Reasons to File a Formal Workers’ Compensation Claim if the Employer is Already Paying for Your Medical Benefits and Lost Wages

Posted on Tuesday, November 5th, 2019 at 10:22 am    

It’s tempting for many North Carolina and Virginia workers to think that their employer and the employer’s insurance company are on their side – especially when they’re paying you 2/3rds of your lost wages and paying for your medical bills. While this may seem nice, it can hurt your case in many ways. The best course of action is to consult with an experienced work injury lawyer who will protect your rights by filing a formal workers’ compensation claim on your behalf. The bottom line is that if you are not under an Award in Virginia or you do not have an Accepted Claim in North Carolina, your benefits are in serious jeopardy. 

In Virginia, a claim is formally started by way of a Claim Form. In North Carolina, this is done via a Form 18. 

Some of the reasons workers need to file a formal claim, instead of relying on the informal kindness of their employer are:

  • The employer can stop the payments at any time. Without a formal Award Order from the Virginia Worker’s Compensation Commission, the burden remains on the employee to show he or she cannot work. If the injured worker is released to return to light duty, even a lifting restriction of one pound, the employer and insurance carrier are within their rights to CUT OFF BENEFITS. Why? Because there has been no pronouncement by way of an Award Order that the injured worker is entitled to benefits. 
  • The filing of a Claim Form starts the clock running for the employer/carrier to declare whether or not they are accepting or denying the claim. The Virginia Workers Comp Commission (VWCC) will typically issue a 20-day Order which requires the employer or carrier to declare one way or another what their position is and why. If they agree your claim is compensable, they will issue an Award Agreement, which is usually filled out and sent to you by the claims adjuster or defense attorney. You should have that Agreement reviewed by a competent Workers Compensation Attorney before signing, but you SHOULD NEVER let an Award Agreement sit around unsigned without either signing it and sending it back to the adjuster or consulting a worker’s comp lawyer. This is because once the Agreement is received by the VWCC, they will convert it into an Award Order, which means you have won your case. 
  • In Virginia, once the Award Order is entered and 30 days pass, the burden of proof then automatically shifts to the employer. Now, even if the injured worker is released to light duty, the benefits will not stop unless and until the employer can either return the injured worker to work in the pre-injury job, or find another job at the same or greater pay for the injured worker. 
  • In North Carolina, the Form 18 starts a 90-day countdown whereby the employer is required to let the injured employee know whether or not they are accepting the claim, conditionally accepting the claim, or denying the claim. They do this through one of three forms: 

A Form 60 is Filed by the Carrier if they are accepting the claim. 

A Form 63 is filed by the Carrier is they are conditionally accepting the claim (i.e. they need to investigate a few things first)

A Form 61 is filed by the Carrier if they are denying the claim. 

  • There are time limits that you have to file a claim, which are two years from the date of injury. Workers who don’t file a claim could:
    • Lose the right to lifetime medical care for your work injuries, and potential settlement of the employer’s lifetime obligations;
    • Lose the right to receive any further ongoing compensation, even if your doctor removes you from work due to your injuries. 
    • Lose the ability to be compensated for a permanent impairment rating. These ratings, applied after the employee reaches maximum medical improvement, often provide substantial additional benefits for workers who can return to work (and those who can’t return to work) – but have a permanent medical injury that meets the state law requirements
    • Lose the right to seek vocational rehabilitation if the worker can’t return to an old job but may be able to learn the skills for a new job
    • Other benefits depending on your health status

Employees should understand that there is no expense to file a claim but, as mentioned, there are time limits – generally one day less than two years from the date of the accident. These limits can be extended in some cases if the employee is receiving benefits, but a competent worker’s comp attorney should be consulted to see if you are being protected appropriately. When in doubt, FILE. 

 

Virginia and North Workers’ Compensation Attorney Joe Miller Esq. has the experience and skills to help you get your full benefits and help you fight attempts by the employer to terminate or reduce your benefits. He has helped thousands of workers get strong recoveries and has been representing injured and ill workers for more than a quarter of a century. To speak with a persuasive workers’ compensation attorney, call lawyer Joe Miller at 888-667-8295. or use my contact form to schedule an appointment.