Health Care

Filing A Claim For Worker’s Compensation Benefits

A Workers’ Compensation Benefit Claim is started by submitting Form 18 to the North Carolina Industrial Commission.

Note: To properly “file a claim”, it is not enough to tell your employer about your injury, submit Form 18 to your employer, or email Form 18 to your insurance company.

To properly file a claim, you must submit the form to the North Carolina Industrial Commission within two years of the date of your injury. Failure to file the form with the North Carolina Industrial Commission within two years of the date of your injury can result in the expiration of your claim.

Anytime that an injury has occurred, I recommend that folks reach out to that attorney to talk about the facts of their case. This way, you can prepare for your recorded statement and have an attorney on the case to file the claim for benefits on your behalf as soon as possible. In doing this, there’s almost never a risk of running afoul of the 2-year Statute of Limitations.

Talking To Your Doctor After A Workplace Injury

If you need medical treatment for your injury, you may wonder about what type of information is safe to share with your doctor.  After all, many people are afraid that talking about any preexisting condition could lead to the denial of their Workers’ Compensation claim.

There are a couple of things to keep in mind here…

  • Anytime someone sees a doctor, the doctor will generate a medical report containing details of the visit. And each time a report is generated, believe it or not, anything you tell that doctor may be included in that report.
  • There are instances in Workers’ Compensation cases where a nurse is assigned by the employer’s insurance company. And in some situations, this nurse is not allowed to go into an appointment with you. This is the case when you are entitled to a “private examination”.
  • A “private examination” only means that the employer-appointed nurse is not present. It is not private in the sense that the information you share with the doctor during this visit is “off the record”.

Therefore, it’s important that you are comfortable with anything you share with the doctor to be passed on to your employer’s insurance company later down the line. This is because the information may show up on a report that is generated by the medical provider.

If you’re concerned about how your personal information may be passed down in these cases, your best option is to speak with an attorney. Your attorney is bound by law to be a confidential resource to you. This way, you can discuss your concerns openly without fear of the information impacting your case. Your attorney can advise you regarding what information you should share with a doctor and what information you can choose to keep confidential.

The most important aspect in any of these situations is to ensure that you receive the care that you need while preserving the greatest value of your claim. So speaking to an attorney can provide you with the best insight as you approach your private examination with a medical professional.

How to Handle Denials

In some cases, you will see employers and insurance companies respond to your claim filing with a denial of benefits. In essence, this means that they’re disputing your entitlement to any workers’ compensation benefits.

In these situations, you may see that your employer is not contesting that you were injured at work. But rather that they are indicating the way in which you were injured does not qualify as an accident.

This goes back to a core principle of the way that Workers’ Compensation cases are handled: that an injury must occur due to an accident for it to produce a valid claim. If you were injured at work, but the injury was not caused due to an accident, it’s not at all unlikely that you would be denied benefits.

In other instances, you may see a denial as part of the investigation of your claim. During the investigation, an employer and insurance company may request prior medical records in search of a preexisting injury.  If your medical records show that you may have been having  issues with this same body part already, they may deny your claim. This is because they will have reason to believe that, yes, an accident did happen at work, but that your injury was not caused by that accident.

In yet one other scenario, a claim may be denied if your employer and their insurance provider look at their database and find that another accident occurred at some point in the past. If they find evidence that your injuries may have occurred due to another set of circumstances, they may deny your claim on the basis that the current condition or injury was not caused by the accident at work.

All of these situations are crucial to discuss with your attorney. Whether a prior work accident occurred or you have a preexisting condition won’t necessarily rule out your entitlement to benefits. However, your attorney needs this vital information so that your attorney can advise you how to handle this situation for the present workers’ compensation claim.

Occupational Diseases

We’ve talked about “injuries by accident” as a way of pursuing a workers’ compensation claim. But there is another way of pursuing a claim by what is known as an occupational disease.

In occupational disease claims, there is not a specific date of injury. Rather, injury occurs due to the repetitive, ongoing nature of the work.

With these claims, there is a heightened amount of emphasis on  the doctor’s testimony.  This is because when filing an occupational disease claim, you must show that your job poses an increased risk of developing the condition you have been diagnosed with. Additionally, this condition cannot be a disease that would ordinarily occur on its own. Instead, you need to show that it was brought on by conditions particular to your occupation.

What’s more, there has to be some evidence from the doctor that your job not only created the risk of developing this condition, but that, in your individual circumstances, the risk is what actually caused your condition.

In other words, when filing an occupational disease claim, it’s vital to show that your job activities directly caused the condition you suffer from.

For more information Filing A Claim For Worker’s Compensation Benefits, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (833)444-4127 today.

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