Health Care

Following my recorded statement, the adjuster now says I was not injured at work

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Following my recorded statement, the adjuster now says I was not injured at work

The information provided in a recorded statement can be critical in terms of the further benefits the employer or workers’ compensation insurance carrier may agree to provide for the work injury. Any time the employer or workers’ compensation insurance carrier is requesting a recorded statement as part of their investigation of the workers’ compensation claim I advise injured workers to consult with an attorney prior to providing the recorded statement. The attorney can provide the injured worker with an overview of the type information that will likely be requested as part of the recorded statement, so the injured worker is prepared to provide the requested information. Additionally, the attorney can advise the injured workers about what information is critical to address as part of the recorded statement in order to make sure the employer or workers’ compensation insurance carrier has all of the information they need in order to make a determine about their possible agreement to provide ongoing benefits for the injury at work.

In short, my opinion is that an injured worker always needs to at least talk with an attorney, even if they do not plan to hire an attorney, prior to providing a recorded statement to employer or workers’ compensation insurance carrier.

Second, in terms of why an adjuster may claim an injured worker was not injured at work following the injured worker’s recorded statement. This statement from the adjuster may be based on the adjuster now claiming that there was not an accident which caused the work injury based on the information provided as part of the recorded statement. In N.C. if an injured worker is claiming that there was a specific incident at work which caused their work injury, there must be evidence that there was an accident which cause the injury at work. Under our N.C. workers’ compensation law an accident is defined as an interruption in the normal work routine, an unlooked for or unexpected event, which resulted in the injury at work.

If there as a specific incident that resulted in the injury at work, it is not enough just to show that there was an injury at work, there must be evidence that there was an accident which caused the injury at work. The example I often times offer is if my job is to stock the shelves for the grocery store I work at and on a particular day as I am lifting the products to stock the shelves, I feel a pop in my shoulder and then a Doctor diagnoses a rotator cuff tear to my shoulder as a result of this incident at work, places me out of work as a result of this incident at work and recommends surgery for my shoulder as the result of this incident at work. There is no question I injured my shoulder due to the incident at work, I cannot work as a result of the incident at work and I need surgery for my shoulder as the result of the incident at work. However, the incident at work does not meet the definition of an accident under the N.C. worker’s compensation law because this incident was not an interruption of my normal work routine or an unlooked for or unexpected event, it just so happened as I was performing my normal job that I was injured as a result of these activities.

Although this would appear to be unfair because there was no question that I was injured while performing my job, the fact that I was simply performing my normal work routine when I was injured without there being any unlooked for or unexpected events which caused my injuries means the incident at work does not meet the definition of an accident, qualifying me for workers’ compensation benefits.

Now, assume I was stocking the shelves for my employer as part of my normal work routine, but as I was place an item on one of the shelves I knocked over another items and in order to prevent the item from falling to the ground I reached out to catch this falling items and in doing so I heard the same pop to my shoulder, under this set of facts I would be able to argue that an accident occurred leading to my entitlement to benefits due to the incident at work.

As you can see from this example the possible entitlement to benefits due to the injury at work can often time hinge solely on how exactly how the incident at work occurred. This example highlights the need to accurately describe how the incident at work occurred in order to be able to provide accurate information concerning whether or not the incident at work meets the definition of an accident under our N.C. workers’ compensation law.

Once again for these reasons I always recommend that an injured worker speak with an attorney prior to providing a recorded statement to an employer or workers’ compensation insurance carrier as part of their investigation of the work injury.

Third, in terms of why an adjuster may claim an injured worker was not injured at work following the injured worker’s recorded statement, there may be some evidence shared by the injured work as part of the recorded statement or obtained by the adjuster following the recorded statement, for which the adjuster feels shows evidence of a pre-existing injury. In this instance the adjuster may not be contesting whether or not there was an injury at work, but instead may be allege that the injury at work is the cause for the need for medical treatment or resulting time out of work. In this instance the adjuster may be alleging the need for medical treatment and resulting time out of work is due to the pre-existing condition vs. the injury at work.

Lastly, in terms of why an adjuster may claim an injured worker was not injured at work following the injured worker’s recorded statement, this may be based on evidence obtained from the employer wherein a co-worker or some at the employer alleges the incident at work did not occur as the injured work described in the recorded statement.

Under any of these circumstances if the adjuster now claims that an injured worker was not injured at work following the injured worker’s recorded statement, the injured worker needs to speak with an attorney about the legal rights the injured worker has in terms of pursuing further benefits regarding the injury at work. If this ever occurs in your workers’ compensation claim, please feel free to contact Cardinal Law Partners so that you can speak with one of our board certified workers’ compensation specialists in order to discuss your legal right and any actions we may be able to assist in obtaining any possible benefits which may be owed for your injury at work.

Disclaimer: This content is prepared for informational purposes only and should not be construed as legal advice.