- How To Fight A Workers Compensation Claim
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How To Fight A Workers Compensation Claim
Should You Hire a Work Injury Lawyer? A detailed overview of the workers’ compensation claims appeals process in North Carolina – from calling an attorney to taking your claim to court
When Can You File A Workers’ Compensation Claim?
After being diagnosed with a work-related accident or occupational illness, one of the biggest sources of stress and anxiety for many injured workers is not knowing what to expect. It’s perfectly normal to feel anxious when facing an uncertain future, but this added stress can negatively impact your recovery, as you want to recover so that you can return to work and start earning an income for yourself and your family again.
If your employer recently denied your workers’ compensation claim, then you may be considering fighting in your best interest and appealing your claim. In making this decision, it helps to better understand the overall workers’ compensation appeals process and the role of a work injury attorney.
While we can’t say for sure how other law firms handle their workers’ compensation cases, we can give you a general overview of how most cases go based on what happens after an injured worker reaches out to our experienced North Carolina workers’ compensation attorney. Lawyers.
Typically, the first step when you decide to contact one of our knowledgeable workers’ compensation attorneys for assistance is an intake telephone interview.
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During this phone call, the attorney or paralegal may ask you what happened (ie, “what happened”) that led to the workplace accident or injury. As you tell your story, we may ask important questions to identify key legal issues.
After the intake phone call, we will work with you to schedule a personal consultation with an attorney to learn more about your specific case. We ask you to bring all documents related to the meeting. These documents help our team prepare your case for trial from the start, should a trial be required.
Again, this time you will be asked by the lawyer to explain what happened and how you were injured. During a personal consultation, we assess the credibility of your claim, evaluate your characteristics as a potential witness, and intervene with questions when necessary.
The purpose of the face-to-face interview is to identify key issues in your claim and answer questions such as:
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During this initial face-to-face consultation, the attorney will also explain the basics of compensation and benefits for work-related accidents, traumatic injuries, and occupational diseases. We discuss key legal issues and concepts:
Additionally, we take the time to answer your questions and explain the process – including the time it takes to pursue a claim. We review the various stages including filing, response, discovery, mediation, hearing before the Deputy Commissioner, subsequent medical depositions, written arguments, opinion and award, Full Commission, Court of Appeal and appeal to the Supreme Court.
It is important to consider that some defendants/insurers will refuse, delay and defend their benefits. Accordingly, we can immediately begin moving your case as quickly as possible. But know that the process may still take some time.
During the consultation, we will also explain the attorney’s fees and the cost of hiring an attorney. We’ll discuss the difference between attorney fees and costs for prosecuting your case and tell you how a North Carolina Industrial Commission plaintiff’s attorney should get their fees approved. Also, we make it clear to you what benefits are payable under the law if we win your case.
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Another important discussion we have during the consultation is what you can expect when you hire us. This conversation is important to clear up any misunderstandings before we accept your case. We explain the role of our staff, our policy on returning phone calls, drop-ins, appointments and the scope of our legal representation.
Although we are not health care providers and cannot fix your medical problems, we will also explain how we can help you get the medical treatment you need.
Finally, if everything goes well and both parties are ready to take the next step, we will sign the following documents to authorize our representation and work on your case:
As soon as we receive these signed documents, we will immediately begin working on your case—including sending letters of representation to the Industrial Commission and your employer’s insurance carrier.
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After we receive all the documents related to your claim, we will obtain all the necessary forms from the North Carolina Industrial Commission, rehabilitation professionals, your employer and their workers’ compensation insurance carrier. These documents may include:
Next, we conduct a thorough and thorough investigation—starting by obtaining all witness statements, police reports, medical reports, and anything else related to your accident. We use our experience and knowledge to facilitate this process, which is often deliberately delayed and obstructed by insurers.
Insurance companies don’t rush to settle cases unless they settle for less than your case is worth or feel pressured by an approaching court date.
Rule 605 of the North Carolina Workers’ Compensation Law permits the use of 30 written interrogatories, which may be given to the opposing party after the filing of a Form 18, Form 18B or Form 33 or approval of a Form 21 or Form 26. , but before the initial hearing on the merits of your case. Most parties can make formal requests for the production of documents necessary to evaluate a claim. The parties may conduct discovery as permitted by the Industrial Commission upon motion.
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During this discovery process, we may ask you to give a recorded statement. We’ve found that the more you share about what happened, the more fruitful the impeachment on cross-examination.
In addition to reviewing written or recorded witness statements already taken, we will interview any potential witnesses.
During this time, we will closely follow your medical treatment and work status. We ask that you keep us informed of doctor visits, return to work status, and copies of documents you receive.
It’s important to note that your employer (or their insurance carrier who pays the medical compensation) is entitled to receive reports from your medical provider documenting your treatment throughout the claims process.
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(122 NC App. 83, 468 S.E. 2d 536 (1996)) prohibits nonconsensual, ex parte communications between employers, insurers or defense attorneys and an injured worker’s medical provider. Prohibited communications do not include communications for the purposes of obtaining medical records, billing, scheduling, or other, strictly administrative matters. Improper communication with an injured worker’s medical provider can strike that provider’s testimony from the record.
Besides NCGS § 97-25.6 allows employers and insurance carriers to communicate directly with the injured worker’s medical provider using a form designated by the Industrial Commission to pay compensation on an agreed claim (or to pay compensation without prejudice). The medical status questionnaire included cause of injury, maximum medical improvement, and ability to return to impairment ratings. This questionnaire may also accompany the job description when appropriate and should always be copied on the injured worker and his or her counsel.
Other communication with the injured worker’s medical provider may be permitted by agreement of the parties, valid written authorization, or order of the Industrial Commission.
As part of investigating your claim, we’ll also get copies of reports or progress notes (as well as emails to carriers and rehab providers). Rehabilitation professionals are bound by the Rules for the Use of Rehabilitation Professionals that govern their conduct in workers’ compensation cases.
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Workers’ compensation is a form of “administrative law” and is therefore primarily form-driven. The North Carolina Industrial Commission website provides electronic versions of the various forms, along with a brief description of each form at: https://www.ic.nc.gov/forms.html
The injured worker and their employer (or their employer’s insurance carrier) must fill out and properly submit these forms.
It is important to understand that there are strict deadlines and time limits that apply to many forms. For example, any employer or insurance carrier filing a Form 60 (Admitting Claim), Form 61 (Denial of Claim) or Form 63 (Early Compensation without Prejudice and Admitting Liability) must do so within 14 days of notice of injury. If the plaintiff does not file either of these forms within 30 days of filing Form 18, a penalty will be imposed if this deadline is missed.
Part of a plaintiff attorney’s job is to keep track of all these deadlines and make sure your claim moves forward smoothly. If your employer or their insurance carrier misses any deadline, we can help you strengthen your claim and make sure the correct penalties are awarded.
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After submitting all the necessary forms, we can attempt to resolve your claim expeditiously through mediation and arbitration proceedings. Many states, including North Carolina, allow voluntary arbitration or arbitration as a tool
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