Navigating North Carolina’s Workers’ Comp Maze: Making Sense of Impairment Ratings and Benefits

October 4, 2023 12:44 am

Navigating North Carolina’s Workers’ Comp Maze: Making Sense of Impairment Ratings and Benefits

Navigating North Carolina's Workers' Comp Maze: Making Sense of Impairment Ratings and Benefits

Workers’ compensation provides wage replacement and medical benefits to employees injured on the job. When an injury results in a permanent disability, impairment compensation helps make up for potential loss of earnings. Impairment ratings in North Carolina determine the amount of benefits an injured worker receives.

How Impairment Ratings Work in NC

After an injured employee reaches maximum medical improvement (MMI), meaning they have fully recovered or their condition has stabilized, they can receive an impairment rating. This is done through the authorized treating physician, or by an independent medical evaluation (IME) by an authorized physician.

The doctor examines the injury and assigns it a percentage rating based on the level of impairment and disability it has caused. This rating is determined using medical assessment criteria from the American Medical Association’s (AMA) Guides to the Evaluation of Permanent Impairment.  The employee has a right to a second opinion on the rating with his/her own doctor.

Higher impairment ratings equate to greater levels of disability and lost earning capacity. The rating directly correlates to the number of weeks of impairment compensation the injured worker will receive under North Carolina’s workers’ comp system.

North Carolina’s Impairment Rating Schedule

North Carolina utilizes a statutory rating schedule adapted from the AMA Guides criteria, but it is independent of the AMA Guidelines. This schedule provides standardized percentage ratings for common workplace injuries such as:

  • Loss of a limb, digit, or parts thereof
  • Disfigurement from scars or burns (which still requires a subjective opinion)
  • Back injuries, fused vertebrae
  • Knee, shoulder, or ankle injuries
  • Hearing loss
  • Vision impairment
  • Lung disease
  • And many other conditions

Using this standardized schedule helps ensure consistency across claims so workers with similar conditions receive comparable ratings. It provides a framework for raters to assign fair percentages based on objective medical criteria.

Factors Affecting the Rating and Payout

Several factors affect the ultimate impairment rating and the amount of compensation a worker receives:

  • Body part injured (e.g. back vs. finger)
  • Type and severity of the injury
  • Expected permanence of the condition

The higher the rating, the more weeks of compensation benefits the injured employee gets according to North Carolina law, but it depends on the part of the body:

  • 10% rating to back = 30 weeks of benefits
  • 20% rating to arm = 48 weeks of benefits
  • 30% rating to leg = 60 weeks of benefits
  • And so on, according to NCGS 97-31…

Someone with a higher rating due to the nature and severity of their injury will receive compensation for more weeks than someone with a lower rating.

Getting an Impairment Rating Assessment

To receive an impairment rating, the treating physician must certify the employee has reached MMI.

The worker’s compensation insurance carrier then will request a rating from the authorized treating physician, or they can arrange for an independent medical exam. An IME doctor reviews medical records, examines the worker, and assesses the level of impairment using the AMA Guides and North Carolina’s rating schedule.

The authorized treating physician or IME doctor submits their report with the proposed rating to the insurance carrier. The carrier then calculates the amount of impairment compensation owed based on the rating and paying out over the designated number of weeks.

If either party disagrees with the proposed rating, they can dispute it through a hearing before the Industrial Commission, and the employee can also ask for a second opinion on the rating alone. Otherwise, the rating stands and benefits are paid accordingly.

Standard Impairment Ratings

Standard Impairment Ratings

Lower Extremity Injuries

Injury DescriptionImpairment Percentage of Part
Leg length discrepancy of 1-3 inches8%-40% of leg
Fixed hip in favorable position50% of leg
Hip replacement40% of leg
Restricted hip movement15%-45%
Restricted knee movement5%-45%
Fixed foot in favorable position25% of foot
Fixed foot in less favorable positionUp to 90%
Restricted ankle movement10%-50%
Restricted foot movement10%-40%
Foot in an inward positionUp to 90%
Fusion of three joints in the foot30% of foot

Upper Extremity Injuries

Injury DescriptionImpairment Percentage of Part
Fixed fingertip joint35% of finger
Fixed middle joint of finger50% of finger
Fixed knuckle joint45% of finger
Finger joint fixed in less favorable position100% of finger
Total lack of feeling in fingerUp to 100%
Fixed wrist in favorable position35% of hand
Fixed wrist in less favorable positionUp to 100% of hand
Restricted wrist movement10%-25% of hand
Fixed elbow in favorable position50% of arm
Fixed elbow in less favorable positionUp to 90% of arm
Restricted elbow movement5%-35% of arm
Fixed shoulder in favorable position50% of arm
Fixed shoulder in less favorable positionUp to 80% of arm
Total lack of feeling in hand/armUp to 90% of relevant extremity

Spinal Injuries

Injury DescriptionImpairment Percentage of Body
Single healed cervical spine fracture10%
Each additional cervical spine fracture5%
Cervical fracture leading to quadriplegia100%
Other spine fractures causing paralysisUp to 50%

Benefits of Accurate Impairment Ratings

Having an objective impairment rating system provides several benefits:

  • Ensures injured workers receive fair compensation for any permanent loss.
  • Minimizes disputes by relying on medical evidence versus subjective judgments.
  • Helps claims resolve faster by providing a standard process.

Overall, North Carolina’s workers’ comp impairment ratings help facilitate reasonable settlements using established medical criteria. When ratings are done accurately per the state guidelines, workers get properly compensated for any lifelong impacts of their injuries.


In summary, North Carolina uses impairment ratings based on AMA Guides criteria to determine compensation for permanently disabled workers. The ratings take into account factors like age, nature of injury, and expected permanence to decide weeks of benefit payouts. Accurate ratings done per state protocols ensure fair treatment and facilitate claim resolutions. Workers should understand the system well to make sure they receive rightful benefits for any permanent disability from an on-the-job injury.

Talk to Perry Morrison – “Perry Knows”

Talk to Perry Morrison – “Perry Knows”

If you have suffered a workplace injury in North Carolina, understanding your rights to impairment compensation can be confusing. Navigating the workers’ compensation system and ensuring you receive the maximum benefits you deserve requires experienced legal guidance.

For over 30 years, Perry Morrison of Morrison Law Firm has successfully represented injured workers across North Carolina. He has extensive knowledge of workers’ comp laws and proven experience securing favorable outcomes for clients.

Don’t leave money on the table – call Perry today at 252-243-1003 for a free consultation on your workers’ comp case. As a Board Certified Workers’ Comp Specialist certified by the North Carolina State Bar Board of Legal Specialization, Perry has the expertise to handle even the most complex claims and get you the maximum compensation.

Whether you need help appealing an low impairment rating, disputing a denied medical claim, or getting the benefits you deserve, Perry Morrison has the knowledge and dedication to fight for you. Contact him today to schedule a free case evaluation.

Servicing The Following Counties In North Carolina