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Are You Eligible for Workers’ Compensation Even if You’ve Been Denied?

Oct 18, 2016 Brown Moore Workers' Compensation

In North Carolina, employers who have three or more employees are legally obligated to have workers’ compensation insurance to cover those employees in case they are ever injured. Occasionally, larger companies will be self-insured. This is fine, as long as there is some form of workers’ compensation coverage for workplaces that employ more than two workers.

If you’ve been injured on the job in North Carolina, you can file a workers’ compensation claim through the North Carolina Industrial Commission (NCIC) to cover your medical expenses and lost wages. These benefits are also available for those who develop work-related illnesses, or occupational illnesses. In most cases, you will work with your employer and your employer’s workers’ comp insurance to file and process your claim for benefits.

So, the first thing you’ll need to know is which sorts of injuries and illnesses are covered, how to file a claim, and what benefits you are eligible for. Then, we can address the appeals process and whether or not you might still be eligible for benefits if your claim is denied.

What Injuries and Illnesses are Covered by NC Workers’ Comp?

If your injuries or illness are directly caused by your work-related tasks or occurred while at work or conducting work-related activities, then they should be covered by North Carolina workers’ compensation. These are also known as industrial accidents and occupational diseases. Common injuries and illnesses that are covered include back injuries, repetitive motion injuries (like carpal tunnel syndrome), knee injuries, shoulder injuries, slip or trip and fall injuries, and illnesses that result from being in contact with hazardous materials. It is important to note that if your injuries occur while you are commuting to or from work, they will not be considered to be work related and will not be covered. However, if you are in an auto accident while driving in the course of work-related activities (such as delivery driving), then your injuries will be covered.

How Do You File Your North Carolina Workers’ Compensation Claim?

It is essential to seek medical treatment when you’ve been injured at work. You’ll need to do this to establish that the injury occurred and that you did what you could to treat and mitigate the effects of that injury. You also need to do this for your own health, of course. Many people will wait to seek treatment, to see if the injury might improve on its own or simply to fit their medical care into their busy schedule. It might not seem like an immediate concern if your symptoms are not severe and debilitating. Waiting to seek treatment, though, can affect your ability to seek compensation. You should inform your doctor that the injury is related to work so that they know to bill your employer’s workers’ compensation insurance provider.

You also need to notify your employer of the injury as soon as possible. Legally, you have 30 days to do so. Yet, the sooner you do, the better off you will be. The longer you wait, the more likely it is that the employer or insurance company can argue that your injuries are not severe or are not work related. The same is true if you wait to seek medical treatment. When you notify your employer of your injury, be sure to do so in writing, so there is physical evidence of you informing the employer that an injury has occurred on the date that you did so.

From this point forward, your employer should work with you to file your workers’ compensation claim. You will need to fill out Form 18, which is the Notice of Accident to Employer and Claim of Employee, Representative, or Dependent for Workers’ Compensation. Your employer will also fill out a form (Form 19), and both forms will be sent by your employer to the NCIC and to the workers’ compensation insurance company.

You do not have to have your employer’s assistance or permission to file Form 18. If your employer is not willing to help or acknowledge your injuries, then you can file this form on your own. You have two years (statute of limitations) to file the form with the NCIC. The sooner you do so, the stronger your claim for benefits will be.

What Workers’ Compensation Benefits Are You Eligible For?

If you have been injured at work or developed an occupational illness, and you have filed your claim, and that claim has been approved, then you are eligible for workers’ compensation benefits. The benefits will include coverage of your medical care expenses and partial compensation for your lost wages. If you are diagnosed with a permanent disability, then you can also receive permanent disability compensation.

To be eligible for all of these benefits, it is important to do your part to follow the rules of workers’ compensation in North Carolina. This means that you must see a doctor that is approved by your employer or the employer’s insurance company, and you must follow the doctor’s orders. If you want a second opinion, then you can petition the NCIC to see a different doctor. Keep in mind that you will need to continue to seek medical treatment from the approved physician until you are approved to see another.

If your treating physician declares that you are unable to work for any length of time, then you must not return to work until you are cleared to do so. If you are released to light-duty work and your employer offers you a light-duty position, then you must accept it.

Wage compensation will not equal the full amount of your former wages. Rather, you can receive 2/3 of your former wages, and only once you’ve been out of work for more than seven days. The amount of this compensation is also limited to a maximum rate which the North Carolina Industrial Commission sets every year. Thus, a high-earning worker may not even receive 2/3 of wages, but only receive the maximum rate. After seven days, your wages will be covered at 2/3 of your average weekly wage, based on the past four quarters. If you are out of work for more than 14 days, then your first seven days out of work will also be compensated. If you return to light-duty work, and if the pay is less than your former wages, then you can receive 2/3 of the difference in wage compensation. Once you are approved by your physician to return to your former work, you will no longer be eligible for these benefits, regardless of whether or not you actually do return to work.

What Do You Do If Your Claim is Denied?

Now that we’ve covered some of the basics of North Carolina Workers’ Compensation Benefits, we can get to the question of whether or not you might still be eligible for benefits when your claim is denied. If you feel that your claim was unfairly denied and that you are legally entitled to workers’ compensation benefits, then you can appeal. When the claim is denied, you will receive notification and an explanation of this decision on Form 61.

From this point, you can discuss the decision with your employer and/or the workers’ compensation insurance carrier in an attempt to resolve the disagreement. If this fails to yield results, then you can file Form 33, which is the Request for Hearing. You have two years from the date of your injury to start this process. If you still don’t get results, then you may need to appeal with the North Carolina Court of Appeals. Ultimately, being denied workers’ compensation does not mean that you are not eligible for these benefits. Rather, it means that you may have to work harder to get the benefits that you need. This is where it helps to work with Brown Moore & Associates, PLLC, to have experienced legal guidance throughout the process of dealing with a denied workers’ compensation claim. Contact our determined NC workers’ compensation claim attorneys today to discuss your claim and get a free consultation.