Missing time from work due to an injury can cause financial difficulties for you and your family.
Thankfully, North Carolina law mandates that your employer purchase workers’ compensation insurance to support you when you have suffered a work-related injury. However, the legal process to claim and receive these benefits is not always easy, nor is it dealing with a for-profit insurance company. The Wilmington workers’ compensation lawyers at Horton & Mendez Injury Attorneys help claimants through the workers’ compensation claims process.
Overview of Workers’ Compensation in North Carolina
Under North Carolina law, employers with three or more employees are required to purchase workers’ compensation insurance coverage. Alternatively, they can qualify to self-insure against employee injuries and illnesses suffered on the job.
If an employer does not purchase workers’ compensation insurance, they can be charged with a criminal offense, which can even be a felony under certain circumstances. In addition, the North Carolina Industrial Commission (NCIC) can also fine these employers. You may be able to file a personal injury lawsuit against an employer if they do not have workers’ compensation insurance. Usually, you are not allowed to sue an employer, workers’ compensation is your exclusive remedy. In those situations where you are able to file a personal injury lawsuit, you may be able to receive more compensation.
How To File a Workers’ Compensation Claim
The first step in the workers’ compensation claims process is notifying your employer of your injury. You must give your employer written notice within thirty days of the injury or risk losing the right to claim workers’ compensation benefits altogether.
Under North Carolina law, your employer has a legal right to select the doctor who provides your treatment. When you are unable to work as you were before your injury or illness, you could then file a workers’ compensation claim to seek both medical care and a portion of your lost wages.
You begin the workers’ compensation claims process by filing Form 18 with the North Carolina Industrial Commission. The NCIC forwards the claim to both your employer and their insurance company. Once the insurance company has received the claim, they review and reach a decision about whether to grant or deny benefits.
You have two years from the date of injury or illness to file your workers’ compensation claim. In reality, there is no reason to wait this long—you need the money that you would receive as part of your claim.
What Workers’ Compensation Benefits You May Receive
If your claim is granted, you would receive a portion of the economic losses you sustained after a work-related injury or illness. Your benefits include reasonable medical expenses to treat your injuries as well as two-thirds of the wages you were earning before your injury, up to the amount of a statutory cap. If you need to learn a new job, the insurance company would also need to cover the cost of vocational training.
Common Challenges in the Claims Process
Insurance companies have a large say in the decision about whether you receive benefits. They are the gatekeeper who makes the initial determination when you file your claim. Insurance companies are the ones who must cover the cost of your claim, so they have an incentive to make your life more difficult. They may deny your claim for a number of reasons, forcing you to fight back through the appeals process.
You may encounter a number of challenges in the claims process, including:
- Proving that your injury was related to your job
- Defending yourself against allegations that you acted intentionally
- Showing that you are disabled and unable to work fully
- Demonstrating that your condition was not pre-existing (although you can be compensated for aggravating a pre-existing injury)
The insurance company does not have the last word in the workers’ compensation claims process. Their decisions are subject to review by the NCIC. You can file an appeal of an adverse decision, whether it is the denial of your claim, a low disability rating, or a decision to force you back to your job before you are fully healed.
Legal Support for Workers’ Compensation Claims
You may seek the help of a workers’ compensation attorney at various points in the claims process. If you have a complex claim, you should consider hiring a lawyer at the early stages.
Your attorney will prepare the claim on your behalf, including evidence that could show you suffered a work-related injury and establish your entitlement to benefits.
You may also consider retaining a lawyer at other parts of the workers’ compensation claims process, including:
- When you have difficulty with the insurance company refusing to pay for your medical care
- Being ordered to return to work before you are healed
- Receiving a lower disability rating after an examination from a so-called independent doctor
- Negotiating a workers’ compensation settlement that will pay you a lump sum
- Appealing a wrongful denial of your claim
Workers’ compensation claims present legal issues at an already difficult time in your life. Often, you are unable to deal with the details when you have been injured. Further, you may not have the wherewithal to go up against an insurance company that does not want to pay you.
Contact a North Carolina Workers’ Compensation Attorney Today
The attorneys at Horton & Mendez advocate for clients at every step of the workers’ compensation process. We ensure that you are well-informed of your rights under the law and that insurance companies are not able to compromise those rights. Our attorneys can stand up for you anytime you receive an adverse decision from the insurance company or when you need to negotiate a workers’ compensation settlement. To set up a free initial consultation with an experienced workers’ compensation attorney, you can reach out to us online or call us today at 910-405-7751.
