Filing a Workers' Compensation Claim

Filing a claim in NC involves submitting the proper form to the North Carolina Industrial Commission (NCIC). The crucial form for employees is Form 18, titled “Notice of Accident to Employer and Claim of Employee.” After you report the injury to your employer, you (the injured worker) should complete Form 18 and send it to the NC Industrial Commission to officially start your claim. You can file Form 18 electronically on the NCIC website, or by mail or fax to the Commission. It asks for information like the date and description of your injury. It’s a good idea to provide a copy of Form 18 to your employer as well when you file it. Your employer, in turn, files the employer report (Form 19) and should notify their insurance carrier, but Form 18 is your responsibility. Remember that simply telling your employer about the accident is not the same as filing the claim – you still need to submit Form 18 to the state.

There are two key deadlines to keep in mind:

1. 30-Day Notice to Employer: As mentioned, you must notify your employer of the injury within 30 days of the accident (preferably sooner). Failing to do so could jeopardize your claim, unless you have a valid excuse and the Commission forgives the delay.
2. Two-Year Statute of Limitations: You have up to two years from the date of injury to officially file your workers’ comp claim with the NC Industrial Commission. This is usually done by submitting Form 18. If you don’t file the claim within two years, you will likely lose your right to benefits, even if you gave timely notice to your employer. (For occupational diseases, the two-year clock may start from the date of diagnosis or disability, but don’t delay in any case.)

In short: report the injury to your employer ASAP (within 30 days) and file Form 18 with the NCIC well before two years pass. It’s best not to procrastinate—start the process early while details are fresh.

Once a claim is filed, a few things happen behind the scenes:

• Insurance investigation: The employer’s workers’ compensation insurance carrier (or the employer, if self-insured) will investigate the claim. They may review accident reports, talk to your supervisor or witnesses, and examine your medical records. They might also require you to be evaluated by a doctor of their choosing (this could be an Independent Medical Examination (IME) to get a second opinion on your injury).
• Acceptance or denial: After investigating, the insurance company will either accept the claim (agree it’s compensable) or deny the claim. If accepted, you should start receiving benefits – payment for missed wages (if eligible) and medical cost coverage. You might receive a formal notice, often a Form 60 (accepting the claim and listing benefits) or Form 63 (conditionally accepting pending further investigation). If the insurer denies the claim, they will issue a Form 61 denial explaining the reasons.
• NCIC oversight: The Industrial Commission is notified of the claim and will oversee the process. If the claim is accepted, the Commission mostly just ensures compliance. If denied or if disputes arise, the Commission can step in to resolve issues (for example, through mediation or a formal hearing).

During this time, it’s important to follow your doctor’s orders and keep all documentation. The initial period can be confusing – don’t hesitate to communicate with the insurance adjuster or the NCIC if you have questions on status. If an unreasonable amount of time has passed with no answer, you or your attorney can prod the insurer or request a hearing.

You are allowed to file and pursue a workers’ comp claim on your own, and many straightforward claims are resolved without an attorney. However, workers’ comp can become complex, especially if there are complications like a denied claim, disputes over medical treatment or disability level, or pressure to return to work prematurely. Many injured workers in Greenville choose to consult with a workers’ comp attorney to ensure all forms are filed correctly and deadlines met, and to have an advocate if the insurance company challenges the claim. An experienced attorney can help if, for example, your claim is denied or your benefits are cut off early – we can request hearings, negotiate settlements, and generally protect your rights. While it’s not required to hire a lawyer, doing so may be beneficial if you feel overwhelmed or if any red flags arise (denials, retaliation, complicated medical issues, etc.). Tip: Most NC workers’ comp attorneys offer free consultations, so you can at least get an initial case review at no cost.

If your employer doesn’t cooperate – for instance, they insist the accident wasn’t work-related and refuse to report it – you can file the claim yourself directly with the Industrial Commission. Complete and submit Form 18 to the NCIC on your own, which officially notifies the state of your injury. You should also inform the employer (and you likely already did), but they cannot block you from filing. The workers’ comp claim is ultimately between you, the Commission, and the insurance carrier. The NCIC will notify your employer and their insurer once your Form 18 is received. It’s illegal for an employer required to have insurance to fail to report a valid injury, but if they do, take matters into your own hands by filing. You have the right to pursue benefits with or without your employer’s help. If you’re concerned your employer lacks insurance altogether, you should still file with NCIC; the Commission has processes to handle uninsured employers (and can penalize the employer). In summary, don’t let an uncooperative boss stop you – file the claim and get advice if needed.