Quick Summary: Three common mistakes that can create unnecessary problems in a North Carolina workers' compensation claim are:
1) waiting to report the injury,
2) failing to clearly communicate with your doctors, and
3) returning to work before you are ready.
None of these mistakes automatically destroys a workers' compensation claim. There may be legitimate reasons for delayed reporting, incomplete medical records, or an unsuccessful attempt to return to work.
But decisions made during the first days and weeks after a workplace injury can affect medical treatment, disability benefits, and how the insurance company evaluates the claim.
Here are three mistakes injured workers should try to avoid.
One of the easiest ways to create an unnecessary problem in a workers' compensation claim is to wait to tell your employer that you were injured.
North Carolina law specifically addresses notice of a workplace accident. Under N.C.G.S. § 97-22, an injured employee should provide written notice to the employer immediately or as soon as practicable. The statute generally requires written notice within 30 days, although there are exceptions where the employer already had knowledge of the accident or where the employee has a reasonable excuse and the employer was not prejudiced by the delay.
But 30 days should not be viewed as a recommended waiting period.
From a practical standpoint, the best approach is usually to report an accident immediately, the same day, and in writing.
Consider an employee who finishes an eight-hour shift without mentioning an injury, goes home, and then reports the following afternoon that he hurt his back at work the previous day.
That does not mean the employee is being dishonest or that the claim is invalid.
There may be a reasonable explanation. Some injuries do not initially seem serious. An employee may experience relatively minor soreness, expect it to disappear overnight, and only realize the next morning that something is actually wrong.
But the delay creates questions that would not otherwise exist.
"If the injury happened at work, why didn't you tell anyone before leaving?"
There is also now a period of time between leaving work and reporting the injury. The carrier may investigate whether something could have happened outside of work during that period.
Delayed reporting can also deprive the employer of the opportunity to investigate while the information is fresh. The employer may have been able to speak with coworkers, inspect the location, preserve surveillance video, document equipment involved in the accident, or immediately send the employee for medical treatment.
Verbal notice is better than saying nothing, but written documentation is preferable.
If you immediately tell your supervisor that you were injured, a good supervisor will often ask you to complete an incident report.
If that does not happen, create some documentation yourself.
A simple text or email may be enough to establish when and how you reported the injury:
"I wanted to document that I hurt my back lifting equipment at work this afternoon. I reported it to John before leaving, but my back is continuing to hurt and I may need medical treatment."
It does not need to contain legal terminology.
The important points are what happened, when it happened, what part of your body was injured, and that the injury occurred while working.
Best practice: Report a workplace injury immediately, preferably before leaving work, and make sure there is written documentation.
Medical records are often some of the most important evidence in a workers' compensation claim.
But doctors can only document and respond to the information they receive.
One common mistake is trying to be agreeable or optimistic during a medical appointment instead of clearly explaining what is actually wrong.
There is nothing wrong with having a positive attitude. But when your doctor asks how you are doing, saying "I'm okay" or "getting better" is not particularly helpful if you are still experiencing significant pain and limitations.
You are at the doctor because you are hurt.
Explain what hurts, what has changed, and what you cannot do.
The initial medical history can be particularly important.
If you injured your shoulder lifting something at work, tell the doctor exactly that.
There is a significant difference between:
"My shoulder hurts."
and:
"I was lifting a heavy box at work yesterday when I felt a sharp pain in my right shoulder."
The first statement documents shoulder pain.
The second explains when the symptoms started, what you were doing, and how the condition relates to your work.
That distinction can become important if the insurance company later disputes whether your medical condition was caused by the workplace accident.
A pre-existing condition does not necessarily prevent an employee from receiving North Carolina workers' compensation benefits. You can read more about pre-existing conditions in our dedicated article.
If you already had a problem involving the same body part, do not hide it from your doctor.
Instead, accurately explain your condition before and after the workplace injury.
For example:
"I have had a sore back a few times in the past, but never to the extent where I've had to miss work or get any serious medical treatment. When I lifted the equipment at work, I felt an immediate sharp pain going down my leg. These symptoms are much worse and different from any back strain I have had before."
