1. Workers’ Compensation The Comingling of Benefits
PANC
Spring Conference
2018

2. 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

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

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

5. 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.

6. 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

7. 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

8. Death Benefits
NCGS 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 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).

9. 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?

10. 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

11. 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.

12. 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.

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

14. 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

15. 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

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

17. 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

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