If you get injured or become ill due to your job in North Carolina, you may be entitled to workers’ compensation benefits.
Workers’ compensation is a type of insurance that provides benefits to employees who are injured or become ill due to their job.
In North Carolina, filing a workers’ compensation claim can be confusing, so here’s a step-by-step guide to help you out.
Step-by-Step: How to File a Workers’ Compensation Claim in North Carolina
While filing for workers’ compensation varies from case to case, the typical process is as follows:
Step 1: Report Your Injury to Your Employer
The first step in filing a workers’ compensation claim is immediately reporting your injury to your employer.
You can do this orally or in writing, but it’s always best to have a written record of your report. Reporting your injury promptly ensures that your claim is not denied for failing to meet the reporting requirements.
Step 2: Seek Medical Treatment
Seek medical treatment right away. Make sure to tell the doctor that your injury is work-related so that they can provide proper documentation.
The medical evidence of your injury is crucial in the workers’ compensation process, so keep a record of all medical treatment you receive. You will most likely have to first see an authorized physician selected by your employer.
Step 3: Fill out Form 18 Workers’ Comp
To officially file a workers’ comp claim, complete Form 18 from the North Carolina Industrial Commission or your employer.
Fill out the form with as much detail as possible, including the date, time, and location of the injury and the names of any witnesses.
After completing Form 18, submit it to the North Carolina Industrial Commission. You can do this online or by mail. Make sure to keep a copy of the form for your records.
Step 4: Wait for a Decision
Once you’ve filed your claim, you’ll need to wait for a decision from the North Carolina Industrial Commission.
It will review your claim and determine whether you’re eligible for workers’ compensation benefits. If your claim is denied, you can appeal the decision.
In addition to Form 18, you may need to complete several other NC workers’ compensation forms and provide additional information, depending on the circumstances of your claim.
The process can be complicated, so you are wise to seek guidance from a workers’ compensation attorney if you encounter any difficulties.
First Report of Injury
When an employee reports their injury to their employer, the employer must complete a Form 19.
This form is called the first report of injury (FROI), and it is to be submitted to NCIC. The FROI must be submitted regardless of the employer’s position and whether they agree, accept, or deny the claim.
The FROI will include basic information about the accident and injury, including where it occurred, when a supervisor was first notified, and the employee’s wage information. After an FROI is completed, your employer will have an opportunity to respond to the claim.
What Response Can I Expect from My Employer?
In North Carolina, an employer can respond in several ways to workers’ compensation claims.
These responses include:
- Accept the claim – An employer can accept the claim and begin providing workers’ compensation benefits to the injured employee.
- Deny the claim – An employer can deny the claim, which means they believe the employee is not entitled to workers’ compensation benefits. They must provide a reason for the denial and file Form 61 with the North Carolina Industrial Commission.
- File a Form 60 – This is the employer’s response to a workers’ compensation claim. The employer must file this form with the North Carolina Industrial Commission within 14 days of receiving the claim. The form must indicate whether the employer accepts or denies the claim.If your employer’s workers’ comp carrier agrees you were injured on the job and have a compensable injury, they will file a Form 60 admitting you are to be compensated. Importantly, this does not specify the type or amount of compensation or medical treatment your employer agrees to pay for.
- File a Form 63 – If an employer disputes the medical treatment or the amount of benefits paid, they can file a Form 63 with the North Carolina Industrial Commission. This form allows the employer to request a hearing to resolve the dispute. Form 63 is a notice to the employee of payment of compensation or medical benefits without prejudice. If an employer submits Form 63 to NCIC, your employer agrees to provide initial medical benefits or pay. However, submitting Form 63 does not mean your employer admits to liability, and often your claim will continue to be investigated.
- Negotiate a settlement – Employers and employees can negotiate a settlement of the workers’ compensation claim outside the formal hearing process. This can involve agreeing to a lump sum payment or other terms.
It’s important to note that if an employer denies a workers’ compensation claim, the employee can appeal the decision and request a hearing before the North Carolina Industrial Commission.
If My Claim is Denied, What Are My Rights?
If your workers’ compensation claim is denied in North Carolina, you can appeal the decision and request a hearing before the North Carolina Industrial Commission.
The appeal process includes several steps:
- File a request for a hearing – You must file Form 33 (Request for Hearing) with the North Carolina Industrial Commission within two years of the date of the injury or the last payment of benefits.
- Mediation – Before a hearing, the Industrial Commission will order a mediation conference to see if the parties can settle.
- Hearing – A hearing before a Deputy Commissioner will be scheduled if mediation is unsuccessful. Both parties will present evidence and testimony to support their position at the hearing.
- Appeal – If either party is dissatisfied with the Deputy Commissioner’s decision, they can appeal to the Full Commission within 30 days of the decision.
- Judicial Review – If the Full Commission upholds the denial of your claim, you have the right to appeal to the North Carolina Court of Appeals and then to the North Carolina Supreme Court.
During the appeal process, it’s essential to have legal representation to ensure that your rights and interests are protected.
A workers’ compensation attorney can help you navigate the complex legal process and increase your chances of a successful outcome.
Our North Carolina Workers’ Comp Attorneys Are Here for You
Suffering an injury at work can be scary, and you may be worried about missing your job and a paycheck.
Filing a workers’ comp claim can feel overwhelming. Don’t face it alone. Let our attorneys do the work for you.
With offices in Winston-Salem and Charlotte, we have decades of experience handling workers’ comp claims for injured workers throughout North Carolina.