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5 Things the Workers’ Compensation Insurance Company Doesn’t Want You to Know


1. Once you notify the workers’ compensation insurance company in writing of your accident by filing your Notice of Accident (Form 18) the insurance company has 30 days to accept the claim, deny the claim, or request more time to investigate. Immediately following an accident at work you should file your Notice of Accident (Form 18).

Once you do so, within 30 days, the insurance company should notify you in writing of their decision as to whether to accept your claim by filing the proper form (Employer’s Admission of Employee’s Right to Compensation – Form 60, Denial of Workers’ Compensation Claim – Form 61, or Notice to Employee of Payment of Compensation without Prejudice or Payment of Medical Compensation without Prejudice – Form 63). If 30 days pass from your written notification and the filing of your Notice of Accident, and you have not received a response from the insurance company, be sure to contact an experienced attorney who can properly advise you what to do next. An experienced attorney can protect you and get you the help you deserve.

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2. You have the right to an Independent Medical Examination (I.M.E.) at any point, if you are not satisfied with the medical treatment you are receiving from the insurance company’s doctor. The law says the insurance company has a right to direct your medical treatment. This means they decide who your doctor will be. However, if you are not satisfied with what their doctor is telling you and your course of treatment, you have the right to request an I.M.E. To get this I.M.E. you should request a doctor in writing from the insurance company adjuster or defense attorney.

If you and the adjuster agree, then you will be allowed to see the doctor you choose. If the insurance company does not agree with your choice, then the adjuster may suggest other doctors. If you and the insurance company cannot reach an agreement as to a particular doctor, then the Court may force the insurance company to provide the I.M.E. with the doctor of your choosing or the Court may choose a different doctor for you to see.


Photo by Tim Pierce.

3. The insurance company and your employer must provide you with your wage information to verify you are receiving the correct disability pay. Provided you continue to meet your burden of proving that you are disabled because of your work injuries, the insurance company will issue you a check each week. Once the insurance company accepts your claim as compensable and begins paying this check, it should be two-thirds (2/3) of your “average weekly wage,” which is an average of what you made each week while working for the past 52 weeks before your injury. (That’s assuming you worked for your employer for 52 weeks (one year) before the date you were injured. If you worked for the company less than 52 weeks, then the calculation is more complicated and you should seek legal advice).

Your employer is required to fill out a Wage Chart (Form 22) that indicates the number of days you worked each month and the total monthly pay. By using this chart, you can verify that you are being paid the correct amount each week and that the insurance company is not short-changing you.

4. Your employer cannot legally fire you because you have filed a workers’ compensation claim. This is retaliatory discrimination and there are laws that protect you against this. However, this is very difficult to prove since generally North Carolina’s laws provide that any employee is an employee at will and can be usually be hired or fired by an employer “at will” and with or without cause. Therefore, if you suspect you are going to be fired because you are unable to work due to your work injury, you should consult and experienced attorney who can protect you and advise you of your rights.

5. Hiring an attorney could cost the insurance company thousands of dollars! Workers’ Compensation laws are very complex and are written to favor your employer and the insurance company. Of course the insurance company doesn’t want you to hire a lawyer because without one you are ignorant about what benefits there are (such as the right to get reimbursed for your mileage to and from your doctor and physical therapy appointments) and so you won’t know ask for those benefits.

Knowing the laws that protect you is crucial to getting proper medical treatment and to getting the compensation you deserve after your injury, especially if your injury is permanent and you cannot return to work. An experienced attorney can help you get the help you and your family deserve and make sure you don’t miss any benefits that will provide for you during your disability and beyond.

Don’t give up your rights when it comes to workers’ compensation. Call us today for a free consultation.

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