When you have sustained an injury or illness on the job, you want to be sure you’re getting the benefits you deserve, so it is vital to understand the workers’ compensation process. These benefits come into effect the moment you are injured, and you typically don’t need to prove that your employer was at fault.
The issues you may encounter often lie with the employer’s insurance company. These businesses are looking to make a profit and will always avoid making large claims payments when they can. Keep these tips in mind as you seek treatment for your work-related injury or illness.
Let Your Employer Know
Any delay in notifying your employer of your illness or injury may give the insurance company a reason to delegitimize your claim. You should never fear being reprimanded or fired for a work-related injury. It is illegal for your employer to do so. If you face any retribution whatsoever, you should contact a workers’ comp attorney immediately.
Seek Medical Attention at Once
You should never put off medical care when you are injured on the job. In some cases, your employer may even offer to send you to the hospital via ambulance. If this is the case, accept the offer. When you delay seeking treatment, it can give the insurance company an excuse to deny your claim. If the injury or illness is not an emergency, be sure to see a doctor as soon as possible, as any delay could give them a reason to say your injury wasn’t severe or that it didn’t occur at work.
Don’t Delay Filing Your Claim
After you tell your employer that you have been hurt on the job, you must file a claim for workers’ compensation benefits. This will help to ensure that you get coverage for your lost wages and medical costs.
In most cases, it is best to apply for workers’ comp benefits within 30 days of your injury. Fortunately, the state of North Carolina allows you to file within two years of the date of the incident. Your employer should provide you with a workers’ compensation claim form, which you must fill out accurately to ensure proper processing.
Choose Your Doctor
You will need to see a doctor that your employer’s insurance company has authorized at first, but you will have the option to change that doctor if you are not comfortable with the treatment they provide. To do this, you must file Form 18 with the North Carolina Industrial Commission. Having a doctor who you trust is essential to your recovery and to maximize your benefits.
In some cases, the doctor your employer’s insurance company authorizes may have a conflict of interest. Although they are supposed to be objective, they may deny certain costly treatments or clear you to go back to work sooner than you should to maintain a mutually beneficial relationship with the insurer.
Give Your Care Providers Consistent, Specific Information
Regardless of how many doctors you see regarding your injury or illness, you must always be prepared to describe the incident in detail. Remember to be honest; don’t exaggerate your symptoms, but don’t make excuses for your symptoms either. The insurance company will look at these reports and try to find any reason to deny your claim.
Also, be sure to disclose any pre-existing conditions. Be sure to stress that any such condition was not a factor in the workplace incident that caused your injury.
Be Careful About Releasing Medical Records
In most cases, you should never release any medical records to the insurance provider other than those related to your workplace injury. Any health records previous to the day you were injured or became ill are, quite frankly, none of their business.
An insurance adjuster may try to convince you that you must sign their medical authorization to make your claim, but this is not true. In these cases, an attorney can help by advocating for you or creating a medical authorization for you.
Be Aware That They Are Watching You
The insurance company may be watching every step you take and may even hire a detective to keep track of you. You must always be aware of what you are doing and anything that you post on social media that could give them an excuse to deny your claim.
The insurer will also take a careful look at all of your medical records, so be sure to take your medications as prescribed, follow doctors’ orders, and don’t miss any therapy appointments. Any actions you take while being treated for your injury or illness may be scrutinized, as the insurance company seeks ways to deny your claim.
Keep Accurate Records
It is vital to keep an accurate account of every medical appointment, every form you fill out, and every detail of your workers’ compensation claim. Be sure to get copies of any form you fill out or sign. You should also keep a journal of each phone call you make or receive regarding your workplace injury and out-of-pocket expenses like gasoline to travel to appointments, parking fees, bandages, over-the-counter medications, and other expenses.
To be reimbursed for your gas, keep track of mileage and appointment dates. This may include trips to doctors, therapists, and pharmacies. You can request reimbursement periodically from the insurance company by providing this information, along with receipts.
Be Aware of Other Details
Many factors are involved with a workers’ comp claim, so be prepared for requests you are not expecting. For one, the insurance company may request that you get an Independent Medical Examination by one of their doctors.
In addition to such examinations, the insurance company will want to get your description of the workplace incident. Be aware, however, that they may attempt to ask trick questions. They may call you and ask to record the conversation while they ask you a few questions. It is always best to have an attorney with you when they question you about the incident.
In the unfortunate event that you are permanently injured, your claim will be based on the doctor’s assessment of the severity of your injury. Your disability rating will range from 5% to 100%, which will affect the amount you are eligible to receive for your medical care. An experienced attorney can guide you through any questions you have about this process.
Have a Reputable Attorney on Your Side
Facing the insurance companies when you file a workers’ compensation claim can be a challenge. This is especially difficult when you are suffering from your injury or illness and need to look out for your physical well-being. An attorney with experience in this field can make the process much easier on you, and M. Reid Acree is here to help. Please visit our website today to find out how we can help with your claim.