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Workers’ Compensation Guide

Workers’ Compensation Guide
By David Inabinett, Attorney
  1. Notify employer of work injury

A. Submit a written accident report to your employer no later than 30 days from the date of the accident.

B. If unable to complete the written report, notify the employer verbally and complete the written report as soon as possible.

C. Be sure to give as much detail as possible about the injury like what you were doing, where you were working, tools being used, who you were working with, supervisor’s name, if machinery malfunctioned, etc.

D. Make sure to tell your employer the names of all witnesses to your injury to ensure the witnesses are asked to complete a written witness statement about what they saw/heard happen, along with their full names and addresses.

E. Try to take your own pictures of the place of accident/injury (if you are able).  If not ask your employer (or a fellow employee) to take photos of the injury and the accident scene.  IMPORTANT:  Specifically make note if any employer-owned machinery or tools were defective, which led to the accident. 

2. Seek treatment immediately

A. Have your employer implement immediate first aid; seek immediate emergency care as needed. 

B. If you need further medical care, ask your employer which doctor you should see.

  • Most employers will have a list of medical providers that are approved by their workers’ compensation insurance carrier.
  •  Most employers will require that you seek treatment at these approved providers for urgent care, ortho, etc.  If you do not, then the workers’ compensation insurance carrier will likely not pay for these medical costs.

C. Seek outside treatment only if necessary or your employer does not respond to your request to see their doctor.

  • You may seek treatment elsewhere, but you could run into denial of payment for outside medical treatment if your employer told you to go to a doctor on your employer’s approved list.
  • If your employer does not have a recommended list of medical providers or an in-house employer physician, you may seek treatment at any provider of your choice.

3. Notify the NC Industrial Commission of the work injury

A. You, the employee, are responsible to completely fill out the NCIC Form 18 (Notice of Accident) and to file it with the Commission.  Occasionally the employer or its workers’ compensation insurance carrier may give you a blank Form 18 to use.  But you, the employee, usually must get a copy yourself and fill it out on your own.

B. A claim must be filed with the Commission no later than 2 years from the original date of injury, otherwise, you will be barred from any payment of medical bills or other covered losses

4. Speaking with the Workers’ Compensation Insurance Carrier for the first time

A. Give details of the accident and any other pertinent information when contacted by a representative of the workers’ compensation insurance carrier.

B. You may be asked to provide a recorded statement of how the accident happened.  If you wish to talk to a workers’ compensation attorney first, we suggest you respectfully tell the workers’ compensation insurance carrier’s representative that you do not want to give a recorded statement until after you have had the chance to talk to a workers’ compensation attorney.

C. If you choose to give a statement before talking with a workers’ compensation attorney, do your best to be clear and state exactly what happened.

D. Almost all accidents “on the job” are covered by workers’ compensation insurance, but not all of them.  If you want to be sure about coverage on your claim before giving a recorded statement, respectfully tell the workers’ compensation insurance carrier’s representative that you do not want to give a recorded statement until after you have had the chance to talk to a workers’ compensation attorney.

E. Do not worry about who was at fault for your injury.  Workers’ compensation is a NO FAULT insurance coverage.  If you are hurt “on the job,” chances are that you will have a good claim for workers’ compensation insurance coverage (but there are some exceptions – talk to a workers’ compensation attorney to be sure).

5. Document treatment related to your workplace injury 

A. Keep track of your mileage to and from your providers that are 10 or more miles away from your residence.  You are entitled to be paid directly by the workers’ compensation insurance carrier for all eligible mileage to and from workers’ compensation medical providers. 

B. Make note of the Practice name and your treating physician and keep up with each date of service (especially for mileage reasons, if applicable).

C. Maintain a running list of all prescribed medicine related to the workplace injury.  Submit all receipts to the workers’ compensation insurance carrier for reimbursement (unless the workers’ compensation insurance carrier has made arrangements to pay a pharmacy directly).

D. If your treating provider refers you to a specialist or to physical/occupational therapy, to include work hardening, diagnostic imaging or other testing, or impairment ratings, follow through with each referral.

E. Attend all appointments scheduled.  Missed appointments or failure to follow your treating provider’s recommendations could result in a termination of benefits.

F. Attend and comply with any Independent Medical Exam (IME) scheduled by the workers’ compensation insurance carrier or its attorney.

6. Missed work due to treatment

A. Make note of any time at work that is missed due to the workplace injury.  You may be entitled to wage loss benefits.

b. Submit all work releases (out of work notes, restricted duty notes) from your treating providers to your employer and the workers’ compensation insurance carrier.  Keep a copy for your records, too.

C. There is a 7-day waiting period for any lost wages.  If you are out of work longer than a total of 14 days, you will be paid for the initial 7-day waiting period.

D. Out of work payments (“indemnity benefits” or “weekly check”) from the workers’ compensation insurance carrier are generally two-thirds of your average total weekly pay (before taxes) BEFORE the date of your injury.  This includes overtime, bonuses, and other taxable income on your W-2.

7. Return to work

A. If you are released to work in a limited capacity or with “restrictions,” your employer is first required to “offer” you work within your restrictions IF your employer has “that kind of work” available. 

B. If your employer has no work within your restrictions, it is your responsibility to find work within your restrictions.  While you are looking for work within your restrictions, it is the responsibility of the workers’ compensation insurance carrier to continued weekly workers’ compensation checks.  If you fail to try to find work, the workers’ compensation insurance carrier could apply to have your weekly checks stopped.

C. Cooperate with all vocational rehabilitation offered by the insurance carrier.  This cooperation is viewed as “trying to find work.”  Even if you are unsuccessful at finding work, you still need to try (NOT being able to find a job within your restrictions is good evidence that your injury is preventing you from getting any work – again, a good argument that you are still unable to work and should continue to receive the weekly checks).

  • Once you return to work (either at your old job or a new one), making what you made before your work injury, your weekly checks will stop.  Restarting those checks is hard.  So, before you start at a job, please seek advice from an attorney.
  • If you return to work, and you are unable to do the job you are assigned, you have the right within 45 days to be seen by your workers’ compensation doctor for an opinion on whether you can do that (or any other) job.  If your workers’ compensation doctor pulls you out of work again, the workers’ compensation insurance carrier is supposed to start up your weekly check again. 

This guide is for general informational purposes only and should not be considered or relied upon as a substitute for personal legal advice because every case is different.

If you would like to schedule an appointment with an attorney to discuss workers’ compensation, please call us at (336) 249-2101 or contact us online.

1 Comment

  1. What is the time line if a settlement was offered to you and due to other medical reasons you weren’t able to follow up?

    Reply

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