If you’ve been hurt on the job, you may be asking yourself, “What are the three main requirements to obtain workers’ compensation?” The question deserves attention and holds significant relevance. Workers’ comp exists to protect injured employees, but it can be a confusing, technical system with deadlines that aren’t always clear when you’re dealing with pain, medical bills, and loss of income.
Understanding Workers’ Compensation
The basic idea of workers’ comp is simple. If you get hurt or sick due to your job, you should receive medical treatment and financial support. In reality, not every claim is approved. The legal requirements for workers’ compensation claims are complex, and insurance companies frequently attempt to reject or challenge valid claims.
When they find out that their claims are contested, many injured workers are taken aback. Insurance companies and employers might contend that:
- The ailment was pre-existing, and the injury did not occur at work
- You were not an actual employee
- The documentation was either late or lacking
Insurance firms are companies. They want to keep their payouts to a minimum. Because of this, even sincere and diligent workers frequently have to fight for benefits they assumed would be available to them.
In North Carolina, employers in the private sector reported 68,600 nonfatal occupational illnesses and injuries in 2023. Of all the cases recorded, 63,700 were injuries, and 4,900 were illnesses.
Requirement 1: You Must Be an Employee
The first requirement for workers’ compensation eligibility involves meeting your state’s legal definition of an employee under workers’ compensation laws. This may seem like a simple requirement, but it is often not. Many employers have workers perform their duties as independent contractors to avoid having to pay any insurance premiums.
The fact that your employer or the person you work for has deemed you a contractor does not automatically make that true in the eyes of the law. The reality of many workers’ comp cases is that the dispute is over the level of control the company exercises over your work.
Questions revolve around whether they set your work schedule, provide your equipment, or supervise your work. All these factors could mean that you are considered an employee for purposes of receiving benefits under the law, despite what your contract or paperwork might say.
Requirement 2: Your Injury Must Be Related to Work
The second basic requirement is that your injury or illness has to be related to your job. A workers’ compensation claim needs to cover all types of workplace trauma, such as falls and crushing accidents, as well as injuries from lifting tasks.
The requirement encompasses occupational diseases that become apparent after prolonged exposure. The most common types of these injuries include repetitive stress injuries, back injuries, and lung diseases that develop because of breathing in dangerous materials over a period of time.
These types of claims are usually fought vigorously by insurance companies. One of the most common defenses used is that the illness or disease was not caused by the workplace but by something else. Obviously, in order to get benefits, a worker needs to prove that strong medical evidence is present, and usually requires the help of a Winston-Salem workers’ compensation lawyer.
Requirement 3: You Must Follow the Required Deadlines
The third main requirement in order to receive workers’ compensation benefits is to follow the legal deadlines to report and file your claim. Failing to give notice in a timely manner can result in even a valid claim being denied. You must give notice within 30 days of the injury or accident. After giving notice, there are various forms required by the state to start the workers’ compensation process.
The forms need to be completed correctly and submitted on time. One of the most common reasons for a workers’ comp case to fail is a missed deadline. This is especially true for claims for occupational diseases, where the injury or illness may not manifest itself until years after first being exposed to a harmful substance. Certain special rules determine when the filing deadline begins in these situations.
Reach Out to a Workers’ Compensation Attorney for Assistance
Reid Acree Jr. has been representing sick or injured workers for 35 years. He is a Board-Certified Specialist in workers’ compensation law and is also a superior court mediator. Mr. Acree is highly respected and has earned many awards and positive reviews for his dedication to injured workers. Your workers’ compensation case is in very capable hands when you partner with M. Reid Acree Jr., Attorney at Law, P.A.
FAQs
Q: What Qualifies for Workers’ Comp in NC?
A: In North Carolina, workers’ compensation typically applies to injuries or illnesses that occur in the course of employment. This coverage extends to sudden accidents and both repetitive stress injuries and occupational diseases. The worker must be an employee, not an independent contractor, and report the injury within specified time limits to be eligible for benefits.
Q: Can You Get Workers’ Comp for a Pre-existing Condition?
A: Yes, you may be able to get workers’ comp for a pre-existing condition if performing your job worsens your existing condition. Under North Carolina law, coverage is allowed for injuries that speed up or make worse a pre-existing condition or merge with it. The important part is demonstrating that work activities were a substantial cause of the disability or need for treatment. A doctor must provide documentation to prove the connection.
Q: What Are the Four Elements of a Workers’ Compensation Claim?
A: There are four key elements of a workers’ compensation claim. The employee status of the worker is required alongside employer compliance with workers’ compensation laws, while the injury must originate from work duties and happen during employment. In most cases, all four elements must be established to have a valid claim.
Q: What Should I Not Say to a Workers’ Comp Adjuster?
A: When speaking to a workers’ comp adjuster, do not say that you are okay, the injury is your fault, or the injury occurred at home or during your free time. Avoid speculating about medical diagnoses or minimizing your pain. Any statements that you make can be used to limit or terminate your benefits. It is usually in your interest to be cautious, truthful, and as concise as possible.
Hire a Workers’ Compensation Lawyer
Hire a workers’ compensation lawyer today if you are looking to make a claim. M. Reid Acree Jr., Attorney at Law, P.A., can help you fight for your rights. Contact a workers’ compensation attorney at our firm today for a consultation.