How do you start your workers' compensation case? I hear from a lot of people who have been hurt at work and weeks have passed and no one has contacted them to start their workers' compensation medical benefits or wage loss benefits. Usually, this is because the injured worker has not known how to "press the correct buttons" or move the correct levers to get the legal process started.
When you get hurt at work, to make sure that your employer takes action to start your workers' compensation benefits, you must do these things:
1. You must report your accident and your injury in writing to your employer within 30 days of the incident. This is required by state law and if you fail to do this, the employer and its insurance company have a good defense to your claim. Many employers have their own “incident report” form that they will want you to fill out and turn in to human resources or your boss, and that is fine. However, the written reporting requirement can also be met if you send your boss and the human resources department an email or even a text telling them that you got hurt at work on such and such day and that you need medical attention. This needs to be done as soon as possible after you get hurt. The best practice is to send the email or the text and then follow-up by filling out the employer's own incident report as soon as possible. Make sure these things get turned in to the right person at work and keep a copy of what you turn in if at all possible. Some of my clients have asked a secretary in the management office to make a photocopy for them, and the secretary has done this. Do not count on your employer to protect your rights, however. Once you get hurt, your employer becomes your adversary on this case and you have to look after yourself without relying on the employer to help you.
2. You also need to file your claim with the North Carolina Industrial Commission. Even if you notified your employer in writing, there is no guarantee that your employer is going to notify their insurance company and get the ball rolling for you. It is the insurance adjuster at the insurance company that actually issues checks for your wage loss benefits and arranges for your medical care. In order to make sure the insurance company knows about your accident and your injury, you need to file the "Form 18" injured employee claim form with the North Carolina Industrial Commission in Raleigh. You can do this online at the industrial commission's website, www.nc.ic.gov. They have a “fill in the blank” Form 18 on the website and after you fill it in, you can sign it electronically, save it to your computer, and email it to the Commission as an attachment. Or, you can print it out and mail it to the Commission. Once the Commission gets that form from you, the Commission will send a copy out to your employer and their insurance company. This puts the employer and the insurance company on notice that you have filed a claim, and it triggers a legal requirement for the insurance company to either “admit” or “deny” liability for your claim within 14 days.
3. If you do not get a response within 14 days after giving your employer written notice of your injury and/or filing the Form 18 with the Commission, then you need to call me, or some other workers' compensation lawyer, for some free advice. It is pretty common for both employers and insurance companies to ignore claims, even when they have been noticed and filed properly, and if that happens, there are actions that we can take as lawyers to force them to pay attention to your claim and respond appropriately.
There is one warning, or caveat, to all of this: Unless you have injured your back, neck, or developed a hernia, in order to get your injury covered you must have suffered an "injury by accident." An "accident" is any event out of the ordinary and out of your normal work routine that causes you to get hurt. Insurance adjusters use the saying "slip, trip or fall" to define an accident, but there are actually a lot of things in addition to slip, trip and fall that constitute an accident. Anything unusual that happens that causes your injury is an “accident.” A person starting a new job task who gets hurt because they're not accustomed to the new task, has been injured by accident. A person who has to perform the jobs of two people one day because someone is out sick for the first time in six months, and that person gets hurt due to overexertion, has probably suffered an “accident” because of the extra work. So, when you report your injury, you need to be clear in your mind exactly what your "accident" was and provide those factual details in your initial report to the employer.
You also need to provide those facts in the history that you give the nurses and doctors when you get medical treatment. They will probably ask you how you got hurt and you don't need to go into great detail, but you do need to mention the unusual aspect of your work activity that led to your injury. In the above example, you would simply say "We were shorthanded and I was doing a lot more work than usual and overexerted myself" or something along those lines. It is extremely important to give a consistent history when you tell the story of how you got hurt. You will be telling this story of how you got hurt to your employer, the insurance company, and all of the treating doctors and nurses, and possibly in court at some point, testifying under oath. You want internal consistency between statements in the way you tell the story of how you got hurt.
If you've been hurt at work and can't get the system to work for you, then call us. That is why we are here! I personally have 30 years of experience making the workers' compensation system work for injured employees and I'll know exactly what to do to help you. So call me and get your free consultation!
Bob Bollinger