Or if you have had a significant prior injury:
"I had back surgery five years ago, but I haven't been having any symptoms or needed any treatment until this incident at work occurred."
Whether a workplace accident materially aggravated or accelerated a pre-existing condition can become an important medical-causation issue.
Doctors also need to understand your functional limitations.
If sitting for 20 minutes significantly increases your pain, tell the doctor.
If you cannot lift with your injured arm, explain that.
If bending, standing, walking, climbing stairs, driving, or sleeping has become difficult, say so.
This information can affect both the treatment plan and your work restrictions.
Do not assume your doctor knows what your job requires or understands your limitations unless you explain them.
The same principle applies as treatment progresses.
Suppose you have completed several weeks of physical therapy and have made very little improvement.
Tell your doctor.
The fact that you like your physical therapist or are faithfully attending appointments does not mean you should say therapy is working when it isn't.
If conservative treatment has failed, the physician may consider diagnostic testing, injections, a specialist referral, or surgical options depending upon the injury.
That does not mean you should demand an MRI or surgery simply because you want one.
It means you should be an informed and active participant in your treatment.
You are often your own best advocate in the examination room.
Unfortunately, some doctors are not good communicators and do not give much attention to their patient's complaints. These types of doctors often have a pre-determined mindset about the injury and do not plan to deviate from their typical treatment plan. This can create a difficult situation where the medical records and doctor's opinions are not accurately showing the injured worker's struggles. In this scenario, it is important to maintain a calm demeanor and not create a hostile relationship with your doctor. Also, it can be beneficial to bring a family member or spouse to your appointments, as it will be harder for the doctor to be dismissive of multiple points of view. Finally, it can be helpful to submit your questions and concerns through the patient portal to make sure there is documentation of your reported problems, as the doctor may not be putting your concerns in the medical records in the detail you have discussed them. Even then, there is no guarantee the doctor will be a good patient advocate.
Best practice: Be accurate and detailed. Explain how the injury happened, how your condition changed, what you cannot do, and whether treatment is actually helping.
Returning to work is one of the more complicated parts of a workers' compensation claim.
Many injured workers understandably want to get back to their jobs. Returning to work can be an important part of recovery when it is medically appropriate.
The problem arises when an employee returns before he or she is physically ready, or returns to a job that exceeds the restrictions imposed by the treating physician.
An employer cannot simply decide that an injured employee has recovered and order the employee back to unrestricted work regardless of the medical evidence.
The treating physician's restrictions are extremely important.
An employee may be completely out of work, released to regular duty, or released with restrictions such as:
If the employee has restrictions, the employer may offer a light-duty or modified position intended to accommodate them.
That does not necessarily mean the employee should refuse the position.
In fact, refusing suitable employment can have significant consequences under N.C.G.S. § 97-32, as weekly disability benefits can be withheld due to an unjustifiable refusal of suitable employment.
Ideally, the treating physician should be given an accurate description of the proposed light-duty job and determine whether the employee can safely perform it. If approved, the doctor should sign and date the job description.
That does not always happen as cleanly as it should.
Sometimes a doctor receives an incomplete job description that does not list the physical requirements, such as how much lifting is required. Sometimes the practical demands of the position are different from what appears on paper. And sometimes an employee attempts the position only to discover that working eight hours significantly aggravates the injury.
Those problems should not simply be ignored.
Explain what you actually do at work, how many hours you are performing it, and which activities are causing problems.
If the job is causing increased symptoms, tell your doctor.
The physician can then determine whether the restrictions need to be modified or whether you need to be taken out of work completely.
There is also a practical medical benefit to delaying a return to work.
An injured employee who is completely out of work may have considerably more time to rest, attend physical therapy, perform home exercises, attend medical appointments, and allow the injured body part to recover.
Returning to an eight-hour workday changes that equation.
Now the employee may be working all day while also trying to attend therapy, complete rehabilitation exercises, manage pain, and recover.
For some injuries, an appropriate light-duty position can be beneficial.
For others, returning too quickly may aggravate symptoms or slow recovery.
The treating physician should be making those medical decisions based upon accurate information about both the injury and the actual job.
