North Carolina Workers’ Compensation
A General Overview
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Cory Blankenship – Treasurer
 Phone: 828-497-7070
 Email: coryblan@nc-cherokee.com
Barbara Owle, Risk Manager
 Phone: 828-497-7068
 Email: barbowle@nc-cherokee.com
Joe Bernhisel, Workplace Safety Officer
 Phone: 828-497-1021
 Email: joebern@nc-cherokee.com
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Joe Bernhisel, Workplace Safety Officer
Phone: 828-497-1021
Email: joebern@nc-cherokee.com
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Employees are entitled to benefits if, while
carrying out activities for the benefit of
their employers, they suffer an injury by
ACCIDENT, a “specific traumatic
incident,” resulting in a hernia or back
injury, or an occupational disease.”
An “Accident” is due to unusual
circumstances, such as slip, trip, fall, or
other unusual activity, likely to result in
unexpected consequences.
“A Specific Traumatic Incident,” as
defined by our courts, includes, “injuries
that occur during normal work activities.
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Accident
Must be a separate event preceding and
causing the injury
Must be unforeseeable and unusual
Must involve the interruption of a work
routine
Must be beyond the usual and customary
duties of the job
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Non Prescription Drugs
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Bandages, Gauze Pads
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Hot or Cold Therapy
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Elastic Bandages, Wraps
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Using Eye Patches
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Use Tweezers to remove foreign material from area
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Removal of items not embedded in the eye
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Temporary Immobilization – Splints, Slings, Neck Collars
When an Employee is involved in an accident – Do the following:
1. Notify your Supervisor
2. The Supervisor will refer you to the Urgent Care for medical care if necessary
If you need to be seen in the ER – Injury must be considered urgent/emergent
Employee will complete EBCI Form 2 – Employee Statement of Incident
Employee will complete EBCI Form 3 – Drug Test & Medical Release Form
Employee will complete EBCI Form 4 – Return to work form from Dr.
Witnesses will complete EBCI Form 5 – Witness Statement of Accident
3. Supervisor notifies the Manager
4. Manager notified Risk Management that an accident/incident has occurred
5. Manager is responsible for ensuring Risk Management received this documentation
within 24 hours of the accident
6. Employee is to return their “Medical Return to Work Note” to Risk Management and
their Supervisor after being seen by the doctor. Risk Management is to keep the
original note and a copy is to be given to the Supervisor.
7. Risk Management will file the WC Claims and determine compensability.
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Incident Report
Non-Employee Accident
Fall at the Council House
Workers’ Compensation Report
Work related Injury
MVA Report
Vehicle Accidents
Theft from vehicle
Vehicle hit by another driver
Forms can be found at:
http://nc-cherokee.com/finance/budget & finance/risk management/ forms library.
The password is - risk
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Form 18 – Notice of Accident to Employer and Claim of Employee,
Representative, or Dependent
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Form 19 – Employer’s Report of Employee’s Injury or Occupational
Disease to the Industrial Commission
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Form 22 – Statement of Days Worked and Earnings of Injured
Employee
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Form 25T – Itemized Statement of Charges for Travel - $0.51 a
mile for medical appointments, physical therapy, or testing. The
trip must be over 20 miles before claiming mileage.
Form 60 – Employer’s Admission of Employee’s Right to
Compensation. This form is sent to the Employee when they are
placed out of work, by the treating physician.
NOTE: Form 22 and 25T can be found at
http://ncherokee.com/finance/treasury/ risk
management/forms library. The password is risk.
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
Employer has the right to direct medical care
Medical notes must be maintained in Risk
Management
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Failure to cooperate can lead to termination of
benefits
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Employees must have prior authorization from
Risk Management before receiving medical care
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Employees will be placed in restrictive duty if the
doctor assigns restrictions. The medical note
designates the employee’s return to work time
not the employee.

Make sure you have selected the
correct form for recording the
accident/incident
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Additional forms needed to be
added to the report
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Submit any medical – return to
work statements to Risk
Management
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Return Drug Testing Forms to
Risk Management
Incident Report
Motor Vehicle
Accident
Workers’
Compensation
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No
compensation is due for the first seven days of lost time unless the
disability exceeds 21 days. Therefore, the first check will not include
payment for 1-7 days. Payment for those days will be made beginning
on the 8th day.
In accordance with EBCI Policy, the injured employee may request
26.5 hours (1/3 of hours worked per week) of Sick or Annual Leave
only per pay period while authorized out of work. The Employee
cannot receive Regular Hours while AOOW, and can’t use Sick or Annual
Leave beyond hours accrued.
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If an employee is referred to a specialist, such as an Orthopedic
Specialist, Risk Management will assign the Case Nurse, Revertia Pegg,
to assist and oversee those appointments.
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Physicians will indicate restrictions on the Medical Return to Work
Note given to the employee.
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Employee must submit this note to Risk Management and they will
assigned restrictive duties.
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Employees will be paid by their department. If the department can’t
provide a restrictive duty assignment, the Employee will be
temporarily assigned to another department. Their pay will still be
paid by their departments.
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Back Injury
- Prepare Travel Materials - Tourism
- Driving Only
- Copying
No Lifting Over 10 Lbs.
- Answer Phone
- Prepare Training Materials
- Assist at Youth Center
Limited Use of One Hand
- Write Medical Orders
- Pass out Marketing Materials
- Administrative Duties
No Prolonged Standing
- Administrative Duties
- Work on Special Projects
- Up-date Training Materials
Question – Can you identify areas within your departments that
could be used to accommodate Restrictive Duty Employees?
Send Risk Management a list of the job that can you used for
Restrictive Duty.
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How Did the Injury Occur?
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Details need to be included in the report –
Who? When? What? Why? How?
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What was the contributing
cause of the injury?
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How can we prevent this from
occurring again?
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Was Personal Protective equipment used?
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
Prevent similar accidents in the
future
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Find the true causes
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Protection of our employees
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Lower Workers’ Comp Cost
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Improve our work environment
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Investigations provide a means
of correcting the hazard to
prevent future occurrences
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Use the Information from your
investigation to:
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Communicate Findings to
Employees
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Replace/Repair all defective items
found
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Re-Instruct Employees as
necessary
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Modify work practices as
necessary
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Ensure your Department is following
Workplace Safety and Health Regulations
when performing their jobs
Risk Control is a means
of reducing Workers’
Compensation Cost
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Cory Blankenship – Treasurer
Phone: 828-497-7070
Email: coryblan@nc-cherokee.com
Barbara Owle, Risk Manager
Phone: 828-497-7068
Email: barbowle@nc-cherokee.com
Joe Bernhisel, Workplace Safety Officer
Phone: 828-497-1021
Email: joebern@nc-cherokee.com
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“Safety First”
Thank You
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