Is my injury covered by Workers’ Comp?

How do I know if my injury should be covered by Workers’ Comp?  Whether your injury should be covered, or actually is covered, are two different questions. If the system worked the way it was supposed to, I wouldn’t have a job, and the insurance companies would do what they should in every case. But this isn’t fantasy land, it is real life.  Here are the type of injuries that SHOULD be covered by Workers’ Comp in North Carolina:

  1. Injuries by accident, arising out of and in the course of employment. If however, you are engaging in your “normal work routine” when you are injured, the injury may not be compensable.
  2. Back Injuries as a result of a specific traumatic incident are also considered compensable.
  3. Occupational Diseases are considered compensable.  NC Statute 97-53 sets out 27 specific diseases which are compensable.  In order to recover for an occupational disease claim, you must be diagnosed with a covered disease, and the disease must have been attributed to your employment.
There are many instances where a worker is injured in the normal scope of his or her employment, and thus has not suffered an “injury by accident“.  Oftentimes, in these cases the employer/insurance company will deny the claim.  However, it is important to review your medical records and determine whether you have also suffered an occupational disease or back injury as a result of a specific traumatic incident, in which case your claim may very well be compensable.
Any variation from the normal, regular work routine may be sufficient to constitute an “accident” at the workplace.  These cases can become very fact-intensive, and the only way to know for sure whether your claim is compensable is to consult a Workers’ Comp Attorney for an initial consultation.  Please feel free to call our office at 919-460-5422 if you have any questions regarding whether you have suffered a compensable claim.

Anatamy of a Workers’ Comp Case

If you have been injured on the job in North Carolina, you are probably scared (about your health and possibly loss of income/job security), nervous and a little uncertain of what the future will hold.  However, knowledge is power – so the more you know about how the process will unfold, the more confident you will become.  Here is a quick rundown (big picture stuff) of the Workers’ Comp process in North Carolina from A-Z…

  1. You are hurt in an accident at work.
  2.  If you haven’t already, you should immediately report the accident to your employer.
  3. Seek medical treatment for your injuries.  Your employer may have a doctor on-site, or they may direct you to a designated health care provider.
  4. Tell the medical services provider that your injury occurred at work, and give them the name of your employer so that the treatment can be billed as a Workers Comp claim.  (Give the doctor as much detail as possible about how the accident occurred, what it did to your body, what you felt/experienced at the time of and immediately after the accident, and any other details that are necessary for the doctor to adequately understand what happened to you and how it has affected your body.)
  5. Give written notice to your employer of the accident.  The law requires that this notice be given within 30 days of the accident.  It would be prudent to copy the notice and give it to several people, in addition to keeping a copy for your files and to give to your attorney (should you require one).
  6. You can use Form 18 to provide the notice in #5 to your employer.  A Form 18 must also be filed with the Industrial Commission within two years of the accident.
  7. Follow the instructions and restrictions provided by your doctor.
  8. Return to work – hopefully without being out for too long.
  9. In the event that your claim is denied, you should speak with a Workers’ Comp lawyer to help you decide what to do next.  You will probably have to request a hearing and will need the help of an attorney to do this.
  10. If you are out of work longer than 7 days, or get terminated as a result of the injury, you should speak with a lawyer about what to do.

Most people are cleared to return to work after only being out a couple of weeks.  However, if you have sustained a more serious injury that involves a complete or partial disability, then you may be out of work much longer than that.  Since Workers Comp benefits can go on indefinitely, the insurance company will do everything they can to cut off or limit the amount of those checks.  Many people are more than capable of handling their claim on their own – but as with everything in life, the more complicated the claim, serious the injury, or difficult the adjuster is being, the more likely you are to need an attorney to help you.

 

Injured at Work in NC – Here’s what you do

One of the scariest things that can happen to a worker who depends on their hourly wage to support their family is to get injured and be unable to work.  If you live in North Carolina, and you are injured on the job, than you will be covered under the Workers Comp statutes.  In North Carolina, Workers Comp is administered by the NC Industrial Commission, which has provided similar guidelines in the even you are injured on their webpage.

The steps you take in your first few hours and days after your injury are important, and if you don’t take the right steps, the insurance company is going to do everything it can to deny your claim or cut off your benefits.  If you don’t properly document and report your accident, you will be facing an uphill battle from the very beginning of your case.  So here are some things that you need to do when you are injured on the job in North Carolina:

  1. Report your accident as soon as it happens.  I know this sounds like common sense, but many people fail to take this critical step, and keep working as if nothing happened.  Maybe it is because you don’t want to “ruffle any feathers” with your boss, or perhaps you don’t want to look weak to the other employees.  But this is extremely important.  As soon as you have been in an accident, you absolutely must report it to your supervisor.  The law says you have 30 days to report your accident, but insurance companies will routinely deny claims where the worker waited until after the weekend to report it.
  2. Remember that your employer is not a lawyer.  Often, employers will try to give you “helpful” advice, such as – you can’t bring this claim because you didn’t report it immediately.  They may also ask you to rest a little while, and then see how you feel.  While helpful, this advice will hurt your claim.  So just remember that anything your employer tells you is probably wrong from a legal standpoint, and is very likely to hurt your claim.
  3. Report your accident to the right people.  Don’t just tell a co-worker.  Don’t just tell your supervisor.  Tell everyone you can.  Tell your supervisor and your human resources officer or safety officer.  Write down what happened to you and who was with you when it happened.  Make sure your supervisor makes a written report and gives you a copy.  Be as accurate and specific as possible in the report and include as much detail as you can.
  4. Get information from your co-workers that were with you.  Get their names and telephone numbers.  See if they will write you a quick paragraph about what they saw.  Be nonchalant about it – most co-workers will be happy to help.  Later on when the insurance company instructs your supervisor to tell them to stop talking to you, then the fact that you already have their statement will be extremely helpful.
  5. Go see a doctor.  Your employer may have a doctor that they want you to see, or you may be able to pick one on your own.  Regardless, when you see the doctor, explain to them in detail what happened to you and how it has affected you.  Be sure to tell the doctor that your accident occurred on the job – you would be surprised how often this fact gets left out.  Ask for a copy of your medical records so that you can review the doctor’s narrative and make any corrections if necessary.
  6. File a Form 18.  Don’t rely on your employer to do this for you – make sure you complete this form and file it yourself.  You can download a copy of Form 18 here.  If you have questions or need help completing and filing the form, let us know.  We would be happy to assist you with this without charge or obligation that you hire us.  If you do it yourself, send it by fax and keep a copy of the fax confirmation sheet showing that it was received.

Bottom line – dealing with the insurance company can be difficult enough, even when you do everything right.  Don’t put yourself at a further disadvantage – make sure you properly report and document your workplace injury as soon as it happens.

As always, if you have any questions along the process, please feel free to call The Hart Law Firm at (919) 460-5422 or fill out our contact form.