Steps to Take When Filing a Workers’ Compensation Claim
Approximately 2.9 million workers across the U.S. sustained workplace injuries and illnesses in 2015, according to the Bureau of Labor Statistics. More than half of the injuries involved time off work, job restrictions or job transfers. Serious workplace injuries put workers in North Carolina out of work every day, leaving them unable to support their families.
The North Carolina Workers Compensation Act was designed to create a speedy, informal procedure by which an employee could recover for the loss of work or for the physical impairment due to an injury or disease sustained in the course and scope of employment. The benefit of such a procedure is that the Act’s benefits provide the injured or deceased employee with a substantial recovery before trial and without litigation of the factual and legal issues involved in the claim. The main objective of the Act is to place the burden of the loss on the employer.
Workers’ compensation is an employer-paid insurance program in North Carolina and other states that pays benefits to employees who cannot work because of a work-related injury or illness. Most employers are required to provide workers’ compensation to employees. It pays for medical care and replaces a portion of lost wages while a worker is unable to work. If you or your loved one has been injured in a workplace accident, there are certain important steps you should take to preserve your rights to receive workers’ compensation benefits.
What Qualifies as a Workers’ Comp Claim?
An injury that was caused by an unexpected accident or incident that occurred in the course of employment generally qualifies as a worker’s compensation claim. Occupational injuries that occur over time such as repetitive trauma injuries like carpal tunnel syndrome also can qualify for workers’ compensation benefits. Employees who are diagnosed with certain diseases that are associated with particular occupations or types of employment also may be covered by worker’s compensation. Nearly all employers in North Carolina are required to carry workers’ compensation insurance to cover employees who are injured or develop an illness related to workplace exposures.
When Do Workers’ Comp Investigators Follow You?
Immediately after you file a workers’ compensation claim, you might get investigated or followed by a private investigator, especially when you have a large claim, have filed a claim previously, or the insurance company suspects there’s fraud involved. But don’t be alarmed, even if your case doesn’t present any of the previously mentioned signs, you may still have an investigator assigned to it in order to gather the necessary evidence to prove whether or not you are injured, with the purpose of not paying benefits or paying less than you deserve.
Eight Steps to Take When Filing Your N.C. Workers’ Compensation Claim
- Notify your employer of your work-related injury orally and in writing as soon as possible. Even if you do not miss any work as a result of the workplace accident, make sure you take this initial notification step. If you are unable to report the accident because of the severity of your injury, then have a family member, friend or your health care provider inform your employer of your work-related injury.
- See a doctor. If your workplace has a health care provider on site and tells you to see that person, then you should do so. If your employer sends you to a doctor or medical facility away from your work site, go to see the health care provider as directed. You may also visit your own doctor, but you are required to see any doctor your employer designates. If you drive your automobile 20 miles or more roundtrip to see a doctor for treatment of a workplace injury, you are entitled to reimbursement for travel at the rate of 54 cents per mile.
- Describe your work-related injury or illness to the doctor. The doctor should be informed that your injury happened in a workplace accident or your illness developed as a result of workplace exposures. Provide the doctor your employer’s name. This allows the doctor to record the treatment as a workers’ compensation expense.
- With 30 days, report the injury to your employer in writing. Make a simple written statement about what happened and include the date of the accident. Take this step regardless of how much your employer already knows about the accident and your injuries. If you cannot write the letter, have a relative or friend write it for you and send it to your employer. Keep a copy of the letter for your records to show that your injury was properly reported.
- Follow doctor’s orders. You should follow any directions that you receive from the doctor provided by your employer regarding the treatment of your injury. The goal of medical care paid by workers’ compensation insurance is to restore the injured employee as much as possible to the health and ability to work as before the injury. Failure to follow the doctor’s instructions and to attend follow-up doctor’s appointments can jeopardize your workers’ compensation benefits.
- Make sure your claim is filed correctly. North Carolina workers’ compensation claims are filed with the N.C. Industrial Commission. All claims begin with the Industrial Commission’s Form 18. Form 18 is available in paper and electronic form. It must be filled out completely and submitted.
- Complete all paperwork. There will be additional forms as your claim is processed. Do not fail to complete and submit any form that applies to your claim.
- Make and keep copies of everything. Make copies of every letter, every medical report, every bill, and every completed form. If there is a dispute regarding your workers’ compensation claim, you will need to show that you did what you were instructed to do to recover from your injury and to obtain the benefits that you deserve.
If you fail to follow the notification process within the time limits, your claim may be denied.
How Long Do You Get Workers Compensation?
An injured employee is eligible to receive workers’ compensation benefits until he or she returns to work. Compensation payments are made weekly, starting in the second week that an employee is out of work.
Filing a workers’ compensation claim and obtaining benefits can be complicated if your employer disputes or denies your claim. The complexity of the law can add to the stress of the situation. If your employer or your company’s insurance administrator denies your claim, you can request a hearing before the N.C. Industrial Commission by submitting a Form 33 Request for Hearing. Many injured workers do not receive the benefits they deserve because they try to appeal a denied claim on their own. You can have an attorney represent you and advocate on your behalf.
Contact a North Carolina Workers’ Compensation Lawyer
If you or someone you love has suffered a job-related injury or illness, call the experienced North Carolina workers’ compensation lawyers at Hardison & Cochran toll free at (800) 434-8399 or fill out our online contact form. We are advocates for injured workers. Three of our attorneys have completed special legal training in this area of law and are certified by the North Carolina State Bar as Board-Certified Specialists in workers’ compensation law. Call for a free consultation to find out how we may assist you. The initial consultation is always free.