How long it takes to get a workers’ compensation check depends on many factors. What has the communication been between the employer and insurance carrier? Does the insurance carrier have all the information they need? Are they even willing to issue a check? Is the adjuster too busy to call you back?
If there are no hurdles for you to overcome, you could receive benefits not long after you file the claim. However, sometimes it can be extremely difficult to simply get the benefits you are entitled to.
It may seem like the employer and insurance company are intentionally trying to delay benefits or are playing games. That sometimes happens. Having an attorney involved even at that stage can make things go much smoother.
The Clock Begins Once You Report the Injury to Your Employer
When you become entitled to benefits and when you receive those benefits can be two separate questions.
You should report the injury to your employer as soon as it happens. The more time that goes by between the injury and the reporting of the injury, the more questions the insurance company will have about the injury. Reporting the injury within 30-days is highly recommended. If you have not made the report within 30-days you will want to consult with an attorney about what impact that will have on your claim.
Be sure to make the report in writing. It can be helpful to have documentation showing that you suffered an injury and that it happened at work. At the same time, you should get a prompt medical evaluation.
Once you report your injury to your employer, they have five days to fill out a form to report the injury to either the North Carolina Industrial Commission or the insurance company. After that, the insurance company will have 14 days to notify you whether your claim has been accepted or denied.
You cannot begin to receive workers’ compensation until you have missed at least 7 days of work. However, if you are out of work for at least 21 days, you can receive payment for those first 7 days as part of your next payment.
The insurance company will begin to pay benefits (both medical and lost wages) as soon as your claim is accepted, except for the first 7 days of missed work.
What You Can Do to Move Your Claim Along
Some of the steps necessary to receive benefits are in your control and by promptly taking these steps you can help your claim move through the claims process.
You control when:
- You report the injury to your employer.
- You get the medical diagnosis necessary to support your claim.
- You file the claim with the insurance company.
You should consult with an attorney about these steps to make sure you report the injury adequately enough for the insurance carrier to have the information they need to know you had a worker place injury and that you are entitled to benefits.
An Appeal Means Your Claim Will Take Longer
But, there are opportunities along the way to reach a conclusion without going all the way through the lengthy appeals process.
The timing of your check is different when the insurance company denies your initial claim. With a denied claim (you should receive a Form 61 formally denying the claim), you would be forced to go through the appeals process. Your lawyer could help you receive benefits more quickly if they can speak with the insurance company and resolve any misunderstanding that caused them to deny your claim, as is sometimes the case.
If you must appeal the denial of your claim, you would need to go through the North Carolina Industrial Commission. The good news is that you would get an objective hearing from someone who does not have a financial interest in the outcome of your claim.
The bad news is that an appeal will delay the start date for your benefits, assuming that you win your appeal. (If you win, your benefits are backdated, and you will not lose anything because of the denial).
Before you get to the hearing stage, you are required to attend a mediation. At mediation, your lawyer would talk directly to the insurance company and their lawyers. A neutral mediator without any interest in the case would work to help the parties reach some kind of agreement that resolves the issues in dispute. Sometimes, but not always, mediation ends with a lump sum monetary settlement of the claim.
Some claims settle at mediation. Some claims do not. It depends on the issues in your case and whether it is appropriate to settle a claim at that stage.
A Hearing Will Add More Time to the Process
Sometimes, three or more months after mediation.
If you do not reach a settlement at mediation, your claim would likely proceed to a hearing in front of a Deputy Commissioner at the Industrial Commission. Deputy Commissioners are administrative law judges that decide disputed issues in workers’ compensation claims.
These hearings are like any other courtroom proceeding, so you need to be prepared with witnesses and evidence to support your workers’ compensation claim.
Once the Deputy Commissioner hears your case, they will issue a decision. Unfortunately, Deputy Commissioners have busy caseloads, and it can take several months before they issue their decision.
You need to be ready because you have 15 days to request a hearing from the Full Commission if you do not win your appeal to the Deputy Commissioner. The appeals process to the Full Commission takes another several months, or more.
If you do not win at the Full Commission level, you can take your case to the North Carolina Court of Appeals. If you exhaust all of your appeal options, the entire process could take more than one year.
Your best hope is that your claim goes smoothly from the outset, and you can begin receiving benefits soon after you report the injury. However, you should be prepared in case the process takes a turn for the worse.
Many claimants can successfully convert a denial to benefits with the help of an experienced workers’ compensation lawyer.
Call a Wilmington Workers’ Compensation Attorney Today
The attorneys at Horton Mendez know how help with claims so they do not reach a denial at the outset. The old adage “an ounce of prevention is worth a pound of cure” is true, even in workers’ compensation claims.
In the event of a denial, our attorneys also know how to fight for you when you have been wrongfully denied workers’ compensation benefits. We routinely handle complex claims from start to finish.
If you have received a denial or have a claim that you feel may present a challenge, you can get our legal assistance by messaging us online or calling us today at (910) 668-8067 for a free consultation.
Workers’ Compensation FAQs
Can I see my own doctor?
Your employer has a right to direct your medical treatment to the providers of their choice. However, there are options for second opinions.
If the insurance company is directing you to a second opinion doctor, you should immediately consult with an attorney. This sometimes happens when the first doctor the insurance company chooses does not give them the diagnosis they want, which is almost always never in the patient’s interest.
Should I take a workers’ compensation settlement?
It depends on your situation and your chances of success in your appeal. You should always consult with an attorney if the insurance company is trying to settle your claim. They will often lowball unrepresented claimants knowing that they are unfamiliar with workers’ compensation claims.
Valuing claims is complex and an experienced attorney can help you know whether they are offering something fair or trying to lowball you to close their file.
