Like many other states, North Carolina has a structured process for how a work injury should be addressed. Workers compensation is available to help address an injured employee’s medical costs, but the employee needs to follow the process correctly. Many employers and their HR offices also don’t always understand the process well and frequently misapply the rules, creating resistance and a denial that isn’t necessary or usually allowed. This happens frequently with turnover, following an older process that hasn’t been updated for new legal changes, or carelessness. It’s due to all these reasons as well as others not clearly apparent at the time, that anyone injured at work should get help from a premier worker’s comp lawyer in North Carolina when starting a claim.
Getting Started – Employer Notification
Professional medical attention should always be obtained before doing anything else. Don’t shirk off being seen by a doctor, especially if you’ve suffered a fall, trauma, impact, or been exposed to a chemical in some form. Many times, any of these issues can trigger results and physical reactions hours or days after the fact. Seeing a physician right away can catch concerns and have them documented as soon as possible. Further, the records are created and finalized by a licensed physician versus just the employee’s personal notes or memory, holding far more weight and authority after the fact.
State law requires an injured employee to notify their employer of being hurt or becoming sick at work or due to work as soon as possible. The notice needs to be in writing to the supervisor, not verbal, and it needs to have been made within 30 days of the start of the issue. This triggers the employer’s responsibility.
Upon notice of a work-related injury or sickness, the employer is required to immediately fill out a Form 19-Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission. A copy is then provided to the impacted employee as well as a blank copy of Form 18 – Notice of Accident to Employer and Claim of Employee, Representative, or Dependent. The key point here is that the employee has to initiate the notice as well a file the actual claim; an employer is not required to file the claim for the worker in North Carolina, even if notified.
Complete the Forms Correctly
Form 18 is the primary document the employee needs to address, fill out, and then file with the North Carolina Industrial Commission, or NCIC. A copy also needs to be sent to the person’s employer as well as/or their insurance carrier for medical costs. Always keep a copy for your own records as an employee. There is a time clock on the filing of Form 18; employees have a limit of two years to file this paperwork, but most experts recommend submitting it within 30 days of the injury or sickness. Delaying and taking longer increases the chances of a claim denial.
Note, if the injury involves a type of lung disease such as asbestosis, byssinosis or silicosis, Form 18B – Claim by Employee, Representative or Dependent for Benefits for Lung Disease should be used instead of the above.
The NCIC can take the forms digitally as well, emailed to their office at [email protected]. Again, having an attorney look over the paperwork before submitting it is strongly advised.
Once notified, the employer has paperwork to take care of as well. Within 30 days, the affected employer is responsible for sending the employee a response. That can be in one of three forms: 1) Form 60 – Employer’s Admission of Employee’s Rights to Compensation, Form 63 – Notice to Employee of Payment Without Prejudice, or Form 61 – Denial of NC Workers’ Compensation Claims. The last one is the most problematic. Without a follow-up, Form 61 will effectively close an employee’s claim for coverage.
Responding to a Denied Claim
If denied, the employee needs to then file Form 33 – Request That Claim Be Assigned for Hearing, and send it to the NCIC. This document triggers a regulatory review. The NCIC takes over the matter and determines whether the employer was correct or not in their denial. If found in favor of the employee, the NCIC will order the employer and their insurance provider to provide medical coverage. Where the employer disputes the matter, the NCIC will then schedule a formal hearing.
The NCIC tries to resolve cases through mediation prior to having the formal hearing. The mediator will work with both parties to probe if there’s any room for working to a resolution for the claim. If not, then the formal hearing is presented in front of an NCIC Deputy Commissioner.
From the formal hearing, if the employee is denied, an appeal can be made to the full NCIC Commissioners panel. The last two avenues of appeal from this level would be the traditional North Carolina Court of Appeals and finally, the state Supreme Court. These last two options are only used in very significant policy cases or egregious behavior. It’s extremely rare that a typical workers’ compensation case falls into this scenario. Most cases meet their final decision at the NCIC formal hearing.
Relying on the Help of a NC Workers Compensation Attorney
There is no question that an experienced workers’ compensation attorney can make a big difference to the potential success of a claim. While the process doesn’t follow a traditional lawsuit format, a workers’ compensation attorney can provide a considerable amount of guidance, help in preparing forms correctly, identifying mistakes by an employer to notice, and assist in making the best argument possible for a formal hearing review. Going into the workers’ compensation process without a qualified attorney’s help is taking a big chance for mistakes and having a claim denied both by an employer as well as the NCIC. And that can be a huge problem given the cost of healthcare today. Don’t be a statistic. Bring in the needed help as soon as possible.
