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Accidents are Not the Only Cause of Occupational Injuries

Jul 28, 2015 Brown Moore Workers' Compensation

The word, accident typically brings to mind one-time incidents, such as falling from a ladder, becoming injured by heavy equipment, or, of course, car crashes. When accidents like these occur as a result of employment, they are certainly covered by the NC Workers’ Compensation Act (WCA). However, certain illnesses or conditions also qualify for coverage, as long as they connect to workplace situations.

The language in the WCA can be confusing and injured workers may accept initial claims denials without question. Our Charlotte workers’ compensation attorneys suggest that anyone whose claim is rejected should seek legal advice before giving up hope.

How the WCA Defines Injury

As a general rule, the WCA defines an injury as one that occurs by accident arising out of and in the course of employment. It specifically excludes diseases in any form and chronic ailments, but it contains exceptions when a condition is work-related, such as the following:

  • Occupational disease: When a disease occurs as a result of employment, as might be the case for someone who becomes ill due to work with toxic chemicals, the WCA views it as an accident and covers it.
  • Back injuries: The WCA covers injuries to the back caused by a specific work-related incident. It also can cover chronic back conditions that were specifically caused by the nature of a person’s work.
  • Hernias: When a worker suffers a hernia resulting from a work-related accidental injury, the WCA may cover it — but these claims typically require extensive evidence that the hernia did not exist prior to the accident and that it meets a strict set of criteria.

Claim Denials May Not Mean the End of the Road

Claims adjustors who assess claims for work-related injuries and illnesses that are not the direct result of a specific accident can easily see valid claims as invalid. Claimants should not automatically assume that they are receiving unfair treatment. In many cases, adjusters simply do not have enough information to validate a claim.

In other words, injured workers may need to take additional steps to pursue the compensation they deserve. In some cases, they can discuss their concerns with their employers to learn if they need to produce a small amount of additional documentation to corroborate their claims.

Just as often, however, denied claims must go through a formal appeals process that begins with the North Carolina Industrial Commission, and might even go to the North Carolina Court of Appeals. Although rare, these cases can go all the way to the North Carolina Supreme Court.

When injured workers cannot obtain relief through a simple discussion with their employers, they need to consult with a workers’ compensation lawyer who can provide an honest assessment of their case. Valid cases require support from an attorney who has experience with the often-complex appeals process.