You should immediate retain a qualified workers comp attorney. While I would need to know more about the specifics of your case, back injury cases are usually easy to establish. You need to contest the denial. Continue using your own health insurance in the meantime.
From: Damon Duncan, Workers' Comp Attorney with offices in Charlotte, Greensboro & Winston-Salem, NC
I agree with John. You need to hire an experienced workers' compensation attorney ASAP because they can help you with the insurance company and can work to get your claim possibly accepted.
Happens all the time. Hopefully you have a good workers' comp lawyer going to the mediation with you. If not, you should get one.
This answer is intended as general information and not as specific legal advice. If you want to have a free consultation with me, please contact me through AVVO.
If your injury was not reported right away, it is not uncommon for the insurance to deny it. The judge will ultimately make a decision based on many factors: (1) were there witnesses (2) how long did it take to report? (3) why didn't you report it right away, did you first think it was a minor incident (4) when you did report it, who did you tell? (5) was a report taken? (6) how soon did you get medical treatment? (6) it's good if you reported to your doctors that the claim was work related. The list goes on and on.
I agree with the others that you should find an attorney. At the hearing, the Judge will hear your side of the story. Judges often find in favor of the injured worker. They denied it this way because they agree it happened, but question if it happened while you were at work. That is what it sounds like from the 2 letters you described. In this case, the judge will make a decision. If he finds you believeable, he will reverse the denial.
If claim was delayed, as you also indicated, the employer may still be investigating, ie talking to your managers and co workers.
What an unfortunate welcome to the workers’ compensation world! I have seen workers’ compensation carriers deny claims because of an alleged failure to timely report the injury. The Workers’ Compensation Act does require than an employee provide written notice of their injury within 30 days. However, the courts have held that if the employer had actual knowledge of the injury, no written notice is required. The timing of when you told your employer will be an important factor in your case.
You say that you have a mediation coming up- that should mean that a request for a hearing has been filed. The mediation is a way to resolve the claim without a ruling from a judge. If you do not resolve your case at mediation, you have the right to ask the judge to order the Defendants to pay for your medical care, lost time from work and permanent injury. I urge you to consult with an attorney who is a Workers’ Compensation specialist- so they can advise you on how best to pursue your case and how cases like yours are valued. Good luck!
Martha Ramsay is a North Carolina attorney. As such, her responses to posted inquiries, such as the one above, are limited to her understanding of law in the jurisdiction in which she practices and not to any other jurisdiction. In addition, this answer is not a substitute for a proper legal evaluation of the facts in your specific case. Additional facts may alter the evaluation. Do not rely upon this answer to decide whether or not to pursue a claim. There are time limits in legal claims and this answer does not evaluate those time limits. No attorney-client relationship has been created by this answer.
DO NOT GO TO A MEDIATION WITHOUT AN ATTORNEY! It will not go well for you. The next step after mediation is an actual hearing on your claim. Again do not go to the hearing without an attorney. Your odds of success are greatly diminished if you do not have an attorney. Some people do not hire an attorney because they do not want to pay a percentage of their claim with an attorney. However, receiving 75% of good settlement or judgment is a whole lot better than receiving 100% of nothing.
It is common for insurance companies to deny cases. They do not make money by paying claims. A delay in notifying your employer is a common reason for a denial. People can hurt their backs anywhere and in an infinite number of ways. The insurance company will try to argue that you did not hurt your back at work but rather hurt it off the job.
I hope the epidural helps. My experience is that they generally provide only short term relief.
You potentially have a serious injury. The decisions you make now could affect the rest of your life. You will not be surprised that my advice is to hire a lawyer.
I am licensed to practice law only in North Carolina. My answer provides only general information. Do not rely on this answer as specific legal advice for your particular situation. This answer does not form an attorney-client relationship. You should consult with an attorney to fully discuss your situation and to obtain advise about your legal rights and obligations.