Common Workers’ Compensation Delay Tactics Seen in North Carolina [2024]

Navigating the workers’ compensation process can be challenging, especially when faced with deadlines, bureaucracy, and lengthy deliberation periods. That’s why understanding some of the most common workers’ compensation delay tactics seen in North Carolina can help employees protect their rights and take proactive steps to avoid prolonged claim processing times.

Delays in receiving benefits can place a tremendous financial and emotional burden on injured workers who rely on them to cover medical expenses and lost wages.

1. Requesting Repeated DocumentationOne of the most common tactics used to delay a workers’ compensation claim is requiring excessive documentation. In North Carolina, insurance companies—or employers—may ask injured employees to provide redundant or unnecessary medical records, additional statements, or even duplicate forms. This tactic can create a loop of endless paperwork, slowing down the entire process and sometimes even discouraging employees from pursuing their claims.
2. Denying Claims Without Clear ExplanationAnother way that some insurance providers delay compensation is by denying claims without offering specific reasons. This lack of clarity forces employees to navigate a confusing appeals process without a clear understanding of why their claim was rejected.An unexplained denial can also result in delays as workers gather additional evidence to support their cases, adding time and stress to the process. To counter this tactic, injured employees in North Carolina can request detailed explanations for their denial and gather legal support to build a strong appeal.
3. Delaying the Initial InvestigationFollowing a workplace injury, insurance companies are required to investigate claims to determine their validity. In some cases, however, this investigation may be deliberately slowed down, causing delays in receiving compensation. Employers or insurers may claim that they need additional time to review medical records, speak with witnesses, or verify workplace conditions, all of which can delay benefits.Injured workers should follow up frequently to keep their cases active and prevent undue delays. Consulting a workers’ compensation attorney can also apply pressure on insurers to expedite the investigative process.
4. Questioning the Validity of the InjuryA common tactic used by some insurers is to question the legitimacy of the injury. This strategy involves scrutinizing whether the injury truly occurred at work, if it aligns with the employee’s duties, or whether it is as severe as claimed. Insurers might argue that the injury happened outside the workplace or that it resulted from preexisting conditions in an attempt to downplay its impact.By casting doubt on the injury, the insurer can delay payments while requiring additional proof from the worker. Employees can counter this tactic by seeking medical documentation that clearly links their injuries to their workplace duties and timelines.
5. Claiming That the Injury Is Not Work-RelatedIn line with questioning the injury’s legitimacy, insurers may argue that an injury is not work-related at all. For instance, if an employee sustains a repetitive stress injury or suffers from an occupational illness that developed over time, the insurer might argue that it resulted from factors outside the job or preexisting conditions.Documenting the relationship between the job and the injury with detailed medical records, statements from colleagues, or expert opinions can strengthen the worker’s claim.
6. Scheduling Independent Medical ExaminationsIndependent Medical Examinations (IMEs) are often requested by insurers to verify the extent of an injury, but they can also be used as a tactic to delay the process. In North Carolina, insurers can require workers to attend an IME conducted by a doctor of their choosing, which can delay the case if they schedule multiple appointments or question the results.Additionally, IME reports are often interpreted in a way that favors the insurer’s interest, which can lead to disputes over the severity of the injury and further delay the claim. Injured employees should consider obtaining second opinions from their own physicians to counter these reports and maintain momentum in the claims process.
7. Offering Low Settlement AmountsAnother delay tactic occurs when insurers offer a low settlement amount in the hope that the worker accepts it rather than endure further delays. These offers can be particularly tempting for employees who are in financial distress due to missed work. However, accepting a low offer without fully understanding the scope of their future medical needs and financial obligations can be detrimental in the long term.In North Carolina, injured employees have the right to negotiate settlements or even take their case to a hearing if they are entitled to more compensation.
8. Ignoring or Delaying CommunicationsInsurance companies sometimes stall a claim by simply not responding to inquiries in a timely manner. Workers might experience significant delays while waiting for updates on their claim status, answers to their questions, or approval of necessary medical treatments. This “waiting game” approach can discourage workers from continuing to pursue their claims or cause them to accept suboptimal terms.

FAQs

Q: What Is the Waiting Period for Workers’ Compensation in North Carolina?

A: In North Carolina, there is a seven-day waiting period before workers’ compensation benefits can begin. If the disability lasts longer than this period, the worker can seek compensation for lost wages. To receive everything that is owed to you, engage the assistance of a skilled attorney as soon as possible.

Q: What Is a Workers’ Comp Ghost Policy in North Carolina?

A: A workers’ comp ghost policy is a type of insurance coverage that shows proof of workers’ compensation for independent contractors or businesses without employees. It provides minimal coverage and is primarily used to fulfill legal or contractual requirements. If you are an independent contractor who was hurt on the job, it is important to seek legal counsel as soon as possible.

Q: What Is the Coming and Going Rule in Workers’ Comp in NC?

A: The “coming and going” rule typically excludes injuries sustained during an employee’s commute to and from work. To put it plainly, the employee was injured while “coming and going.” However, certain exceptions apply if the travel is part of the employee’s job duties; for example, business trips or running errands for work. Insurance companies use this rule to disqualify workers from benefits.

Q: How Are Workers’ Comp Settlements Calculated in NC?

A: Workers’ compensation settlement amounts in North Carolina are calculated based on medical expenses, wage replacement, and the severity of the injury. Specific formulas are used to determine the appropriate compensation based on the worker’s average weekly wage and impairment ratings. This amount is generally two-thirds of the worker’s salary, but there is a maximum cap. This cap fluctuates yearly.

Consult the Seasoned Attorneys at Ayers, Whitlow & Dressler

If you have been injured at work, the team at Ayers, Whitlow & Dressler is prepared to fight for your rightful compensation while advocating for your rights. We can deal with the paperwork—and the insurance companies—so you can focus on your recovery.

Contact us today for a consultation.