If your employer or their insurer disputes your claim for workers’ compensation benefits, the burden is on you to prove your eligibility. This requires a medical diagnosis and evidence of a link between your job duties and/or work environment and your injury.
When you see a doctor for a work-related injury or illness, you should tell the doctor about your job duties that may have caused your cumulative trauma. Evidence to support your claim may include a job description that details your job duties and testimony from supervisors or other coworkers about your job requirements.
Often, workers with cumulative trauma can speak about job requirements that include:
- Repetitive motion, such as in a computer, typing, or other clerical work, or production or manufacturing jobs
- Repeated lifting, lowering, reaching, pushing, pulling
- Bending, stooping, twisting, working in awkward positions
- Prolonged use of vibrating tools, such as hand-held power saws, power drills, or chipping hammers.
Generally, the employer or the employer’s workers’ comp insurance provider chooses the doctor to treat the worker or offers a list of doctors to choose from and directs medical care for work-related injuries. You must see the selected doctor and adhere to their treatment plan. You may request a second medical opinion, which may be presented as evidence when appealing a denied claim or refusal to pay certain medical benefits.
If you and the workers’ comp insurance administrator cannot agree on a doctor to give a second opinion, you can file a request that the Industrial Commission agree to accept a second opinion from a doctor of your choice.
How To Proceed With a Cumulative Trauma Claim In North Carolina
Once you have been diagnosed with a work-related cumulative injury, it is your responsibility to notify your employer that you need to file a claim for workers’ compensation benefits. You must give written notice of the occupational disease within two years of the time a doctor informed you that your condition was caused by your work, or within two years of death or disability from the occupational disease. N.C. Gen. Stat. § 97-58
Never trust your employer to file the claim for you. Do it yourself to be sure it has been done properly. You have up to two years from the latter of the date a doctor told you that your condition was caused by your job or the date you were first disabled by your cumulative trauma. N.C. Gen. Stat. § 97-58.
To file for workers’ compensation, submit a Form 18 Notice of Accident with the N.C. Industrial Commission and send a copy to your employer.
Within a few weeks of filing a claim, your employer or its insurance carrier should either accept your claim and begin paying benefits or deny the claim.
Your employer should take care of all necessary work to obtain workers’ compensation benefits for you or contact you with an explanation as to why your claim is being denied. If your claim is denied, you may request a hearing before the North Carolina Industrial Commission to restate your case for benefits. This is the first appeal opportunity in a multi-stage appeals process, which becomes more formal and adversarial at each step. You would be very unwise to go to a hearing without a lawyer who specializes in workers’ compensation. People who represent themselves rarely win.
If your employer ignores your claim for workers’ comp benefits, orders you back to work, or threatens your employment, you should speak to an experienced North Carolina workers’ compensation lawyer as soon as possible.