This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured during the course of your work responsibilities and work hours, contact your employer as soon as possible and seek the appropriate medical attention. You may work in a place where an on-site health care provider is available; if so, you may need to visit this specified health care office to treat any injuries you may have. However if your employer has not designated a health care provider or office to seek treatment from, your own health care provider and/or hospital emergency room are acceptable places to receive treatment.
It is essential you establish open communication between you and your physician as well as with your employer. Tell your doctor or caregiver you were injured on the job and also identify your employer. As soon as possible or within thirty (30) days of your injury, notify your employer of your work-related accident. You may do this personally or a friend or family member may do so. Strive to make these communication in writing or to at least have some documentation of these events.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
If your employer employs three or more employees, North Carolina state law states your employer must provide workers' compensation coverage to all individual employees.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
Timely filing of all documents and keeping a detailed and accurate record of all filings and medical expenses is the best way to ensure the most successful claims process.
4. What benefits might I be eligible to receive?
Payments for benefits are paid by your employer and/or employer's insurance provider. This can mean that your employer and/or employer's insurance provider can play a substantial role in the direction of your medical treatment, i.e. who you seek treatment from, consultation in the course of your medical care.
The kinds of benefits you receive and the amount of time you are eligible to receive them will depend largely on the extent of your injury, the duration of treatment necessary, and whether the injury prevents you from maintaining gainful employment. Your doctor or medical care provider will be expected to categorize your injury and establish whether your injury permanently or temporarily disables you, and to what extent, partial or full. If your injury leaves you disabled for twenty-one (21) days or more, you may be eligible for lost wage compensation.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
After notifying your employer of your injury (remember, you should do this in writing within thirty (30) days or sooner!), you or your employer should complete a Form 18 and file it with the Industrial Commission. This officially begins your claim process. You or your employer have two years to file the Form 18 with the Industrial Commission. Failing to do so could disrupt your ability to successfully attain a full range of benefits as a result of your work-related injury, so remember to stay up-to-date and check with either your employer or the Industrial Commission about the status of your claim.
If your employer fails to cooperate or acknowledge responsibility for your work-related injury, the employer or the employer's insurance provider should provide you or your treating physician the reason for denying your claim. You may choose to accept the denial or request a hearing with the Industrial Commission to challenge it.
All cases filed with the Industrial Commission are automatically sent to a mediation settlement conference. This is a way to eliminate costlier litigation-type proceedings, and serve as a first step in not only attempting to solve any disputes but also can serve to identify key issues in your case should your claim move to the hearings process.
If you reach the hearings process with your claim, you should expect a more-trial like scenario where you and your employer will or can present information regarding the nature of the claim, previous events, and even evidence of your medical care. You may find it beneficial to seek the counsel of an attorney during this process. The Industrial Commission will make a determination regarding your case at the hearings stage; however, if you are unhappy with the determination you and/or your attorney may choose to file an appeal. You must provide in detail your reasons for appeal and the Industrial Commission will review this statement to determine whether an appeal is warranted. The Industrial Commission can choose which issues to review and determine how proceedings will be conducted, i.e. whether new evidence may be presented or not.
6. If I am not happy with the determination, how do I appeal?
If your or your employer continue to be unsatisfied with the determination of the claim, either party can submit an application for appeal to the North Carolina Court of Appeals. All appeals will be governed by the Rules of Appellate Procedure as well as the rules of the court.