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If you have been injured while at work or if a loved one became ill while performing his or her job duties, you may have several questions and concerns about your rights and options under the law. Our North Carolina workers’ compensation attorneys know the workers’ comp process can be confusing, and we are here to help.
The following is just a sampling of some of the common questions we hear from our clients. Please do not hesitate to contact us to discuss the specifics of your situation, as not all workers’ compensation cases are the same.
I Thought All North Carolina Employers Were Required to Have Workers’ Compensation Insurance. What if Mine Doesn’t Have Coverage?
In North Carolina, employers with three or more employees are generally required to carry workers’ compensation insurance to protect their employees in case of work-related injuries or illnesses. However, there are some exceptions, particularly with respect to certain agricultural employers or businesses in which all employees are immediate family members.
If you sustain a workplace injury and find out that your employer does not have the required workers’ compensation insurance, you still have options for obtaining benefits, though the process may be a bit more complex.
Injured employees must first file a claim and prove that the employer is liable for their injury or disease. Filing with the NCIC involves completing Form 18, which is the official Notice of Accident form, and Form 33 to request a hearing. Additionally, the NCIC may take legal action against the employer, which can result in penalties or even criminal charges if the employer is found to be willfully non-compliant.
Workers who successfully prove their claim may receive the same benefits they would have received under a traditional workers’ compensation policy, including medical treatment and wage replacement. However, navigating claims with an uninsured employer can be legally complex, which is why we encourage injured employees to seek qualified legal guidance from an experienced workers’ compensation attorney to protect their rights.
I Sustained an On-the-Job Injury. As an Employee, What Are My Next Steps to Obtain Workers’ Compensation Benefits?
In North Carolina, when an employee sustains a workplace injury, following specific procedures is crucial to ensure compliance with workers’ compensation laws and protect eligibility for benefits. Seeking immediate medical attention is the first step, especially if the injury appears severe. Even if the injury seems minor, like a strain or sprain, or if you feel capable of continuing work, it’s essential to get checked out by a healthcare professional. Workplace injuries can sometimes have delayed symptoms, similar to injuries sustained in car accidents. For instance, internal injuries, soft tissue damage, or concussions may not show symptoms right away but can worsen if left untreated. Consulting a doctor as soon as possible also establishes a medical record that links the injury directly to the workplace incident, which can be invaluable when filing a claim.
Once you have received initial treatment and stabilized, North Carolina law requires that you inform your employer of the injury promptly. Reporting the incident as soon as possible can help avoid potential complications or disputes that could arise later. Although North Carolina mandates that employees notify their employer in writing within 30 days of the incident, providing this notice sooner—preferably immediately after the incident—can expedite the claims process. Written notification ensures that a clear record exists, which can help avoid discrepancies or delays in your claim.
The next essential step is completing Form 18, the Notice of Accident to Employer and Claim of Employee, Representative, or Dependent. This form officially documents the claim with the North Carolina Industrial Commission (NCIC) and must be submitted within two years from the injury date. This deadline is strict; missing it may result in a denial of workers’ compensation benefits, regardless of the injury’s severity. Filing Form 18 establishes your right to pursue benefits under North Carolina’s workers’ compensation system and opens up access to medical treatment and wage replacement benefits if needed. Additionally, the NCIC uses this form to assess the claim’s eligibility and to contact the employer for verification and further processing.
Alongside filing Form 18, it’s advisable to keep thorough records related to the injury. This includes documenting the names and contact information of any witnesses to the incident, the medical treatment received, and details about each healthcare provider consulted. Tracking these details can be particularly useful if complications arise, such as if the injury worsens or if the employer or insurance carrier disputes any part of your claim. You should also maintain records of any time taken off work due to the injury, as this information may be necessary to calculate wage replacement benefits accurately. Detailed record-keeping not only strengthens your case but also helps you account for all injury-related expenses and losses, which can directly impact the benefits you receive.
Following these procedures is essential to protecting your rights as an injured employee in North Carolina. Any deviation from the required steps could result in claim delays or even denials, which could significantly impact access to necessary medical care and wage replacement benefits. By adhering closely to North Carolina’s guidelines, you help ensure that your claim is legally recognized, maximizing your chances for a smooth and successful recovery process supported by workers’ compensation. In situations where questions or disputes arise, consulting with a workers’ compensation attorney may also be beneficial, as they can provide additional guidance and representation to safeguard your rights and benefits.
What Are My Options if My Employer Refuses or Fails to Report My Injury?
If your employer fails or refuses to report your injury after being notified in a timely fashion, you should take the appropriate next steps on your own to ensure your workers’ compensation claim is processed. It is important for you to be aware that the employer is legally required to report workplace injuries that result in more than one day of missed work, involve medical treatment beyond first aid, or result in the loss of consciousness.
More specifically, in cases where the employer does not fulfill this obligation, the employee should complete and file Form 18 with the North Carolina Industrial Commission (NCIC). This form serves as a notice of injury and claim for benefits, and submitting it directly to the NCIC allows the employee to take charge of their claim without employer interference.
In addition to filing Form 18, the employee should document all interactions with the employer regarding the injury, including any attempts made to request the reporting of the incident. These records can be valuable if a dispute arises or if the employer continues to refuse to report the injury.
If needed, the NCIC provides mediation and hearing options to resolve disputes between employers and employees over reporting or compensation issues. Consulting a skilled workers’ compensation attorney may prove to be helpful in situations where the employer is uncooperative, as legal professionals can generally advise employees about the proper documentation and next steps to ensure the claim proceeds without delay.
Who Is Responsible for Directing and Providing My Medical Treatment After a Workplace Injury?
