefits period has ended, and if disability is likely to be permanent, long-term disability will be payable to employees with at least 5 years of contributing membership service with the Teachers’ and State Employees’ Retirement System (earned within 96 calendar months prior to the end of the short-term disability period). Employee must make Application Employee must provide any social security, veterans administration, and/or workers’ compensation information. Eligible employee may receive monthly long-term benefits equal to 65% of 1/12th of annual base of compensation

Why Provide Disability Paperwork? Long-Term monthly benefits are offset by any workers’ compensation temporary total disability (TTD) payments for the same or related disability Employee must be approved by the Medical Board for a permanent disability that has been continuous and was incurred wile employee was actively employed Employee must terminate their employment If employee has retired, long-term disability benefits become ineligible.

Workers’ Compensation v. Long-Term Disability Once Employee is approved for long-term disability, workers’ compensation claim can often be settled. PLEASE make your adjuster aware that employee has been approved for long-term disability.

State Disability Group 877-627-3287 Option #4 Helpful Number State Disability Group 877-627-3287 Option #4

Health Insurance Benefits While on workers’ compensation leave an employee is in pay status and will continue coverage under the state’s health insurance program. Employer pays monthly premiums. OPTIONS Employee applies and is approved for State Disability benefits Employer policy Separate Due to Unavailability

Retirement Benefits While on workers’ compensation leave an employee can retire. Retirement Benefits are IN ADDITION to Workers’ Compensation Benefits. There is no offset. Workers’ Compensation claims become more difficult to settle Value of the WC settlement increases

Medicare Set Aside Needed Medicare Benefits Medicare Set Aside Needed When claimant reaches 62.5 years of age When claimant is receiving SSDI Annuity??

Employment Dismissal Employee receiving Workers’ Compensation TTD Benefits continue if --- Employer Dismissal Occurs WC Claim accepted Prior to Dismissal Dismissal is Justified Separation Due to Unavailability PLEASE communicate with adjuster when employment dismissal occurs or when being considered

Eileen Townsend, Chief of Insurance 919-807-3522 eileen. townsend@dpi Eileen Townsend, Chief of Insurance 919-807-3522 eileen.townsend@dpi.nc.gov