If you have sustained an at-work injury in North Carolina, workers’ comp insurance is likely available to you. However, the process of filing for workers’ comp is both complicated and fraught with restrictions. It is very common for employers or their insurance carriers to deny or reduce the amount of compensation at first, and both the initial claims process and the appeals process have to be accomplished in a very short time frame.
This comprehensive guide, provided to you by the work injury attorneys at Lewis & Keller, will walk you through the process of filing for workers’ comp in Winston-Salem so that you can be empowered and knowledgeable when filing for these benefits.
First Steps
As soon as you are aware of an injury, illness, or accident related to your work, you should apply first aid and seek medical treatment. This is important to ensure that the illness or injury will not get any worse.
If your employer has on-site medical treatment facilities, they may be able to provide you with the necessary forms to report your injury or illness to the workers’ compensation carrier. If not, you will need to obtain the appropriate forms from the North Carolina Industrial Commission and submit them to your employer and the carrier.
If you seek medical treatment from a provider outside of your employer’s network, you must inform your healthcare provider that your condition is work-related so that the medical costs will be billed through the appropriate channels as a workers’ compensation claim. Keep in mind that any medical bills you incur before your claim is approved may not be covered, so it is important to seek medical treatment as soon as possible and follow the proper reporting procedures.
Formally Notifying Your Employer
The most common reason given for denied workers’ compensation claims is that the employer or the insurance company was not informed quickly enough. Informing your employer of the problem right away will give them less opportunity to delay informing the insurance carrier by their specified deadline.
You should report your injury or illness to your supervisor, manager, or HR representative in writing or in person. Your notice should include the date and time of your injury or illness, a description of the incident, and any relevant details like the location of the incident and the names of any witnesses.
North Carolina workers’ compensation law requires you to provide your employer with written notice of the accident or injury within 30 days of its occurrence. If it is an illness or condition that has built up over time, such as hearing loss, repetitive motion injury, or exposure to a toxic substance, then the count begins on the date that you discovered the problem. The notice does not need to be long or complicated.
Make sure to keep a copy of this notice and some kind of documentation that shows when you sent it to your employer.
Claims, Denials, and Appeals
At any time after this written notice, but before two years pass, you will need to file a formal notice of your claim with the North Carolina Industrial Commission using the state’s Form 18, available at ic.nc.gov, and send a copy to your employer. You should keep a copy of this notice as well.
Unless the NCIC gives an extension, your employer must respond to this notice within 14 days of receiving it, with one of three other state forms: Form 60 acknowledges your right to compensation, Form 61 is a denial with an explanation, and Form 63 is an acknowledgment that can later be reversed to deny your claim.
Many claims are denied at first even though by law they should be covered, and you have the right to request a hearing and appeal the decision. From this point on, the process becomes complex enough that it is a good idea to seek legal help to increase your chances of winning the workers’ comp appeal.
Our experienced Winston-Salem workers’ injury attorneys can assess your case and advise you on how to proceed. If you have been hurt on the job in North Carolina and are planning to file for workers’ comp or considering appealing a denial, contact Lewis & Keller right away.