In North Carolina, workers’ compensation law requires that the employer or their insurance carrier direct medical treatment for employees injured on the job. This means the employer typically chooses the initial treating doctor and determines the medical facilities where the employee should receive care. The goal of the employer’s control over medical treatment is to ensure that the injured employee receives necessary and appropriate care while managing costs effectively. By directing treatment, the employer can limit unnecessary expenses, such as overutilization of services or out-of-network providers, which can help maintain sustainable insurance costs.
However, injured employees still have rights regarding their medical treatment. If an employee is unsatisfied with the initial treatment or diagnosis, they are entitled to seek a second opinion. North Carolina law recognizes that the initial provider selected by the employer may not always address all the employee’s concerns, and the law provides options for seeking additional input on the injury or condition.
If the employee wants to change doctors or get a second opinion, they must obtain approval from the North Carolina Industrial Commission (NCIC). This can be done by filing Form 33, which requests a hearing to review the current medical care and to determine if a change in provider is justified. Filing Form 33 allows the employee to present any reasons for dissatisfaction, such as believing that the treatment is inadequate or that their recovery is not progressing as expected.
While the employer has the right to direct treatment initially, they must still adhere to reasonable and necessary standards of medical care. Employees have the right to receive competent treatment and should not be denied the quality or frequency of care needed for their recovery. If an employee believes that their medical needs are not being met, they can request a review of the treatment plan through the NCIC, which has the authority to mandate adjustments in care if necessary. For example, if an employee’s recovery has stagnated or their condition worsens, they can present this to the NCIC as grounds for requesting a new provider.
In cases where the Industrial Commission approves a change, they may authorize treatment with a different doctor or specialist who might provide a more suitable treatment approach. Employees have a right to advocate for their health needs, especially if they believe that their recovery could improve with alternative treatment. Moreover, employees should keep thorough records of their medical visits, treatment details, and any conversations regarding their care, as these can support their case if they seek approval for a change in provider. In all cases, North Carolina workers’ compensation law ensures that while employers have initial control over treatment, employees have avenues to ensure their health needs are fully addressed.
What Are My Rights if I’m Seriously Injured at Work, but My Employer Refuses to Provide the Necessary Medical Treatment I Need?
In North Carolina, workers’ compensation laws aim to ensure that employees injured on the job receive immediate and necessary medical treatment. Employers are responsible for arranging and covering medical care under these laws, usually through their workers’ compensation insurance. However, if an emergency occurs and the employer fails or refuses to provide treatment, North Carolina law allows injured workers to take certain actions to protect their health while still preserving their right to workers’ compensation benefits.
What Is Considered an “Emergency?”
An emergency situation is one in which the injury is so serious that delaying treatment could lead to significant harm, deterioration of the injury, or even death. In such cases, North Carolina’s workers’ compensation law prioritizes the worker’s health and allows employees to seek medical attention independently if their employer does not or cannot provide it. According to North Carolina General Statute § 97-25, an employee can choose their own medical provider in an emergency if treatment cannot be reasonably accessed through the employer’s workers’ compensation insurance or if the employer fails to direct the employee to a provider promptly.
So, What Should You Do?
When the employer fails to provide medical treatment during an emergency, the employee should immediately seek care. In emergency cases, workers’ compensation law protects the employee’s right to prompt medical attention without needing prior authorization from the employer or insurer. However, to ensure the medical bills from this treatment are covered by workers’ compensation, the employee or their representative must inform the employer of the treatment as soon as possible. Documenting this communication helps ensure that the treatment is recognized as part of the workers’ compensation claim.
After emergency treatment, the employee should notify their employer in writing, explaining the nature of the injury, the treatment received, and the need for further medical care if necessary. Additionally, employees should complete North Carolina Industrial Commission Form 18, which is the official Notice of Accident to Employer and Claim of Employee form, and submit it to the Industrial Commission. This form initiates a workers’ compensation claim and helps establish the incident in official records, which can be essential if any disputes arise about the necessity or coverage of the emergency treatment.
If there are additional medical expenses or follow-up treatments required, the employer or workers’ compensation insurer should then take responsibility for coordinating ongoing care. In some cases, the workers’ compensation insurance may initially deny coverage for emergency treatment if it was obtained without employer consent, particularly if the employer disputes the injury’s work-related nature. If this occurs, employees have the right to request a hearing with the North Carolina Industrial Commission to argue for the necessity of the emergency treatment. During such a hearing, an employee can present medical records, witness statements, and documentation of the employer’s failure to provide timely care to demonstrate that the treatment was urgent and necessary.
Another important provision in North Carolina workers’ compensation law allows employees to seek a different medical provider if they are dissatisfied with the treatment provided through their employer’s insurer. However, this must usually be approved by the North Carolina Industrial Commission and is typically pursued after the emergency has been addressed. To request a change in provider, the employee may file Form 33 with the Commission, explaining why the change is needed and detailing the concerns with the initial care.
Simply stated, North Carolina workers’ compensation laws uphold an employee’s right to emergency medical treatment even if the employer fails or refuses to arrange it. In an emergency situation, employees should seek immediate care to avoid health complications and notify their employer promptly. Filing the necessary paperwork with the North Carolina Industrial Commission can help protect the employee’s right to coverage and ensure that their medical expenses are addressed. If there is any dispute regarding coverage for emergency treatment, the Industrial Commission provides opportunities for the employee to challenge a denial and prove the need for immediate care. This process protects injured workers and ensures that their health remains a priority, even when employers or insurers do not fulfill their legal obligations.
Reach Out to Our Workers’ Compensation Attorney to Discuss Your Specific Situation Today
If you or someone you love has been hurt on the job or while performing work-related duties while away from your jobsite, you have rights under the law. Contact our office today to discuss the next steps for obtaining the compensation to which you are entitled.
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