Our Durham Attorneys Outline the Process for Your Workman’s Comp Claim
Workers’ compensation pays income replacement and medical benefits to workers who suffer from a work-related injury or illness that leaves them unable to work. While workers’ comp is a “no-fault” system of insurance, that doesn’t mean that benefits will be paid to you automatically. You will have to file a claim to receive your benefits, which can sometimes take longer than you might expect. In some cases, your claim might even be denied.
You do not need to hire an attorney to pursue a workers’ comp claim. The process can sometimes be challenging to navigate, especially if your case is complicated. In addition, most people cannot pay their bills unless they work, so you could quickly be facing a financial crisis if your claim is delayed or denied. If you cannot work due to a work-related illness or injury, a Durham workers’ compensation attorney from Martin & Jones can help you get your benefits as quickly as possible.
The First 30 Days After Your Work Injury
If you are suffering from a work-related injury or illness, the first step is to report your injury or illness to your employer. This should be done immediately, both verbally and in writing. If you were injured in a workplace accident, your employer’s knowledge of the event may be sufficient. However, at a minimum, North Carolina law requires that you notify your employer of your illness or injury within 30 days.
Once you have reported your injury or illness to your employer, they should file the necessary paperwork with their workers’ compensation insurance carrier within five days. Then, within 14 days of receiving the claim, your employer or their insurance carrier should inform you that the claim has been accepted or denied. It is important to note that, in some cases, your employer’s insurance carrier may begin paying benefits while retaining the right to deny your claim within 90 days.
Medical Treatment in the First 30 Days
If your claim is approved, your employer’s insurance carrier will begin paying benefits for medical treatment immediately. This does not mean that you should wait for your claim to be approved in order to seek medical treatment. You should see a doctor as soon as possible. However, you should seek guidance from your employer as to whether they or their insurance carrier have an appointed health care provider for work-related injuries and illnesses. This minimizes the risk that you will be personally responsible for any medical bills and facilitates quick payment in the event that your claim is approved.
Whether or not your claim has been approved, it is critical that you follow the physician’s instructions. Failure to follow your treatment plan could result in your claim being denied, even if it has previously been approved.
Your workers’ compensation claim must be filed with the North Carolina Industrial Commission within two years of the date you were injured or became ill and unable to work. This is a long time to wait for benefits. If your employer refuses to file the claim, you should contact a Durham workers’ compensation attorney immediately to discuss your rights.
Wage Benefits in the First 30 Days
Unlike medical benefits, wage benefits are not paid immediately if your claim is approved. Instead, wage benefits will not be paid until you have missed seven days of work. You will be entitled to compensation for the first seven days only if you are unable to work for at least 21 days.
If Your Workman’s Comp Claim Is Denied
As mentioned above, your employers’ insurance carrier must approve or deny your claim within two weeks of the date you became ill or were injured. Workers whose claims have been denied have the right to request a hearing before a deputy commissioner. However, upon receiving a request, your claim will be automatically referred to mediation by a third party.
If the parties cannot agree to a resolution of your claim, your case will be scheduled for a hearing within 30 to 60 days. While the hearing with the deputy commissioner isn’t a trial, it is very similar. Both sides will have the opportunity to submit evidence and call and cross-examine witnesses. At the conclusion of your hearing, the deputy commissioner will issue a written decision regarding your claim.
Hearings Before the Full Commission
If the deputy commissioner denies your claim, you have 15 days to file your appeal for a hearing before the full commission. The commission will be composed of three judges who will receive written briefs on your claim and then schedule oral arguments. Similar to the hearing before the deputy commissioner, the full commission will allow the parties the opportunity to submit evidence and call and cross-examine witnesses at the hearing.
If the full commission denies your claim, your only remedy is to appeal the commission’s decision to the North Carolina Court of Appeals.
Why You Should Work with a Durham Workers’ Comp Lawyer
The workers’ compensation process includes several time-sensitive deadlines. These deadlines become even more critical if your claim has been denied. Failure to meet these deadlines could irreparably harm your claim, regardless of how strong it may be. To further complicate matters, it may be difficult to know when the deadline expires, depending on the facts and circumstances surrounding your illness or injury. Working with an experienced workers’ comp lawyer removes the guesswork and ensures that your claim will be handled in a timely fashion.
Many claims are denied due to insufficient evidence or other factual problems. A Durham workers’ compensation attorney can also help you gather the evidence you need to make your claim as strong as possible. They will know how to successfully argue your case, whether it is in mediation, before the deputy commissioner, or has been appealed to the full commission.
Talk to a Durham Workers’ Comp Attorney at Martin & Jones Today
If you are sick or injured and unable to work, we can help you understand your options and get the benefits you need no matter where you may be in the workers’ compensation process. To discuss your case, call us at 800-662-1234 or contact us online to schedule a free consultation today.