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

If you’ve been injured on the job, you may be filing a workers’ compensation claim. But, insurance companies won’t give you all of the facts upfront. Before you file your claim, there are some important things to make note of. Here are 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). Do so within 30 days.

construction worker carrying pipe

Photo by Yury Kim from Pexels

Next, the insurance company should notify you in writing of their decision as to whether to accept your claim. They will do this by filing one of these forms: 

  1. Employer’s Admission of Employee’s Right to Compensation – Form 60
  2. Denial of Workers’ Compensation Claim — Form 61
  3. 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 your Notice of Accident’s filing, and you have not received a response from the insurance company, contact an experienced attorney. An experienced attorney can protect you and get you the help you deserve.

  1. You have the right to an Independent Medical Examination (I.M.E.) at any point. 

The law says the insurance company has a right to direct your medical treatment. This means they decide who your doctor will be. However, suppose you are not satisfied with what their doctor is telling you and your treatment course. In that case, 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, 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. Suppose you and the insurance company cannot agree about a particular doctor. In that case, 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.

  1. The insurance company and your employer must provide you with your wage information to verify you are receiving the correct disability pay.

If 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. 

The formula assumes you worked for your employer for 52 weeks (one year) before the date you were injured. If you worked for the company for 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 receive the correct amount each week and that the insurance company is not short-changing you.

  1. Your employer cannot legally fire you because you have filed a workers’ compensation claim.

Termination is retaliatory discrimination, and some laws protect you against this. However, this is very difficult to prove because North Carolina’s laws provide that any employee is an employee at will and can usually be hired or fired by an employer “at-will” and with or without cause. Therefore, if you suspect you will be fired because you are unable to work due to your work injury, you should consult an experienced attorney who can protect you and advise you of your rights.

  1. 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 you are ignorant of the benefits without one. For example, you have the right to mileage reimbursement for doctor’s appointments.

Knowing the laws that protect you is crucial, 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. Contact us today for a free consultation.

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