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Suffering injuries on the job can turn your life upside down. In addition to experiencing excruciating pain, you may also be forced to miss work, incur overwhelming medical bills, and be unable to enjoy your hobbies. Filing a workers’ compensation claim can help you secure much-needed benefits to cover your medical expenses, lost wages, and other losses.
However, for many employees, the workers’ compensation claims process is shrouded in mystery. How long will it take to get a decision? When will the money arrive? The skilled and knowledgeable attorneys at Bradford Law have compiled this guide to help you understand more about the timelines and other aspects of the process.
Understanding the Workers’ Compensation Timeline
When you file a workers’ compensation claim in North Carolina, the insurance company must follow specific deadlines. Here is what you need to know:
The timeline for a North Carolina workers’ compensation claim generally follows these steps:
1. Injury Occurs
- Day of Injury: The employee sustains an injury or illness related to their work.
2. Notification of Employer
- Within 30 Days: The injured employee must notify their employer of the injury in writing. It’s recommended to do this as soon as possible to avoid issues with the claim. An incident report conducted by the employer maysuffice to satisfy this requirement.
3. Employer’s Report to the North Carolina Industrial Commission (NCIC)
- Within 5 Days of Notification: The employer must report the injury to its workers’ compensation insurance carrier or the NCIC if the injury results in more than one day of missed work, over $4,000 in medical expenses, or death. This is done by filing Form 19, “Employer’s Report of Employee’s Injury to the Industrial Commission,” with the NCIC. The employer is also required to provide the employee with a copy of the filed Form 19 and a blank Form 18, “Notice of Accident to Employer and Claim of Employee.”
4. Employer’s Decision on Compensation
- Within 14 Days: The employer or their insurance carrier must either accept or deny your claim. The insurer may begin paying benefits while reserving the right to continue investigating the claim for up to 90 days before making a final decision.
5. Medical Treatment
- The employee receives medical treatment. If the claim is accepted in North Carolina, the employer not only pays for the treatment but also typically has the right to choose the healthcare provider.
6. Temporary Total Disability (TTD) Benefits (Wage Replacement Check)
- After 7 Days of Missed Work: If the injury causes the employee to miss more than 7 days of work, they may begin receiving TTD benefits, which is typically two-thirds of their average weekly wage.
- After 21 Days of Missed Work: If the employee is out of work for more than 21 days, they can receive compensation for the first 7 days as well.
7. Maximum Medical Improvement (MMI)
- Time Varies: The employee reaches Maximum Medical Improvement (MMI), meaning their condition has stabilized. A doctor will then assess any permanent disability.
8. Permanent Partial Disability (PPD) Rating
- After MMI: If the employee has a permanent impairment, the doctor will assign a disability rating which determines eligibility for PPD benefits.
9. Settlement or Further Action
- After MMI: The case may settle through an agreement between the employee and employer/insurance company. If not, the case could proceed to mediation or a hearing before the NCIC.
- Within 2 Years of Last Payment: If the employee wants to reopen the claim for additional benefits after reaching MMI, they must do so within 2 years of the last compensation payment.
10. Disputes
- If your claim is denied or you do not receive the full benefits you believe you are entitled to, you can request a hearing before a Deputy Commissioner to decide your case and determine what benefits you are entitled to.
11. Appeal
- Within 15 Days of Decision: If the employee disagrees with the decision by the NCIC, they can appeal to the Full Commission.
This timeline can vary depending on the specific circumstances of the injury, the employer’s responsiveness, and whether disputes arise during the process.
Factors That Can Affect the Timeline
While these deadlines provide a general framework, several factors can influence the process’s length. These include:
- The Complexity of Your Case – More complex injuries may require additional investigation time.
- Medical Evidence – Delays in obtaining medical records or assessments can slow the process.
- Disputed Case– If the insurer contests your claim or an aspect of your claim, resolving it may take longer.
Working with an experienced Charlotte workers’ comp attorney can help you understand how the unique nature of your case might affect the timeline.
Handling Claim Denials
If the insurance company denies your claim, you can take the following steps:
- Request a Written Explanation – The insurer must provide specific reasons for the denial.
- Consider an Appeal – You have the right to appeal the decision through the Industrial Commission.
- Gather Additional Evidence – Strengthening your case with more medical evidence or witness statements can help during the appeal process.
Maximizing Your Claim’s Chances of Success
To improve the likelihood of a smooth claims process, the attorneys at Bradford Law recommend taking the following steps:
- Report Your Injury Immediately – Notify your employer as soon as possible after the incident.
- Seek Prompt Medical Care – Getting timely treatment creates a clear record of your injuries.
- Follow Your Doctor’s Orders – Adhering to prescribed treatments demonstrates your commitment to recovery.
- Keep Detailed Records – Document all medical appointments, treatments, and how your injury affects your daily life.
Need Help with a Workers’ Compensation Claim? Call Us Today
Understanding the workers’ compensation timeline can help you set realistic expectations and take appropriate action if delays occur. While the process can seem daunting, working with a skilled workers’ comp lawyer can help make it more effective and efficient. At Bradford Law, we have proudly served North Carolina clients for years. Our experienced attorneys can guide you through every step of your workers’ compensation claim.
Contact us today for a free case review. We’ll evaluate your situation, explain your rights, and help you pursue the compensation you need to recover and move forward with your life.
