Problems that injured workers experience in North Carolina
This guide addresses common problems that workers in North Carolina experience when they are hurt on the job and file a claim for medical and disability benefits under workers' compensation.
Many claims are unfairly deniedAll too often in North Carolina when an injured worker files a workers' compensation claim, that claim will be denied by the insurance company claims adjuster or the employer's risk manager. When they receive this denial, many workers assume that they have, once again, been messed over by the "system", do nothing about the denial, and go on with their lives as best they can.
In fact, many of the claims that are denied are very clearly legally compensable and valid claims. They are denied because the claims adjuster or risk manger want to save and keep the money that should go to pay medical bills and weekly disability benefits for the injured worker. They know that many workers, and maybe the majority of workers, will never get advice from a competent workers' compensation lawyer, never file for a hearing about the unfair denial; and, as a result the insurance company keeps the money that it should have paid out for the injured worker and makes more profits.
If you are injured on your job and your workers' compensation claim is denied, you should consult with a lawyer who knows workers' compensation law to see if you have a valid claim. If you do, then the lawyer can help you file for a hearing and hopefully get you the benefits that you deserve.
Most covered workers' compensation injuries in North Carolin must occur from an accident.Most workers assume that if they are hurt on the job, they must be covered by workers' compensation. That is not always true. If you are injured doing some routine activity on the job that you have done numerous times during your employment, and nothing out of the ordinary occurs at the time of the injury, your injury may not be covered by workers' compensation because it did not arise from and "accident" as required by the workers comp law.
An example of a real situation involved a firefighter who, at the end of their shift, realized that they had left some gear up on the back of the truck. They went up the ladder on the side of the truck and got the gear. They came back down the ladder which ended maybe 30 inches or so off the ground, jumped down, and felt immediate pain in their left knee. Ultimately the injury was diagnosed as a torn meniscus.
The firefighter filed an accident report, and within a day or so the claims adjuster called them and took a recorded statement. Since the claims adjuster knows that the law requires an "injury by accident", they asked a series of questions, some of them leading, to try to establish that there was no accident. Thus they asked how many times the firefighter had gone up and down that ladder. Answer: maybe a thousand. Were there any rocks or sticks on the ground that the firefighter landed on? Answer: no, it was the engine bay and smooth concrete. Was there any water or other substances on the floor where the firefighter landed? Answer: no, I just landed and felt immediate pain in my knee.
The claims adjuster denied the claim, and when the firefighter then called me, I immediately asked them if they had been interviewed. When I was told that they had, I made "guesses" as to the questions that had been asked and the answers given, which were basically the ones in the preceding paragraph. When the firefighter confirmed the answers that I expected had been given, I had to tell them that I could not win their workers' comp case because there was no "accident". Luckily the firefighter had arthroscopic surgery on their knee and returned to full duty within about a month.
Claims adjusters will say that an "accident" is a "slip, trip or fall". That is not entirely correct, as courts have found work-related injuries to be from an "accident" when there is something unusual that contributed to the injury. Thus if you are assigned to work on a new piece of equipment that you have never previously operated or worked on, and in the first few hours on that equipment you get injured because you are not familiar with it, that can be an "accident" that makes your injury compensable. Really anything out of the ordinary that may contribute to your injury can make it an "accident". In the example of the firefighter, if the gear that they were bringing down from off the top of the truck was exceptionally heavy --- much heavier than what they had normally handled on that ladder, that could make the incident into an "accident" under the workers' compensation law. If you claim is denied because "there was no accident", you should talk with a workers comp attorney.
Back injuries are "special" and DO NOT need to be casued by an "accident"While most injuries under the North Carolina workers' comp law must be caused by an "accident", because back injuries are often the most disabling ones, and often mean that the worker will never go back to work, several decades ago the workers' comp law was amended to remove the requirement for an "accident" with respect to a back injury. Instead, a back injury must only result from a "specific traumatic incident".
A "specific traumatic incident" means that you were doing something on your job and at a particular point during your work, you felt a sharp pain. Often that pain will go down one or more of your extremities, and sometimes be accompanied by tingling or numbness in the extremity. Since the "back" is defined as the entire spine, this applies to neck injuries as well as mid or low back injuries. Thus if you twist, or band over, or stand up, and you feel a sharp pain in your low back while you are at work, that is a "specif traumatic injury", and you should fill out an "accident report", even though there was no accident.
