Receiving Workers’ Compensation Benefits
How quickly the insurance company is moving through the process will determine how soon you will begin receiving workers’ compensation benefits. Generally, the first step an employer should take following being made aware of an employee’s work-related injury is to report the injury to their workers’ compensation insurance company. At that point, the insurance company should gather information from the employer about the reported injury and reach out to the injured employee.
The insurance company may request a recorded statement to gather additional information about the injury at work. They may request medical records in order to see a doctor’s opinion about the accident. These records may include any necessary medical treatment and if the injury resulted in any lost time from work and, in some instances, an insurance company may wish to see prior medical records. Prior medical records will help an insurance company to determine if the condition or injury is something for which you sought or received treatment for in the past.
The only thing that really sets any timeline or limit on how long this process will take is filing the claim for workers’ compensation benefits. Once the claim is filed by the individual by filing a Form 18 with the North Carolina Industrial Commission, it will generally take about two weeks for the North Carolina Industrial Commission to issue an acknowledgement letter. That letter will give the employer and the insurance company no more than 30 days within which to issue a formal response.
Should the insurance company fail to issue a formal response within 30 days, an attorney can assist the individual in filing a motion with the Industrial Commission to force a response. Generally, benefits only begin being provided once the response is filed by the insurance company. Their response will either admit liability, deny liability or agree to provide medical-only benefits on a conditional basis. If the insurance company denies benefits, that is going to prompt a hearing or a trial should the individual choose to pursue benefits.
This is why it’s highly recommended that an individual file their claim with the North Carolina Industrial Commission as soon as possible. This action is what sets the process in motion. Failure to do this immediately is only going to result in giving the insurance company more time to wait and see what happens before deciding how they wish to treat the case moving forward.
Caps On Receiving Or Collecting Workers’ Compensation Benefits
The duration of time you will receive workers’ compensation benefits depends on the type of benefits you are receiving. There are two types of benefits you can receive for a work related injury:
- Medical compensation
- Disability compensation
There are no time periods on how long an individual can receive medical compensation when an employer and insurance company have admitted liability for that case. As long as the individual is receiving treatment from their authorized doctor, at least one time very two years, they can continue receiving that medical benefit. If more than two year pass with no medical treatment, you run a risk of the employer insurance company alleging that medical treatment is now time-barred, however. The safest thing to do is to ensure you are seeking treatment for any ongoing issues from your authorized treating physician at least once every two years.
There are some limitations for receiving disability compensation following a work-related injury. There’s a cap of 500 weeks for temporary partial disability. Those are partial benefits based on a reduction in wages. The 500 weeks begins the first day that someone receives disability benefits. It’s important to note that these benefits aren’t based on how many weeks one receives the benefit. The 500 weeks begins and, even if you go back to work for a short period of time and then are out again for surgery relating to that injury, the 500 weeks runs the entire time. There are no credits or additional weeks offered just because the person goes back to work in between treatment.
There’s also a cap of 500 weeks for temporary total disability. Those are benefits when the injury prevents as individual’s return to work. However, once an individual has received 425 weeks’ worth of temporary total disability benefits, they are able to request extended benefits by requesting a hearing before the North Carolina Industrial Commission. That hearing can address the individual’s entitlement to temporary total disability benefits beyond that 500-week maximum amount. Based on the current cases that the North Carolina Industrial Commission has decided concerning extended benefits, they tend to focus on the individual’s complete inability to earn wages.
In order to argue for extended benefits, your physician is going to have to indicate that you can do no work. Alternatively, your physician can assign work restrictions and you can have an expert vocational specialist testify that, based on those restrictions, there are no available jobs. It’s a pretty high standard that the Industrial Commission is using for purposes of determining an individual’s entitlement to extended benefits.
Speaking with a board-certified workers’ compensation specialist can be essential to your case. A specialist will be able to advise you on the potential chances of receiving extended benefits based on the facts of your case. They can also advise you on any evidence or steps that may be necessary in order to offer evidence to prove your entitlement to extended benefits.
Workers’ Compensation Law For Injuries Outside Of The Workplace
As long as someone is injured in the course of their work, doing an activity to further benefit their employer, that individual could potentially pursue and receive workers’ compensation benefits for their injury even if they were injured outside of the workplace. For example, if an employee is asked to drive to the store and obtain a material for the employer and they get in a car accident in the course of that duty, they may still be covered by Workers’ Compensation Law as long as there was no deviation from their task, such as personal errands.
For more information on Receiving Workers’ Comp Benefits In NC, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling
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