Health Care

The Timeline of A Workers’ Compensation Claim

Unfortunately, one of the most frustrating aspects of Workers’ Compensation cases is the length of the process. In some ways, this is just based on how the process has been built. In other situations, case resolution may take a long time because of actions taken by the employer and their insurance provider.

In any case, understanding the timeline of Workers’ Compensation cases in North Carolina can provide valuable insight before you begin the process…

1.) You file a claim for benefits by submitting Form 18 to the North Carolina Industrial Commission.

2.) After about two weeks, the North Carolina Industrial Commission will send out an Acknowledgement Letter. This letter will go to your employer and their insurance company, and it explains that an employee has filed for Workers’ Compensation benefits.

3.) After they have received the Acknowledgement Letter, your employer and their insurance provider will have no more than 30 days from the date of the letter to respond.

(Of course, your attorney can contact your employer’s insurance provider in an attempt to get a response before the 30-day period. However, you can see how the initial process already allows for some significant delays.)

If your case is denied, the trial process will typically take about a year from start to finish.

1.) If a claim is denied and trial is requested, the North Carolina Industrial Commission will allow up to 120 days to complete mediation. In some situations, insurance companies will wait as long as possible to conduct that mediation. If the case is not resolved at mediation, the date is set for a trial.

2.) About two months following the date of mediation, the first stage of the trial will occur within which the employer and injured employee will testify. No doctors testify at this point in the trial.

3.) The parties are then given 60 days within which to get the testimony of any physicians who are providing treatment to the injured employee.

4.) When the medical testimony has been obtained, the parties are given 30 days to file their written arguments.

5.) Once the written arguments are submitted, the North Carolina Industrial Commission has up to 6 months to issue a decision.

Unfortunately, these cases don’t have an immediate decision from the North Carolina Industrial Commission, as you would see from a judge or jury for  personal injury claims. Instead, you can see how the structure of the process creates a timeline that results in incredibly drawn-out case resolutions.

Some of the most common delays that occur don’t have to do specifically with the process of Workers’ Compensation claims, but instead with the manner in which these claims are handled by your employer’s insurance provider.

Other delays can occur because:

Insurance companies count on you to get tired of calling.

If you don’t have an attorney, an insurance company may “promise to get back to you” with no intention of doing so. Sometimes, claimants will be promised checks and treatment, only to have their claim ultimately ignored by an insurance provider that knows that some people will stop following up. In these cases, the insurance companies use your fatigue to their advantage.

Insurance companies file forms as a stall tactic.

Your employer’s insurance company may file forms that create delays. One of these is called a Form 63, and it is used for “payment without prejudice”. This allows the insurance company to pay for only a few medical bills and wait to see how the case progresses.

Insurance companies sometimes do this with the hope that the medical treatment will be inexpensive. This allows them to perform a cost-benefit analysis as it pertains to whether or not they will accept liability for the claim down the road. The problem with this is that it draws out your case by halting it in its tracks. If your claim hasn’t been accepted or denied, you can find yourself waiting for an answer for months. It’s common in these situations that it’s not until surgery is required, or you are prevented from going back to work that an insurance company will accept or deny liability for the claim.

This can create quite a bit of difficulty if you are seeking benefits, especially because most people who receive payment for medical treatment will assume that their case has been accepted. In reality, this strategy puts you in a holding pattern without any promises regarding future medical treatment or disability benefits.

In this case, if you are denied benefits later on when you need surgery, etc., you can face a yearlong trial process in the middle of your treatment. This is another reason why an attorney plays such a vital role.

By forcing timely responses and proper filings, your attorney can help you to get a case determination as quickly as possible. This way, you don’t find yourself back at the beginning of your case months down the line.

For more information Timeline of A Workers’ Compensation Claim In NC, 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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