Many times the sharp pain in the low back or in the neck, with pain going down into a leg or an arm, happens because you were lifting something heavy. Even if lifting that heavy object is something that you regularly do as part of your job, and you have done it maybe thousands of times, and there was nothing out of the ordinary that occurred, your back injury should still be covered by workers' comp because it was caused by a specific traumatic incident.
To establish a back injury from a "specific traumatic injury", you do not need to know the exact time that the injury occurred. It is enough if you can give an approximate time frame and specify what you were doing when you felt the pain. Thus if you say in an accident report that the pain occurred maybe an hour after your lunch break and happened when you picked up a box/case of copy paper for the office copier, that is enough to establish a specific traumatic injury.
If you do experience back pain from a specific incident on the job, DO NOT wait to report it even though you think that it is just a minor "back strain" that will get better. The time limit for reporting injuries is 30 days. Hopefully the injury is just a "strain" that gets better. But if you wait and the pain continues with little improvement and you finally go to a doctor who orders an MRI which shows a bulging or ruptured disk, and by then it is maybe 40 days after the specific incident, your workers' comp claim may be denied because it was not timely reported.
If your claim is denied because it was "not reported" within 30 days, there may still be some ways around that to make your claim compensable. Even if it is correct that you did not fill out a written accident report within 30 days, you should still contact a workers' comp lawyer to discuss other facts that that could support a claim that the employer "had knowledge" of your injury.
Medical problems that arise from exposure to conditions at work over years may be coveredA separate category of "injuries" that are covered by the North Carolina workers' comp law, are known as "occupational diseases". These are medical problems or conditions that are caused by exposure to conditions or risks that are unique to your job. A common type of occupational disease claim is a "repetitive motion" injury. Thus someone who types on a computer key board for maybe 6 hours a day, and who, after many years of doing this, develops carpal tunnel syndrome in their hands, probably has an occupational disease claim that should be covered by workers' comp.
A different type of exposure on the job might be chemicals or dust that leads to things like breathing problems, or unique forms of cancer. Asbestos is certainly known to cause a very unique form of cancer, and if you have that form of cancer and had some exposure to asbestos on your job, maybe even many years ago, you may have a valid workers' comp claim.
Occupational disease claims are harder to establish than injury by accident claims. Often a worker who has developed a medical problem will come in and say that their doctor has told them that the conditions on their job COULD HAVE caused their medical problems. That statement from a doctor is not enough to establish a valid occupational disease claim. If all the doctor can say is that the conditions on the job "could have" or "might have" led to the medical problems, that statement also means that the conditions on the job might NOT have caused the problems. What a doctor will have to be willing to say in order for you to have a valid occupational disease claim, is that it is their professional opinion that it is at least "more likely than not" that the conditions at work caused or significantly contributed to the medical problems that the workers has.
The only way that you can determine if you have an occupational disease claim that will be covered by workers' comp, is to consult with a workers' comp attorney.
NEVER sign the medical release that the claims adjuster sends youOnce you fill out the paper work for a workers' comp claim, a short time later you will usually receive some correspondence from the insurance company claims adjuster. Included with that letter will be a medical release that they will tell you you have to sign and return to them. That medical release will allow them to get your medical records from any medical provider that you have ever seen for any kind of problem, disease, or injury, literally back to the day of your birth. Even worse, the medical release will authorize representatives of the insurance company or your employer to contact your medical providers either in writing or verbally, without you knowing they are doing that, to obtain information about you. One of the WORST THINGS that can happen in a workers' comp case, is for the claims adjuster to be talking to your treating doctor, perhaps making all kinds of mis-representations about you, your job, and how you got injured, without you even knowing about it.
Under the North Carolina workers' comp law, the employer and insurance company can get the medical records related to your on-the-job injury, if they are paying for the medical treatment, WITHOUT any medical release from you. Thus they do not really need a medical release signed by you if they are going to pay for the medical treatment required by your injury. Additionally, the only medical release that you are required to sign under the rules and regulations of the North Carolina Industrial Commission, the agency that administers the workers' comp law, is an Industrial Commission From 25C. That form ONLY authorizes the insurance company to get records related to treatment for your injury. More importantly, it DOES NOT allow representatives of the insurance company or the employer to talk to your treating doctor, unless you are present.
If you receive a medical release from your employer or the insurance company, DO NOT EVER SIGN IT. Instead, you should "respectfully decline" to sign it and indicate that you would be happy to sign an Industrial Commission Form 25C, if they want you to.