How Long Do You Have to File a Claim for Workers’ Compensation?

If you’re hurt on the job in North Carolina or you become sick due to conditions you were exposed to at work, you may be eligible for benefits through the workers’ compensation program. The process of obtaining these benefits is more straightforward than seeking compensation through a personal injury lawsuit. However, you need to comply with specific deadlines, and the time you have to start a claim is much, much shorter than the time you would have to file a lawsuit.

If your injury occurred at work and your employer is covered by workers’ compensation insurance, then you don’t have the option of filing a lawsuit in most cases, so you must apply for benefits according to the workers’ compensation requirements, or you’ll be prevented from getting any help at all. That makes it vital to understand how the workers’ compensation program works and how to comply with deadlines.

At Martin & Jones, we frequently help injured workers obtain the disability benefits and medical care they need through the North Carolina workers’ compensation system, so we are familiar with the rules. It is always a good idea to comply with the requirements for filing workers’ compensation claims, including the deadlines for filing claims and appealing denials.

When the Claim is Based on an Accident at Work

The deadlines for filing a workers’ compensation claim can vary depending on whether the claim is based on an injury from an accident, such as a neck injury caused by a fall from scaffolding, or a workplace illness, such as cancer, from exposure to thermal metal spray. When a claim is based on an accident, there is a definite time to start the clock running. By contrast, illnesses often develop gradually over time and can take years to show symptoms.

If your workers’ comp claim is based on a work site accident, Section 97-22 of the North Carolina Workers’ Compensation Act says that injured workers should give written notice of the accident to their employer either “immediately” or “as soon thereafter as practicable.” At the very least, an injured worker must ensure the employer receives written notice within 30 days.

There are a few exceptions. First, if a worker can prove that the employer or a representative of the employer had actual knowledge of the accident, then written notice may not be required. Second, if a worker lacks the physical or mental capacity to provide written notice, then they may be excused from complying with the 30-day deadline. Finally, if “fraud or deceit” on the part of a third party prevented the worker from providing proper written notice, then the deadline may be waived. 

However, any excuse for missing the deadline must seem reasonable to the North Carolina Industrial Commission, which is the agency responsible for administering the Workers’ Compensation Act and certain other laws. The worker must also satisfy the Commission that the failure to meet the deadline has not “prejudiced” the employer.

Even though the law allows some exceptions, it is always best to make every possible attempt to comply with the written notice requirement. If you notify your employer and they don’t take action as they’re supposed to, you have up to two years to file a claim directly with the North Carolina Industrial Commission.

When the Claim is Based on a Workplace Illness

If you need to file a workers’ compensation claim because you’re suffering from an illness triggered by conditions in the workplace, there’s no single moment you can point to and say, “I got hurt at this particular time.” You might not have realized you were exposed to a toxic substance or that the substance is making you sick. The North Carolina Industrial Commission refers to this type of claim as one based on “occupational disease,” and the rules establishing deadlines can be complicated.

Section 97-58 of the Workers’ Compensation Act specifies that you still need to provide written notice to your employer within 30 days for most diseases. However, the 30-day period begins from the time your doctor has advised you that you have the disease, rather than the time you may have suffered from exposure or started to develop the disease.

An exception is made for three diseases:

• Asbestosis
• Silicosis
• Lead poisoning

The law states that claims for workers’ compensation benefits must be filed with the Commission no later than two years after the worker faced disability, disablement, or death because of the disease.

Deadline to Appeal a Denial

Even though workers’ compensation benefits do not cost insurance companies as much as personal injury claims, the insurance companies still seek to save money by denying claims whenever possible. That means that workers hurt in an accident or injured by an occupational illness often need to file an appeal before they can receive medical benefits and disability payments. To appeal a workers’ comp claim that has been denied, the worker or their attorney must request a hearing before the Industrial Commission by filing Form 33, “Request for Hearing.” While there is no official deadline to request a hearing, it is wise to do so quickly while evidence to support your claim is still readily available.

Most of the time, the Industrial Commission will require you to go through a mediation process to see if the claim can be resolved without a formal hearing. If the mediation session does not resolve the stalemate, then a hearing will be scheduled with the Commission. Then, if the result of your hearing is not satisfactory, you can appeal to a 3-judge panel, but you must request the appeal within 15 days of the decision from the initial hearing.

An Experienced Workers’ Comp Attorney from Martin & Jones Can Guide You Through the Claims Process

While the workers’ compensation system may have been intended to provide simple relief for injured workers, the system has now become so convoluted that it can be extremely difficult to navigate on your own. Insurance companies often deny claims as part of their routine, forcing workers to fight their way through appeals to obtain the benefits they deserve.

At Martin & Jones, we’ve been fighting to uphold the rights and interests of injured workers for decades. Rather than struggling through the claims process on your own, we invite you to schedule a free consultation to learn how we can help. Just call 800-662-1234 or contact us online now to get started.