There are numerous stages and requirements included in filing a North Carolina workers’ compensation claim. This is why it is likely in your best interest to contact an experienced workers’ comp attorney to assist you in the process.
Steps In Filing A NC Workers’ Compensation Claim
The first step in filing a workers’ compensation claim in North Carolina is to seek medical attention for your injuries. If possible, notify your employer or supervisor about your injuries and seek guidance about where you should go for medical assistance. Your employer may have a medical professional on-site or an affiliation with an outside medical provider. If you are directed to a particular provider or location, follow that direction. Unless you are given permission to utilize another physician, you are obligated to get treatment from the doctor of your employer’s choice.
If you are unable to notify your employer or receive no guidance about where to seek treatment, you can see a doctor of your choice for immediate, emergency treatment. Be sure to inform the treating physician that your injuries are work-related.
In situations where you were unable to immediately speak with your employer, it is important that you inform the employer as soon as possible, either verbally or in writing. However, under North Carolina law, you are obligated to provide your employer with written notification within 30 days of the date of injury. This is accomplished with a written letter or you can submit North Carolina Industrial Commission Form 13 to the commission, which effectively serves as notice to your employer.
Next Steps In Filing A Workers Comp Claim
Once you inform your employer of your injuries, he or she should provide you with Form 13 if you have not already submitted it. It’s important that you fill out this form completely, listing all relevant injuries and conditions. Failure to include one or more injuries can prevent you from ever receiving workers’ compensation benefits for the condition in the future. For example, if you list an injury to your foot on Form 13, but leave off an injury to your leg, your compensation will only cover the injuries to your foot. This means that medical treatment for your leg will go uncovered, even if the condition worsens to the point where you are no longer able to work.
Choosing A Doctor
After you file the form, you should receive communication from the employer’s insurance company regarding your injuries. When speaking to the insurance adjuster, speak honestly and discuss the details of your injuries and the incident leading up to your injuries. You will likely be referred to a specific doctor for an initial evaluation if they haven’t already done one. When speaking with the physician remain calm and completely disclose the nature of your injuries and/ or illness.
If you are not comfortable with the insurance company doctor, you must request permission to seek treatment from another physician. You cannot arbitrarily switch doctors. Doing so can result in nonpayment of your medical expenses. You must wait for authorization first. It’s important to note that these claims are rarely granted without good cause.
After the first doctor’s evaluation, you will receive one of two responses from the workers’ compensation insurance company. They will either flat out deny your claim or accept it and begin creating treatment options. Upon denying your claim, the insurance company must provide you and the Commission a detailed explanation for the decision.
A Denied Claim
If your claim is denied, you can file an appeal with the Industrial Commission. Some common reasons for denial of a workers’ compensation claim include a lack of causation between the work accident and the injury, or the existence of a preexisting condition. Once you request an appeal of your denial, the Commission will conduct an investigation and make its own independent determination. In response, the Commission may side with the employer and issue a right to sue letter or require that both parties take part in mediation.
Once you are granted compensation benefits, you should see the physician on a regular basis for continuous treatment. follow the orders of the doctor and keep all scheduled appointments. The physician will bill the insurance company directly. One determination that your doctor will make is whether or not you can work with the injury. If the answer is yes, the doctor may place certain limitations on what duties you can undertake or how long you can work each day.
Once your work schedule is determined, you may become eligible for lost wages payments from the workers’ compensation insurance company. This applies in cases where you are either working part-time or not able to work at all. Under North Carolina law, you can receive weekly pay at a rate of 66 ⅔ percent of your average weekly wages. It’s important to note that compensation does not become due until day eight of your work absence unless your disability exceeds 21 days. Once you have been absent from work for more than 21 days, you will receive a payment to cover the first seven days of your injury claim.
Returning to Work
As you continue to see the workers’ compensation physician, she will eventually give you the go-ahead for returning to work. This cannot occur until your physician signs off and gives you permission to continue working. If you require additional training or retraining before returning to work the employer will arrange for it to occur. You will either return to work in your previously held position or return to another position that is comparable to your old position.
It is possible to continue receiving workers’ compensation benefits after your return to work. However, the received benefits will only cover medical expenses and costs. You will not receive lost pay benefits once you return to work.