Working to Secure Full Benefits for Workplace Injuries and Illnesses Caused by Conditions in the Workplace

The workers’ compensation system should make it fairly simple to obtain medical and wage benefits in Durham when an on-the-job injury prevents you from working. The system prevents workers from suing their employers in most situations, but in exchange for losing the amounts they could recover in a lawsuit, employees are supposed to receive medical care and money to make up for lost wages without the need to prove that their employer acted negligently.

Insurance companies are heavily involved in North Carolina’s workers’ compensation scheme, making the process of recovering benefits less simple or guaranteed.

It is helpful when you have an experienced Durham workplace injury lawyer fighting for your rights. The team at Martin & Jones has over 40 years of experience securing resources for workers harmed by on-the-job accidents and exposure to hazards. We know how to manage the claims process effectively and efficiently and to resolve conflicts in a way that serves our clients’ best interests.

Steps to Take After a Workplace Injury or Diagnosis of an Occupational Illness

One reason workers’ compensation claims are so challenging to manage is the strict rules governing injury reporting and medical care. If you make a mistake, you could end up paying for extra medical bills on your own or missing out on benefits entirely.

Every workers’ comp claim involves different circumstances, so we cannot provide legal advice online that will apply in every situation. If you contact our team, we can discuss the right steps based on the circumstances of your case. But for general reference, here are some key steps to take if you’ve been hurt on the job or your doctor has diagnosed an illness caused by conditions in your workplace.

Seek Medical Care That’s Right for the Situation

While there are rules that restrict which doctors you can see when you’re receiving workers’ compensation benefits, those rules are modified in emergency situations. If there’s a life-threatening emergency, whether at the time of the initial injury or later, it is best to get emergency care as quickly as possible. This could involve calling an ambulance or going to the emergency room.

If you’re injured at work and your employer has a health suite on site, then, unless your employer has instructed otherwise, the North Carolina Industrial Commission recommends going to that health care provider first. In situations where there is no health care facility on site, you should seek care from a facility recommended by your employer unless you are dealing with an emergency.

Receiving medical care is the first priority. If it’s an emergency, get appropriate help right away. But if it is not urgent, then you need to find out who your employer has designated to treat workers’ compensation injuries and see that provider. For instance, if a worker’s hand is crushed by machinery, emergency treatment at the nearest hospital would be required. But if a worker has developed carpal tunnel syndrome due to repetitive motion, that injury would not be considered an emergency, so the employee should seek treatment from the employer-designated provider. The injured worker should inform the health care provider that the injury occurred at work so the provider can send the bill to the employer.

Reporting the Injury

A worker injured on the job or suffering from an occupational illness must report the injury twice to give the employer the opportunity to fulfill their obligations. Initially, an injured worker is supposed to notify management of the injury as soon as possible. This could be a simple verbal statement made to a supervisor, either by the employee or a co-worker or a family member. This informal report is the first part of the reporting obligation.

The second part requires providing written notice. An injured worker (or someone helping them, such as a Durham workplace injury lawyer) needs to submit a written report of the injury within 30 days of the time the injury occurred. The notice should include the date of the injury, a description of the injury, and how it occurred. If you fail to provide written notice as required within the 30-day deadline, your employer can deny your claim. If you (or your attorney) can present a good reason as to why you failed to provide written notice as required, your failure may be excused by the Industrial Commission.

It can be challenging to determine when the reporting deadline occurs in situations where an employee is seeking benefits for a condition that develops over time, such as cancer or a repetitive stress injury. The deadline could be 30 days from the time the doctor issues a diagnosis, but when the cause of the diagnosis is not immediately connected to workplace conditions, an attorney may be able to argue that the deadline to provide notice should be extended.

Further Obligations

Once an injured employee has received initial medical care and reported the injury to the employer, additional obligations take effect. It is important to follow the doctor’s recommendations for treatment and for refraining from certain activities. Returning for follow-up visits is critical.

If your doctor is not providing satisfactory care, you can apply to see a different physician, but you need to have the change approved either by the employer (in writing), insurance company, or by the Industrial Commission. If you see another doctor on your own, the cost of your care may not be covered by workers’ compensation.

Physicians chosen by employers often refuse to acknowledge the extent of an injury or its connection to the workplace. A Durham workplace injury lawyer can help you find appropriate alternate care and to get your care approved for coverage, but it is wise to seek legal advice before taking action.

Injured employees are also expected to complete and file a Form 18 with the Industrial Commission. Failure to submit the form properly can lead to a loss of benefits. An attorney can assist in the process.

FAQs About Workplace Injuries in Durham

How long do I have to report my workplace injury to my employer in Durham?

The North Carolina Workers’ Compensation Act specifies that injured employees should give their employer a written notice of an accident “immediately” or “as soon thereafter as practicable.” Employees are not eligible for workers’ compensation benefits until they have provided this notice, unless they can show either that the employer had notice of the accident or that the employee was prevented from giving notice. If written notice is not provided within 30 days of the accident and no “reasonable excuse” is made to the Commission, the employee is not eligible for benefits.

Who pays for my medical bills, prescriptions, and necessary travel to appointments?

When medical benefits are approved, the employer or the insurance company providing workers’ compensation coverage should pay for reasonable medical care, including prescriptions. If an injured worker needs to travel 20 miles or more (round trip) to receive medical treatment, the employee is eligible to collect mileage expenses from the employer or insurance company. This should be paid at the IRS standard mileage rate.

What am I entitled to other than medical care?

If an injury interferes with your ability to work for more than seven days, then you can receive compensation to make up for some of the wages you would be paid if your injury didn’t prevent you from working. You do not receive your full wages, but instead receive a benefit equal to 2/3 of your average wage. If your disability lasts 21 days or more, you can receive benefits to cover wages lost during the first 7 days. Payments continue as long as the disability remains or until doctors determine that you have reached your maximum level of recovery. You may also be eligible to receive payments for a disability considered to be permanent and benefits that provide some vocational rehabilitation. If a work injury results in death, family members may receive death benefits.

What should I do if my existing injury or condition is worsened by my job duties?

Insurance companies frequently deny workers’ compensation benefits when an employee suffers from a pre-existing condition. However, when a worker can show that job duties have made a pre-existing condition worse or caused re-injury, then the additional injuries or aggravation of the condition should be covered by workers’ compensation. A Durham workplace injury lawyer will often need to present extensive evidence and arguments based on legal precedent to succeed in getting benefits in these situations.

How much does it cost to hire a Durham workplace injury lawyer to help with my claim?

The team at Martin & Jones works on a contingency fee basis. Our fee is based on a percentage of the amount of financial compensation we recover for clients, and if we don’t succeed in recovering compensation, the client does not owe us any legal fees. In workers’ compensation cases, our fees are limited by law and must be approved by the Industrial Commission.

Get Help Filing a Workers’ Compensation Claim or Appealing a Denial in Durham

The workers’ compensation system is far more complicated than it should be, which allows insurance companies to deny employees’ claims when they should be receiving benefits. At Martin & Jones, we cannot make your injuries go away, but we can work to help you obtain the medical care and financial resources you need to recover after a workplace injury or occupational illness. For a free, confidential consultation to discuss the assistance a Durham workplace injury lawyer on our team could provide in your situation, call us at 800-662-1234 or contact us online now.