10 Important Steps
Many workers feel worried and overwhelmed when they suffer an injury on the job. They do not want to lose their jobs. They are hurting due to their injury or disease. They are confused about exactly what benefits they are entitled to under the North Carolina Workers’ Compensation Act. The following is a list is of very important initial steps to take when you have been injured.
1. Report your Injury. You should report your injury as soon as it occurs to your supervisor. Report the injury orally and in writing. Even if you are not yet sure whether the injury is a serious one, it is always best to report the injury. Your notice should include your name, address, time, place, nature, and cause of the accident. If you do not report your injury to your supervisor within 30 days of it occurring, your employer may argue that it did not have proper “notice” of the claim. See N.C. Gen. Stat. § 97-22. Your employer wants the opportunity to timely investigate your claim to determine if they deem the injury to be work-related.
2. Request medical treatment or second opinion, if needed. Once you realize your need for medical treatment, you should ask your employer to set up a visit with a physician. Your insurance adjuster has the initial right to direct your medical treatment to the facility/doctor of their choice. However, if that doctor at some point thinks you need a specialist to address your unique injury or disease, that doctor can refer you to a certain doctor, type of doctor, or facility for an examination. You are entitled to second opinion examination(s) with a doctor of your choosing for a second opinion on a permanent disability rating (N.C. Gen. Stat. § 97-27(b)) and a doctor of your and the insurance adjuster’s mutual choosing for additional treatment options (N.C. Gen. Stat. § 97-25(b) and (c)). You can also ask that the Industrial Commission approve a doctor of your choosing for ongoing treatment. Your medical treatment and second opinion rights can often be confusing. Ask a workers’ compensation attorney for help or advice if you have trouble receiving the medical treatment or second opinions you need.
3. File legal notice of your claim with the North Carolina Industrial Commission. You are required to file legal notice of your injury/disease with the Industrial Commission within two years of when the disabling injury occurred, was diagnosed, or was linked to your employment by a competent medical authority. The Industrial Commission created a form called a Form 18 so employees can easily accomplish this. The Form 18 includes detailed filing instructions at the bottom of the form.
4. Communicate with the right person. Many workers continue to communicate with their supervisor, human resources (HR) representative, or company nurse after an injury. In many cases, that is not the appropriate person to have ongoing communications with regarding your work injury. All employers with 3 or more regular employees are required by state law to carry workers’ compensation insurance. See N.C. Gen. Stat. § 97-2, § 97-93, § 97-94. You should ask your employer to provide you the name and number of its workers’ compensation insurance carrier. If the company is self-insured, you should ask for the insurance representative. If your employer neglects to provide you the insurance carrier information, the North Carolina Industrial Commission provides a free database, called the Insurance Coverage Search System, where you can look up which carrier insures your employer. Once you have found the insurance carrier, you should call them and give them your name and SSN and ask to speak to the insurance adjuster assigned to your claim. If your calls go unanswered, we encourage workers to ask for their insurance adjuster’s email address and to put any unanswered requests in writing.
5. Wait for a determination on whether your claim is accepted or denied. The North Carolina Workers’ Compensation Act in § 97-18 provides your employer and its insurance carrier a reasonable amount of time to determine whether to accept or deny a claim. The Industrial Commission recommends that within 30 days after your employer has notice of the injury it should accept the claim and/or deny the claim. If you have not received a response from your insurance adjuster within 90 days (3 months) after you gave notice of injury despite your follow-ups, you should consider hiring an attorney. If you learn that your claim has been denied, the employer or insurance adjuster must submit a written explanation describing why your claim has been denied. If you do not understand the reason for denial, you should contact a workers’ compensation attorney who can explain the law given your injury or disease case facts. An attorney may be willing to represent you and fight for your right to workers’ compensation benefits.
6. Consider whether to give a recorded statement. During your employer/insurance adjuster’s investigation period, they may ask that you give a recorded statement. You can only be recorded with your consent. Your insurance adjuster plans to ask you questions to determine whether they will accept or deny your injury. Not all injuries that happen at work are compensable. Your answers to the insurance adjuster’s questions will be recorded and transcribed. If you have questions about whether your injury is a compensable one, you should contact a workers’ compensation attorney.
7. Request benefits for time out of work. If your claim is accepted and you have missed work due to your injury, you are entitled to weekly benefits while you are out of work. (See Step 8 below to determine the amount of your weekly benefit.) There is a 7 day waiting period until your benefits will start. (You can use paid sick leave, vacation, annual leave, or disability benefits during the first 7 days out of work.) After you have missed 7 days of work, whether consecutive or not, you should start receiving weekly checks. If you miss more than 21 days of work, you are entitled to a weekly check for the first 7 days missed. See N.C. Gen. Stat. § 97-28. There are different compensation rules that apply if you have returned to work with your employer or a different employer and are earning less money weekly than you earned before your injury. If you have more detailed questions about your entitlement to weekly benefits, ask a workers’ compensation attorney.
8. Determine your correct weekly workers’ compensation rate. If you are out of work due to your injury, you are generally entitled to 2/3rds of your average weekly wage for the 52 weeks preceding your injury. See N.C. Gen. Stat. § 97-2(5). For example, if you made $500.00 per week including overtime, your workers’ compensation rate would be $333.35. ($500 x .6667 = $333.35) Your average weekly wage should include your overtime and per diem pay. Request yourt insurance adjuster provide you a completed Form 22 to make sure you are being paid the correct workers’ compensation rate. If you have returned to work with your employer or a different employer and are earning less money weekly than you earned before your injury, you are entitled to 2/3rds the difference between your average weekly wages pre-injury versus post-injury. If you have questions or concerns about your workers’ compensation rate(s), contact a workers’ compensation attorney.
9. Request a complete copy of your medical records. Other than providing for your family, the most important thing during this time is your medical recovery. Your goal is to get all the treatment that doctors think is necessary to cure or provide relief to your condition. Many times, when workers are in a medical visit, they are not taking notes and sometimes forget many things the doctor says, including the exact work restrictions or diagnoses. Workers can request a copy of their medical records from their insurance adjuster or from the health care provider itself. It may be helpful to review your own medical records so you have an in depth understanding of what your condition is, your timeline for recovery, and what type of medical treatment your doctor thinks you may need down the road.
10. Be willing to contact the IC and/or an attorney for advice or, if necessary, representation. In 10 steps, it is impossible to articulate all the complexities of the NC Workers’ Compensation Act or to explain what benefits you may be entitled to as a result of your work injury. Before accepting any settlement of benefits, be sure to talk to someone knowledgeable about the workers’ compensation system. The North Carolina Industrial Commission has a hotline available to injured workers – (800) 988-8349 – and our firm, Wallace & Graham, 704.633.5244 / 800.849.5291 is always willing to answer questions. You can also visit our Frequently Asked Questions (FAQ) regarding workers’ compensation injuries.