Make Sure Your Headed In The Right Direction

It always helps to know where you are headed. Your workers' compensation claim is no exception. All claims are different, but can generally be grouped into two categories:

Accepted Claims

If the insurance company admits that you were injured in the course and scope of your employment, you have an accepted claim. The insurance "should" arrange all necessary medical treatment so that you can recover from your injury. The insurance company will get to dictate which doctors you treat with for your injury. If you are unable to work, your doctor "should" write you out of work. If you are written out of work, the insurance company "should" start sending you weekly checks equal to 2/3 of your average weekly wage.

Once you have completed your treatment or have reached maximum medical improvement, the insurance company "should" have you evaluated to determine if you qualify for a Permanent Impairment Rating. If so, the workers' compensation doctor "should" assign an appropriate rating to your affected body part(s). An impairment rating entitles you to a lump sum payment that is determined by the particular body part, the level of impairment and your average weekly earnings. The insurance company will try to push you back to work as soon as possible so that they can stop paying you benefits. Similarly, the insurance company will try to cut off your medical treatment as soon as possible to save on expenses.

The insurance company will not tell you, but you may have the option of signing a "clincher" agreement once your injury has stabilized. A "clincher" is a settlement of claims in exchange for a lump sum of cash. Clincher agreements can include payment for future medical expenses and/or future lost wages. Most clients like this option for several reasons. First, a clincher agreement gets a client the maximum settlement possible. Second, a clincher agreement allows a client to take control of his or her medical treatment moving forward. (rather than allowing the insurance company to control treatment)

Denied Claims

The insurance company loves to deny claims. This saves the insurance company time and money. A "denied claim" can mean that the insurance company refuses to pay for your medical treatment. It can also mean that the insurance company refuses to pay you weekly benefit checks. When an insurance company wrongfully denies part or all of a claim, Alliance Law Group can file a Form 33 with the North Carolina Industrial Commission. The Deputy Commissioner assigned to your case will then schedule a date and time for a hearing.

Assuming that we are successful at the Form 33 hearing, you should then receive appropriate medical care and financial benefits. If this happens, your claim will often function like an "accepted claim" moving forward. You should be eligible to recover for any permanent physical impairments and you may also be in a position to enter into a "clincher agreement" to settle out your claim. As explained above, a "clincher agreement" allows a client to receive a lump sum payment for future medical treatment and/or future lost wages. Many clients prefer this option because it gets them the maximum settlement possible.

**Please click here for a more complete flow chart illustrating the possible paths that a claim can take.