Understanding the Workers’ Comp Claims Process

In 2013, the Bureau of Labor statistics found that three million non-fatal workplace injuries were reported by private employers. Thankfully employers are mandated by state law to provide worker’s compensation cover to injured workers.

This is not Saudi Arabia where all the labor is done by people from India or Bangladesh who do not wear shoes, helmets, and have probably never seen a hearing device in their entire life.

Employees who have suffered from work related injuries can file to get benefits. Worker’s compensation claims do not work like lawsuits. In a lawsuit you are required to establish liability of your employer to get compensation. In worker’s comp you will not have to prove guilt. You just have to show that the injuries and the ailments are job-related. This means even if the worker is responsible for his own injuries he will get benefits, say Charlotte, NC workers’ compensation lawyers.

Now if you are Shia LaBeouf and you hurt yourself in the phenomenal movie Transformers II (but not while filming, he was doing something on his own) you make enough money to pay for your own insurance and since it was your fault, you cannot really point the finger at anyone. You can though get the writers and director (Michael Bay) to write your injury into the storyline. Good for you!

Moreover, in the event a workplace accident leads to the death of a worker, the dependents of the deceased get compensation and have the right to file the claim on his or her behalf. If the worker happened to be the only bread earner, workers comp insurance ensures that the family can support themselves until the time they can get back on their feet and this also includes funeral and other expenses.

Filing a claim

As soon as you are injured notify the worker’s comp agency of your state and your employer. Many states have deadlines within which the injury must be reported. In some states however no such time limit is mandated but the worker must report as soon he can. In states like North Carolina, the deadline is 2 years from the date of the workplace injury or death.

In most states you are not required to adhere to a specific format while reporting an injury. You can send an email, inform a supervisor, or call the right department. But in a few states only written claims are accepted. This is also a judicious practice as this allows you to keep a copy for future reference. Even if no format is prescribed it is prudent to submit a written claim for the sake of record keeping.

Worker compensation attorneys in North Carolina point out that some states it is mandatory to complete an official claim form which you need to submit to your employer as well as the worker’s comp agency.

Response from the insurer

There are typically three types of responses that you can get. Your claim can be accepted which means you will obtain an acceptance letter. Your can be put on hold for need of further information in which case you will intimated by the insurer or thirdly your claim can be denied. Charlotte, NC workers’ compensation lawyers reiterate that if a claim is rejected the worker can appeal to the workers’ compensation agency for a hearing.

Appeals process

To appeal against a workers’ comp denial you will have to file a series of paperwork at the worker’s compensation agency. The process is complicated because you will have to gather evidence to support the legitimacy of your claim and therefore it is best to engage a legal pro to help you. 

Your legal representative will immediately commence a fact finding mission by gathering documents such as hospital bills, doctor’s prescription, medical bills, lab results, income loss sheets, and so on.

They will also begin interviewing witnesses who were at the scene of the workplace accident and will send a questionnaire to the insurer to clarify any doubts. At the hearing before the administrative judge legal pros from both parties will present their case. If you still do not get a satisfactory outcome you can file a petition at the state court.

If you have problems claiming workers’ comp benefits or your claim has been denied, speak with a North Carolina workers’ compensation lawyer as soon as possible. Your legal counselor will contact experts to appear on your behalf, file complicated paperwork, negotiate with insurers, gather evidence, and interview witnesses, leaving no stone unturned to help you receive adequate compensation for your workplace injuries.

If you have any questions about this, contact us. You can find us right here: Workers-Comp.USAttorneys. Use this digital tool to find the legal help you hopefully do not need. It is better to have it and not need it than to need it and not have it!