When we get a call from someone asking for assistance with their case we commonly ask if their case is accepted. The general response is “yes they are paying for my treatment.” Unfortunately, this does not mean your case is accepted or that a certain body part is accepted.
Just because an Insurance Company is paying for your medical treatment and paying your weekly benefits doesn’t mean you have an accepted claim. Insurance companies want injured workers to believe this but it is not always accurate. Do not be tricked by the insurance company because they Tell you your case is accepted or they are paying for treatment. Two main statutes control this!!
In Order to have an accepted claim an injured worker must have a Form 60 (G.S.97-18(b)) or a Form 63 section 1 (G.S.97-18(d)) once the 90 days has expired. Second, the body part or injury must be listed on the form. Not just one body part but all the body parts you need treatment on.
Insurance companies are attempting to get around injured worker accepted claims by not listing all the body parts or listing a very small body part/injury and later denying medical care if it becomes too expensive. This is dirty but is what we are seeing from Insurance companies in attempts to save them money.
Example: An injured work falls and hurts their back, head and both legs when a machine falls on them. The Injured worker files a Form 18 listing “back, head, both lower extremities.” The Insurance company files a Form 60 accepting the back. Despite this they pay for medical treatment for years on the both legs and knees. When a knee surgery is ordered they deny it and state it was not listed on the Form 60. Unfortunately, the insurance carrier will be allowed to force the injured worker to go to court to get the treatment they need.
If the Insurance company has told you your case is accepted and are denying you medical care, please contact us and speak with one of our board-certified workers compensation lawyers to discuss your claim. We can examine what forms are filed and help you determine if your claim is accepted.