Filing a Workers’ Compensation Claim in North Carolina

Oct 13, 2016

Filing a Workers’ Compensation Claim in North Carolina

North Carolina law requires almost all employers who hire more than three individuals to purchase workers’ compensation insurance. This ensures that employees who are injured while working on the job or who develop an occupational disease as a result of their work environment can collect compensation for the losses they suffered. If you sustained an injury while at work, it is critical to speak to an experienced Charlotte workers compensation attorney who can help explain your legal options.

Coverage

Workers’ compensation laws require an employer’s insurance policies to cover all injuries and illnesses attributable to work-related accidents or diseases. Work-related accidents are usually caused by lifting heavy objects or excessive typing, so victims must have access to funds for treating injuries, such as:

  • Carpal tunnel syndrome;
  • Back injuries; and
  • Knee, shoulder, and joint conditions.

Workers’ compensation also covers occupational diseases, which are illnesses caused by the specific environmental hazards associated with individual workplaces. These types of injuries include cancers caused by toxic exposure. Whether an injury is work-related or occupational in nature, it must have occurred in the course and scope of a person’s employment to be covered.

Filing a Claim

After sustaining an injury while at work, an employee must first obtain immediate medical treatment. It is important, however, that an injured employee tell his or her doctor that the injury was sustained at work and to provide the hospital with the employer’s name. If an employee fails to take this step, he or she may receive the bill for treatment, rather than his or her employer, which can be a complicated issue to resolve.

An injured party should then notify his or her employer orally and in writing of the illness or accident and how it occurred within a month of the accident. Once an employer has notice of an injury, he or she is required to assist the employee in completing the necessary forms, one of which is Form 18, or Notice of Accident to Employer and claim of Employee, Representative, or Dependent for Workers’ Compensation Benefits. The employer must also fill out his or her own form before sending in both to the North Carolina Industrial Commission (NCIC), which is an entity that administers the workers’ compensation laws in the state.

While most employers carry appropriate insurance and are eager to help their employees obtain compensation for their injuries, unfortunately, others fail to follow up and never submit the forms. In these cases, an injured party can report the injury him or herself to the Industrial Commission by submitting Form 18 as long as it is done within two years of the accident.

Workers’ Compensation Benefits

Once a claim has been reviewed, an injured party will be eligible to receive benefits. These benefits can include medical treatment, compensation for lost wages, and compensation for permanent disability. Because an injured party’s employer or insurance company is held liable for these costs, employees may be required to receive care from a particular clinic. If this is unsatisfactory, an employee has the option of filing a petition with the Commission requesting leave to receive care from another medical professional.

Some injuries take weeks or even months to heal, meaning that an injured party cannot return to work. If an injured employee is unable to work for more than a week, he or she will receive 2/3 of the wages that he or she lost as a result of not being able to work during that time period. These payments are made weekly and will cease once an injured party is able to return to work.

Other injuries are so severe that they qualify as permanent impairment. Once a doctor has determined that no additional treatment will help a specific injury improve, he or she will give the injured party a permanent impairment rating. The Commission then uses this rating to determine how much money the individual will get for permanent partial disability. In the event that an injury or illness caused total and permanent disability, the party will continue to receive 2/3 of his or her weekly wage.

Appeals Process

Employers and insurers who deny workers’ compensation claims must notify the applicant, the doctor, and the Commission of the reasons for the denial. Some of the most common reasons cited for a denial include the following:

  • The applicant provided insufficient information about the injury;
  • The applicant failed to prove that the injury was caused in the course of a work-related activity;
  • The claim was reported too late; or
  • The proper paperwork was not submitted.

If an employee receives medical treatment for an injury and his or her employer denies the claim, the doctor can only send the bill directly to the employee after the appeals process has been completed. If an employee and his or her employer are unable to come to an agreement regarding the issue of workers’ compensation through mediation, the injured party must request a formal hearing with the Commission. This requires the submission of Form 33, which must be completed within two years of the date of the injury or the appeal will be denied.

Most employers are legally required to carry workers’ compensation insurance or self-insurance, so if an employee is injured and discovers that his or her employer does not have coverage, he or she must notify the Commission’s fraud division.

Contact an Experienced Workers’ Compensation Attorney Today

All employees should be able to go to work with the peace of mind that comes with knowing that if an accident were to occur, they would be able to cover their medical bills. Unfortunately, many individuals are unaware of their rights to compensation and so struggle to pay debts or daily expenses after sustaining an injury while at work, so if you or a loved one live in Charlotte and were injured in the workplace, please contact the law firm of Ted A. Greve & Associates, P.A. to schedule a free consultation with a dedicated workers compensation lawyer in Charlotte who can ensure that you receive the compensation that you deserve.