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How to File a Claim for a Workers’ Compensation in North Carolina

North Carolina workers compensation claim

Following the process accurately can be the difference between receiving full benefits and... not

If you suffered a work-related injury in North Carolina, the workers’ compensation insurance process can help you receive the funds you need and deserve. But there are important deadlines, forms, and evidence you’ll need to provide in order to secure your benefits. Here’s how the system works and what you need to do to have your claims processed correctly and quickly.

There were 93,000 recorded work-related injuries and illnesses in North Carolina in 2018. Of those, nearly 26,000 resulted in days away from work, and nearly 24,000 resulted in a job transfer or restriction.

The workers’ compensation system exists in order to provide a way for employees to receive benefits if they’re injured at work. It also ensures that an employer can’t be sued for negligence related to the injury. That’s because workers’ compensation is a no-fault system.

If you’re injured in a North Carolina accident that’s not related to your job — whether it’s a car accident, slip-and-fall, or any other type of personal injury — you can’t recover damages if you had any amount of liability, no matter how small. The person who is at fault for the accident or injury is responsible for paying for the related costs.

But thankfully, that’s not how workers’ compensation operates.

No matter how you were injured at work, whether it was the fault of your employer, a co-worker, or your own fault, a work-related injury or illness should be covered by workers’ compensation in North Carolina. This makes the process of filing a claim a little easier than filing a lawsuit because you don’t need to prove causation.

You only need to prove 3 things:

  1. You were injured.
  2. The injury happened while you were at work or performing a work-related task.
  3. Your injury costs money, either for medical treatment or lost wages.

That’s not to suggest that the process is simple, though. Here’s what to do if you were injured or became ill due to your job:

Step 1: Notify your employer

Your employer needs to be informed in writing about your injury as soon as possible. If you’re in the hospital and can’t speak directly with your employer, you can ask a family member or coworker to give notice on your behalf. You can also send an email as written notice. Notice should be provided to your manager, supervisor, or human resources representative.

You don’t need to go into great detail at this stage; simply let the employer know that you were injured in a work-related accident and that you’re seeking medical treatment.

If you are only able to provide immediate notice verbally, that’s acceptable. You must follow up with a written notice of the injury to your employer within 30 days of the accident (or within 30 days from the date you knew or should reasonably have known that you suffered a work-related injury or illness).

#NorthCarolina employers with 3 or more employees are required to provide workers’ compensation to each employed person. Tweet this

Step 2: See a doctor

Your employer is allowed to designate a doctor for you to see for an initial diagnosis or treatment. If there’s an on-site physician at your workplace, you should go to that doctor unless you require immediate treatment at a hospital. Your employer also might give you a list of approved doctors.

You’re certainly welcome to get a second opinion from your own primary care physician, but the claim will likely rely upon the diagnosis and treatment of the approved provider. If you’d like to seek treatment from your own doctor or another specialist, you need to make a request in advance and receive approval from your employer to use a doctor who’s not on their approved list.

What to discuss with the doctor

It’s very important that you make sure the doctor knows you’re there for a work-related injury or illness. You should explain to the doctor how the injury happened and request that the information is included in your medical record.

Along those same lines, if you’re visiting a doctor for an illness that you suspect is work-related (for example, mesothelioma, hearing loss, ongoing back, neck, or orthopedic stress injury, carpal tunnel syndrome, or another condition that might be related to toxic exposure or conditions related to your job), be sure to tell the doctor about any work conditions you’ve experienced that might be related to the illness.

If you inform the doctor that you’re seeking treatment for a work injury, they can bill your employer or its insurance company directly.

Step 3: Submit a Form 18 to the North Carolina Industrial Commission

Form 18 provides notice to the Commission that you were injured and begins the claim process.

You must complete the form and send it by email to the Industrial Commission (IC) within 2 years of the date of your injury or accident. You can find more forms and instructions on their website.

Within 14 days of when the IC receives your claim, you’ll receive 1 of these 3 forms in return:

 

Form 60

Form 61

Form 63

Indicates that your employer admits your right to compensation

Denies your claim

Provides a provisional acceptance of your claim that can be reversed later

Form 61 will also explain the reasons why your claim was denied. If your claim is denied, you have the right to request a hearing before the Industrial Commission. Often, the Commission will order a mediation conference before the hearing in order to attempt to settle the claim without a formal hearing.

Do I need to hire a workers’ compensation lawyer?

It depends.

If your injury was minor, you’ve received treatment, and you’re back at work, then maybe not. Some claims are more straightforward than others. Since a situation like that is probably easily resolved and you know exactly how much you’re owed for medical treatment and lost work time, your employer’s insurance company should settle your claim without issue.

But if your injury requires ongoing treatment, you’re still out of work (or can’t return to the same job you had before), there are some expenses that still need to be accounted for, or any part of your claim has been denied, now is the time to consult a workers’ compensation lawyer.

It can be very difficult to estimate how much your future costs will be. That’s why lawyers have actuarial tables, medical experts, and all kinds of other resources that they use to make these calculations — and unless you’re trained to do that, you probably won’t be able to reach an accurate figure.

You don’t want to be shortchanged on your benefits because of a miscalculation.

Once a settlement is reached where you and the Commission agree on what your benefits should be, you can’t go back and change them, except in very limited circumstances. It’s crucial that you get it right the first time. Remember that the insurance company’s objective is to pay out the least amount possible to satisfy your claim — they’re not trying to be helpful or generous. They want to settle your claim at the lowest cost to the insurer.

Your workers’ compensation lawyer can help you complete the Form 18 filing for your claim, participate on your behalf in mediation or a hearing, and assist you in calculating exactly how much you’re entitled to in benefits.

Use the Enjuris law firm directory to find a qualified, experienced North Carolina workers’ compensation lawyer who can answer your workers’ comp questions and skillfully handle your claim.

 

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