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  1. #1
    Join Date
    Mar 2009
    Posts
    3

    Default Time Frame for Reporting Accident

    My workers compensation claim was made in the State of: NC

    There's actually no claim yet...just need some advice.

    My husband stepped off a piece of equipment and his knee popped, less than an hour before quitting time. It caused some discomfort, but nothing any normal person wouldn't just work through, so he didn't think much of it at the time.

    It wasn't until he got home that it started swelling and hurting. The next day, he went to work, filed an accident report first thing, and then worked all day. By the end of the day, he was miserable in his knee pain, and his employer called to set up a dr. appt. They told him at that time that they would cover all medical costs, and if he was out more than 7 days, they would pay his missed time, 100%. He believed and trusted them, and liked the idea of getting 100% pay instead of the 66.x% that WC pays.

    So he went to the dr. and the dr. assessed that he tore some cartilage, but scheduled an MRI to confirm, and put him out of work until further notice.

    As the hospital was setting up billing and insurance before the MRI (which has not be performed yet..scheduled tomorrow), the "big" boss at his employer all of a sudden says he's not paying for ANYTHING because hubby did not fill out accident report the day of.

    I read through the NC WC laws: Here are two key phrases under the "Notice of Accident to Employer" section:
    Every injured employee or his representative shall immediately on the occurrence of an accident, or as soon thereafter as practicable
    and
    but no compensation shall be payable unless such written notice is given within 30 days after the occurrence of the accident or death

    If I understand this correctly, he has 30 days to file that accident report and still get WC coverage, and that he DID report the accident "as soon thereafter as practicable" since the injury didn't "set in" until after he left work the day it happened.

    He plans to talk to the big boss about this, and point out that there's no law saying you can't get benefits if you didn't report the accident on the same day. If his boss is still pig-headed about it, should we file the WC ourselves? Should we hire a lawyer to help with that process? Am I understanding the wording about the time frame for reporting an accident correctly?

    Thanks!

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Time Frame for Reporting Accident

    Information for IW's is here...http://www.ic.nc.gov/ncic/pages/faq.htm#payments

    Q: What must an employee do when an injury occurs?

    A: Report the injury to the employer, orally and in writing, immediately and in any event within 30 days.

    Q: What should be done if the employer fails or refuses to report an injury?
    A: Employee should file a claim (Form 18 or 18B) within two years of the accident with the Industrial Commission.
    Actually, there are 2 years to file with the WC commission.
    But the form 18/18B should be filed now...
    It would probably not be a good idea to confront your ''big boss'' with your knowledge of the 'law'.

    If the claim has been accepted, appearantly it has... then the medical will be taken care of, and the TTD/66.66% of the average weekly wage will be provided, according to the 'laws'.

    They told him at that time that they would cover all medical costs, and if he was out more than 7 days, they would pay his missed time, 100%. He believed and trusted them, and liked the idea of getting 100% pay instead of the 66.x% that WC pays.
    Who is ''they/them'' that provided the information you are relying on ..?
    The TTD rate is defined in the rules, and IF the ER opts to supplement that amount, that would be thier option. The TTD is also subject to min/max rates. So you may not receive the full 2/3's of the pre injury wage.

  3. #3
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Time Frame for Reporting Accident

    yes he should file the claim directly with the carrier asap.
    neither the injured employee nor the paying employer have the authority to deny or approve work comp benefits. If the carrier denies then your husband can appeal to the comp commission.
    a bogus denial could also be against state fraud statutes

  4. #4
    Join Date
    Dec 2007
    Posts
    775

    Default Re: Time Frame for Reporting Accident

    You might read here a bit. You'll find that worker's compensation is a nationwide horror show. especially for those who have soft tissue injuries in our joints. I begin to suspect that the employer may be lacking coverage (which doesn't improve your situation one bit).

  5. #5
    Join Date
    Mar 2009
    Posts
    3

    Default Re: Time Frame for Reporting Accident

    "They" is my hubby's immediate supervisors. Apparently, the employer regularly handles injuries internally, without filing WC, so "they" were following normal procedure. The "big" boss (plant owner/mgr) was absent, but gave approval for this by phone call.

    Not until a week later, when sorting out details for paying for the MRI did the owner suddenly decide that he would not foot the bill. I guess the idea of taking care of the situation internally, and not filing WC was to keep the employer's insurance rates down, because they do have coverage.

    Thanks for the advice...off to dl the form 18 now!

  6. #6
    Join Date
    Dec 2007
    Posts
    775

    Default Re: Time Frame for Reporting Accident

    I would read more first. This is not to suggest that you let the time frame pass. Having an MRI denied for up to a year is standard practice in w/c. You may have options that haven't been considered.
    Last edited by lost in connecticut; 03-10-2009 at 07:20 AM.

  7. #7
    Join Date
    Mar 2009
    Posts
    3

    Default Re: Time Frame for Reporting Accident

    Have learned that the employer's Employee Handbook states that you must report an accident immediately or Employer will not be responsible.

    I'm thinking there's no way a company's employee handbook overrides WC rules and regulations....


    Lost In Connecticut...I'm so overwhelmed by all the information. Could you give me a starting point or a couple ideas?

    I have learned, from speaking with my state's Industrial Commission, that I can call employer's insurance carrier and go ahead and get expedited authorization to do the MRI (pending their approval, of course, so who knows how long that could take).

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Time Frame for Reporting Accident

    I guess the idea of taking care of the situation internally, and not filing WC was to keep the employer's insurance rates down, because they do have coverage.
    WC IC"s have different policies and vary by state...some provide for higher deductibles before coverage kicks in (like your home/auto coverage)...some have no deductible at all... that too would depend on how the state provides the sale of a WC policy.

    So, yes, 'they' would have some decision making authority in the early stage of a claim.


    I don't know that the 'boss' has much ground here in denying payment for treatment when the code is pretty clear in the reporting mandate...'immediate' carries an addional defination of '30 days'...
    Q: What must an employee do when an injury occurs?

    A: Report the injury to the employer, orally and in writing, immediately and in any event within 30 days.
    WC=Workers Compensation
    IC= Insurance Company
    CA= Claims Examiner
    AA=Applicant's Attorney
    DA=Defense Attorney
    Atty=Attorney
    TTD=Temporary Total Disablitity
    TPD=Temporary Partial Disability
    PPD=Permanent Partial Disability
    P & S= Permanent and Stationary
    MMI=Maximal Medical Improvement
    MSC=Mandatory Settlement Conference
    DOR= Declaration of Readiness to Proceed
    EH=Expedited Hearing
    AD= Administrative Director
    WCJ=Workers Compensation Judge
    PJ=Presiding Judge
    Stips w/FM=Stipulation with Future Medical Care
    C&R Compromise and Release http://www.workerscompensationinsura...ad.php?t=27550

  9. #9
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Time Frame for Reporting Accident

    technically they are violating the law on self-inurance requirements by not reporting claims to the carrier and "handling" them internally. your husband can file a complaint with state Insurance commissioner

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