There is another practical consequence that injured workers sometimes overlook.
If an employee is completely out of work and receiving weekly disability compensation, the insurance company is paying an ongoing weekly benefit while the claim continues, and they are generally more motivated to provide medical treatment and other benefits that will lead to a return to work.
If that employee returns to work earning the same wages, the carrier may no longer be paying that weekly disability benefit.
That can materially change the practical dynamics of the claim. Once the employee has successfully returned to work at full wages, that particular ongoing expense may be reduced or eliminated, and often the insurance company has less motivation to provide benefits in the claim.
That does not mean an employee should stay out of work simply to create settlement leverage.
The goal of workers' compensation is not to remain disabled. If you have medically recovered and can safely return to your job, returning to work is generally a positive development.
The important point is that you should not rush the process merely because an employer or insurance carrier wants you back at work.
Your return should be based upon your actual medical condition and appropriate medical restrictions.
There is another complication when an employee has not yet begun receiving weekly disability compensation.
An employee may believe:
"If I try light duty and can't do it, I'll just stop working and workers' comp will start sending me checks."
It may not be that simple.
Whether disability compensation begins can depend on the status of the claim, whether compensability has been accepted, the medical evidence, the employee's restrictions, the circumstances surrounding the unsuccessful return to work, and other factors.
An employee who stops working may therefore find himself or herself in the difficult position of having no paycheck and no immediate workers' compensation check.
This is one reason return-to-work disputes can become legally and financially complicated very quickly.
Do not simply suffer through it without telling anyone.
Tell your doctor specifically what is happening. If you don't have an appointment coming up, request an appointment or message the doctor through the patient portal.
For example:
"I've been working the modified job for a week. After about three hours of standing, my back pain becomes significantly worse and the pain starts going down my leg. By the end of the shift I'm having difficulty walking."
That gives the physician useful information.
The doctor may leave the restrictions unchanged, modify them, reduce the employee's hours, or take the employee back out of work depending upon the medical circumstances.
What an employee generally should not do is independently decide to stop reporting to work without understanding the potential consequences for the workers' compensation claim.
Best practice: Follow your doctor's restrictions, make sure the doctor understands the actual demands of any light-duty position, and immediately report if working is materially aggravating your symptoms.
These three mistakes have something in common: they are much easier to address before a serious dispute develops.
An attorney can help an injured worker determine how an accident should be documented, identify potential reporting or causation problems, review medical records, explain the significance of work restrictions, and help navigate a proposed return to work.
This is particularly important with return-to-work issues because the correct response may depend upon whether the claim has been accepted, whether weekly benefits have started, the physician's restrictions, the proposed job, and the employee's actual ability to perform it.
Waiting until after benefits have been terminated, a light-duty dispute has developed, or the insurance company has denied the claim can make the situation considerably more difficult.
For that reason, we generally recommend speaking with a workers' compensation attorney as early as practical rather than waiting for something to go wrong.
When choosing an attorney, an injured worker may also want to consider whether the attorney regularly practices workers' compensation law and whether the attorney is a North Carolina Board Certified Specialist in Workers' Compensation Law.
Many workers' compensation disputes begin with relatively small decisions. None of the mistakes discussed in this article necessarily destroys a workers' compensation claim. But each can create an issue that did not need to exist or make it harder to get the benefits you deserve.
In my experience, getting legal advice early can help prevent a manageable issue from becoming a much larger problem. You can discuss all aspects of your injury and case with your attorney in real time, as opposed to trying to fix a problem that has already occurred.
Three relatively simple decisions can have a significant effect on a North Carolina workers' compensation claim:
Every claim is different, and return-to-work issues in particular can involve important legal distinctions.
David Galbavy is a North Carolina Board Certified Specialist in Workers' Compensation Law and represents injured workers throughout North Carolina. You can learn more about David's experience and qualifications here.
To learn more about workers' compensation representation from Galbavy Law, visit our North Carolina Workers' Compensation page, or contact Galbavy Law to discuss your claim.
This article is provided for general informational purposes and is not legal advice. Every workers' compensation claim depends upon its particular facts.
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