If you’ve suffered a workplace injury in North Carolina, the North Carolina workers’ compensation system could pay for your most critical recovery expenses. However, navigating the claims process can feel challenging without legal experience.
In this guide, the Kornbluth Ginsberg Law Group, P.A., team will explain each step and share what you can do if your initial claim is denied or undervalued.
Contact the work-related injury lawyers at Kornbluth Ginsberg Law Group, P.A., now to find out how to file a workers’ compensation claim in Durham, NC. Our team is available 24/7 at 919-980-9895. We’re ready to put our century of decades of combined experience with workers’ compensation in NC to work for you.
Our office is conveniently located at 3400 Croasdaile Drive, Suite 300, Durham, NC. We can help you!
Step-by-Step Guide on How to File a Workers’ Comp Claim in Durham, NC
These steps cover the claims process for employees covered under the North Carolina Workers’ Compensation Act. Some groups, like federal employees and railroad workers, must seek compensation through a different process. Our lawyers can explain more about these exceptional cases if they apply to you.
Step 1: Report the Injury to Your Employer Immediately
North Carolina workers’ compensation law requires you to report workplace injuries to your employer within 30 days. It’s best to write an immediate report while the details are still fresh in your memory.
Include the following information:
- The nature of the injury
- The date, time, and location of the accident
- How the injury happened
- Names of witnesses who may have seen the injury
Even if your injury initially seems minor, you should still report it. Some injuries worsen with time, and with substantial documentation from the beginning, you’ll improve your odds of a positive outcome. If you wait to report your injury, the insurance company may have additional reasons to attempt to deny your rights to receive workers’ compensation benefits.
Step 2: Seek Medical Attention and Document the Injury
You should seek medical treatment as soon as possible after the workplace accident. North Carolina allows employers Nd insurance companies certain rights to choose the treating health provider for injured workers, so you might not be able to see your personal physician through the workers’ compensation system.
Protect your rights during treatment by following these tips:
- Describe in detail how the injury happened.
- Explain that your injury is work-related, and do not say anything that could indicate otherwise.
- Follow your prescribed treatment plan.
- Keep printed copies of your medical records, bills, prescriptions, and documented work restrictions.
The more medical documentation you keep, the stronger your claim for workers’ compensation benefits may be.
Step 3: File Form 18 with the North Carolina Industrial Commission
To start your workers’ compensation claim, you must file Form 18 (Notice of Accident to Employer and Claim of Employee) with the North Carolina Industrial Commission (NCIC).
The form asks for the following:
- Contact information for you and your employer
- Wage and employment information
- Details about your injury
You can submit workers’ comp Form 18 by fax, mail, or electronically. Keep a copy for your records, and send another copy to your employer.
Remember, it is best to file the Form 18 as soon as possible within 30 days of the accident date. If you wait to report your claim, the changes of the insurance company denying benefits may increase.
Step 4: The Employer Files Form 19
Once your employer knows about the accident, they are required to file a Form 19 (Employer’s Report of Employee’s Injury or Occupational Disease) with their insurance company. While this step isn’t your responsibility, you should still confirm that your employer has completed the form and obtain a copy for your records.
Step 5: Wait for a Response
Once you’ve filed Form 18 and your employer has filed Form 19, the workers’ compensation insurer should begin their investigation .However, this may not occur in a timely and fair way to the injured employee.
Follow these steps while your claim is getting underway:
- Keep all medical appointments.
- Continue to follow your doctor’s treatment plan.
- Keep records of all communications related to the claim.
- Continue to document how the injury affects your life and ability to work.
Insurance companies generally have 30 days from date of notice to accept or deny workers’ comp claims, but this often does not occur and the law does require certain amounts of limited time extensions.
Step 6: Appealing Denied Claims
If the insurer sends a denial letter and files a denial of your workers’ compensation claim, our lawyers can explain possible avenues for appeal to obtain the benefits you may be entitled to. We may need to gather additional evidence to address disputes or request appeal hearings through the NCIC. This frequently then results in a settlement conference, known as a mediation, within 120 days of the appeal being filed.
Workers’ compensation benefits may cover all necessary injury-related medical expenses, including doctor visits, medications, procedures, hospitalizations, and rehabilitation.
Benefits for lost wages depend on several factors which include the extent of your injury, impairment percentage, wages and work restrictions
- Temporary total disability (TTD) – If you’re temporarily unable to work, you can receive two-thirds of your average weekly wages up to a maximum amount. Benefits may end once you’re cleared to return to work by a physician and if there is a suitable job for you to return to if you still have work limitations.
- Temporary partial disability (TPD) – If you can return to restricted-duty work that pays less than your pre-injury job, you can receive two-thirds of the difference between your pre-injury average weekly wage and the wage you’re currently earning.
- Permanent partial disability (PPD) – You may be entitled to PPD benefits if the injury caused permanent disability to a specific body part. PPD benefits are two-thirds of your average weekly wage based on a calculation under North Carolina law that takes into account the percentage of impairment assigned by a qualified physician.
- Permanent total disability (PTD) – If you can no longer work in any job due to your injury, you may be entitled to receive two-thirds of your weekly wages up to the limit for 500 weeks. Some employees qualify for extended compensation if they still have no earning capacity whatsoever beyond the 500 week timeframe.
The facts of every injured worker’s case are unique, so there’s no fixed answer to how long it takes to receive workers’ comp benefits. However, there are legal requirements for employers and insurers to decide on claims within 30 days of notice and filing of the claim. This frequently does not occur, however. For approved claims, you should start receiving wage-replacement benefits that begin after you have missed more than 7 days from work. For accepted claims with authorized medical treatment, your treating medical providers will bill the insurer directly.
It’s not unusual for a workers’ compensation claim to get delayed. Insurers may ask for more exams or information, and employers may challenge how your injury happened or how it affects you. Our lawyers will fight to resolve these delays and protect our clients’ rights.
Unfortunately, workers’ compensation denials are common, but they don’t necessarily mean the end of your case. Many claims are denied wrongly contrary to the facts and law of the case.
Some common reasons why denials happen include:
- Disputes about the injury’s nature and cause
- Disputes over whether the worker was an employee
- Pre-existing conditions
- Inconsistent evidence
- Missed deadlines
Your appeal options may include the following:
- Mediation – In mediation, a neutral third party facilitates negotiations between your legal team and the insurance company. The goal is to push the workers’ compensation claim toward a resolution.
- Deputy Commissioner hearing – You can formally contest a denial with the North Carolina Industrial Commission (NCIC) by filing Form 33 (Request That Claim Be Assigned for Hearing). An NCIC Deputy Commissioner will hear evidence and witness testimony from both sides.
- Full Commission hearing – You can appeal a Deputy Commissioner’s decision by filing Form 44, which is a request for a hearing before the Full Commission of the NCIC.
- Further litigation – Decisions from the Full Commission are appealable to the North Carolina Court of Appeals.
