North Carolina Workers’ Comp Claims Process
Workers’ compensation is a type of mandatory insurance that employers in North Carolina, and other states in the nation, must carry. The insurance is designed to provide medical benefits and wage replacement benefits in the event that a worker is injured on the job, and it does not require the employee to prove fault or negligence in order to recover compensation.
If you are injured while working in North Carolina, it is important that you understand your options for filing a claim and seeking benefits. A Charlotte workers’ compensation lawyer from Stewart Law offices can help you in every step of the way.
The first thing that you must do following a workplace accident is to provide your employer with notice of your injury. If you fail to provide notice, your employer will be unable to initiate the claims process on your behalf.
You have the right to seek medical attention for your work-related accident and injury, including emergency medical attention when necessary. Before you see a doctor, though (except for in the event of an injury that demands emergency care), make sure that you are seeking care from an approved medical provider.
When you get medical attention, be sure to tell the doctor that the injury happened at work.
While providing your employer with verbal notice of the accident is important and should be done immediately, you should also file a written accident report with your employer within 30 days.
Step 4: Reporting the Injury to the NC Industrial Commission
Providing your employer with notice of the injury is only the start of the N.C. workers’ compensation claims process. Your claim then needs to be processed by the North Carolina Industrial Commission.
- Your Employer Must Report the Injury to Its Insurance Carrier and the N.C. Industrial Commission. After you provide notice of the injury to your employer, it is their responsibility to report the injury to both the employer’s workers’ compensation insurance carrier and the North Carolina Industrial Commission.
- You Must File a Form 18. When you file notice with your employer, your employer is required under law to provide you with a Form 18-Notice of Accident to Employer and Claim of Employee, Representative, or Dependent. Form 18 establishes a legal claim of injury on your behalf.
- Take Action Even If Your Employer Does Not Have Workers’ Compensation Insurance. If your employer does not carry workers’ compensation insurance or does not have approved self-insurance, it is likely in violation of the law. As such, you can report your employer’s failure to carry insurance to the N.C. Industrial Commission Fraud Section.
After you receive initial medical treatment, it is critical that you follow all of your doctor’s orders. If you fail to follow orders and your condition worsens, or does not improve to the degree that it could otherwise, you may be denied your full compensation award.
Step 6: Save All Receipts, Bills, and Paperwork Related to Your Medical Treatment
In order to pursue compensation for the full value of your medical expenses, as you are entitled to do under workers’ compensation, you need to keep a thorough record of all medical costs related to your work injury. This includes keeping all receipts, bills, and paperwork related to your medical treatment.
In some cases, workers who are injured on the job may be entitled to lost wage compensation. Lost wage compensation does not begin until the worker has missed work for a minimum of seven days, and then it begins on the eighth day. However, in the event that the disability extends for more than 21 days and the worker is prevented from working for three full weeks (or more), payment for the first seven days that the employee missed work will also be authorized.
If your initial claim is denied, you will receive a notice of the denial, and the reason for the denial will be stated. You maintain the right to appeal the decision.
- Appeal (Form 33). The first thing that you should do is to file a Form 33-Request That Claim Be Assigned for Hearing with the North Carolina Industrial Commission. In doing this, you are asking the N.C. Industrial Commission to make a decision about the outcome of your case.
- Mediation. Before a formal hearing occurs, you and your employer will attend mediation, which is facilitated by a neutral third party called the mediator.
- Formal Hearing. If mediation is unsuccessful and you and your employer are still in disagreement about what the outcome of your claim should be, the formal hearing before the commission will proceed.
- Full Commission Review. If the hearing does not conclude in your favor, you can request an appeal before the full commission. In order to do so, you must file your notice of appeal to the full commission within 15 days.
- Appeals to the North Carolina Court of Appeals and the North Carolina Supreme Court. If the review of the full commission does not yield workers’ compensation benefits, you still have another shot. You can file an appeal with the North Carolina Court of Appeals, and if this is unsuccessful, the North Carolina Supreme Court.
If you are appealing a denied claim, working with an experienced worker compensation lawyer is of critical importance.
Your workers’ compensation benefit award will be based, in part, on the degree of disability that you incur as a result of your work-related injury. If you have a permanent disability, then you are entitled to compensation for the permanent loss of the body part that was injured. However, how much disability pay you may receive will depend on whether or not the injury is partial or total:
- If the injury that you have suffered is deemed to be permanent, but the loss of the function to the injured body part is less than 100 percent, then your injury will be considered a permanent partial disability.
- If the loss of function to the affected body part is 100 percent, then you have suffered total disability.
What to Do If Your Doctor Says You Can Go Back to Work but You Disagree
In some cases, a workers’ compensation doctor may release a person back to work before the worker believes that he or she is ready to return due to the extent of disability. If there is a dispute about your condition, you maintain the right to ask for a second opinion from another medical professional.
Note that in some cases, the workers’ compensation insurer may request that you submit to an independent medical examination (IME) at any point. While you are allowed to have your own doctor present at an IME, you will need to pay for your own doctor yourself.
Assuming your workers’ compensation claim is approved, you will be offered a workers’ compensation settlement. It’s important to remember that you have the right to negotiate an offer and do not have to accept it. Some important terms to know related to workers’ compensation settlements include:
- Compromise Settlement for Lump Sum. In many cases, claimants will agree to give up their right to pursue further compensation in exchange for payment in the form of a lump sum.
- Form 26a. If you have suffered a permanent partial disability, then you and your employer will need to fill out a Form 26a-Employer’s Admission to Employee’s Right to Permanent Partial Disability.
- Form 21. Form 21 is almost the same as Form 26a, except that it is applicable to temporary disability benefits rather than permanent partial disability benefits.
How an NC Workers’ Compensation Lawyer Can Help You Throughout the Process
The workers’ compensation process can be complicated, especially if you have any unique or complex issues, including:
- Disputes about whether or not your injury is work-related
- Serious injuries
- An employer who doesn’t carry workers’ compensation
- A denied claim
An experienced North Carolina worker compensation attorney can arm you with knowledge and act as a strong legal advocate throughout the process. An attorney can explain what forms are necessary for your claim, when and from whom you should seek medical care, steps to take throughout the process for workers’ compensation, how to appeal a denied claim, how to prepare for a hearing, how to negotiate a claim, and more.
Call Our N.C. Workers’ Compensation Law Firm Today
We know that bringing forth a workers’ compensation claim can be intimidating, which is why our lawyers want to even the playing field and increase your confidence. When you call our law firm, we will review your case free of charge, with no obligation to you.
To schedule your free consultation with our law firm today, please contact us directly to discuss the unique details of your workplace injury and your situation. Our legal team is here to help.