North Carolina follows a similar process to many other states when it comes to addressing a workplace injury. The workers compensation program can help cover the medical expenses of an injured employee, but they must follow the correct process. The process is often misunderstood by employers and HR offices, resulting in a lack of understanding and an unwarranted denial. It happens often with turnovers, older processes that haven’t been updated to reflect new laws, or even carelessness. All of these factors, as well as some that are not immediately apparent, should be taken into consideration by anyone who is injured at work when filing a claim.
Getting Started – Employer Notification
Always seek professional medical attention before taking any other action. Do not avoid seeing a doctor if you have been injured in a fall or trauma. These issues can often trigger physical reactions and symptoms hours or even days later. A physician can help you catch any concerns as early as possible and document them. The records are finalized and created by a licensed doctor, not just an employee’s notes or memory. This gives them far more authority and weight after the event.
According to state law, an employee who is injured or becomes sick due to their work must notify his or her employer as soon as they can. It must be written, not verbal and made within 30 calendar days of the onset of the problem. The employer is responsible for this.
The employer must immediately complete a form 19-Employer Report of Employee Injury or Occupational Disease upon receiving notice of an injury or illness at work. The employee is given a copy as well as a blank Form 18, Notice of Accident to Employee and Claim by Employee, Representative or Dependent. In North Carolina, the employer is not required by law to file a claim on behalf of the employee.
Fill out the forms correctly
The employee must complete Form 18, and submit it to the North Carolina Industrial Commission (NCIC). You should also send a copy to your employer and/or insurance company for any medical expenses. Keep a copy of the form for your records as an employer. The filing of Form 18, which is required by law, has a deadline. Employees have two years to submit this paperwork. However, most experts advise that it be submitted within 30 days after the accident or illness. The chances of your claim being denied increase if you delay and take longer.
If the injury is a lung disease, such as byssinosis, asbestosis, or silicosis form 18B – Claims by Employee, Representation or Dependents for Benefits from Lung Disease, should be used in place of the above.
You can also email the NCIC forms to their office by sending them an email at [email protected]. It is recommended that you have an attorney review the paperwork prior to submitting it.
The employer must also take care of paperwork once notified. The employer must respond to the employee within 30 days. This can take one of three formats: Form 60 – Employee’s Right to Compensation; Form 63 – Notice to Employee without Prejudice or Form 61 – Denial of NC Workers’ Compensation Claims. This last form is the most problematic. The Form 61 is a final step in the process of determining coverage for an employee.
Reacting to a denied claim
The employee must then send the NCIC F Form 33 – Request that Claim be Assigned for Hearing if the claim is denied. This document initiates a regulatory assessment. The NCIC will take over and decide whether or not the employer’s denial was justified. The NCIC, if it finds in the employee’s favor, will order that the employer and insurance provider provide medical coverage. The NCIC will schedule a formal hearing if the employer contests the claim.
Prior to formal hearings, the NCIC will try to resolve all cases by mediation. The mediator will probe both parties and see if they can work together to resolve the claim. The formal hearing will be conducted in front of a NCIC Deputy Commisssioner if the claim cannot be resolved.
If the employee is refused, they can appeal to the NCIC Commissioners Panel. From this level, the North Carolina Court of Appeals is the last option for appeal. The state Supreme Court would then be the final avenue. The last two options can only be used for very important policy cases or in the case of egregious conduct. This scenario is extremely rare in a typical workers compensation case. The NCIC final hearing is where most cases reach their conclusion.
Relying on a NC Workers’ Compensation Attorney
A workers’ compensation lawyer can be a huge asset to the success of your claim. A workers’ compensation lawyer is able to provide valuable guidance and assistance in the preparation of forms, in spotting mistakes made by employers, in helping make the best arguments for a formal review hearing. Without the help of a qualified lawyer, you run the risk of making mistakes that could lead to a claim being denied by both the NCIC and the employer. The cost of healthcare can make this a major problem. Do not become a statistic. Get the help you need as soon as possible.
The article How to get workers compensation in Charlotte, NC? first appeared on Attorney at Law Magazine.