In a Workers’ Comp Claim, the Injured Employee has to Prove Just About Everything

What You Need To Know About North Carolina Workers’ Comp Claims

If you have a workers’ comp claim and it is denied, you probably understand that it will take some work to win in court. What you might not understand is that you have to keep proving that you have some disability every day that you claim workers’ comp. It doesn’t matter if your case is accepted or denied, it is your responsibility. That is hard to get across to some people who think they are doing everything right in their claims: maybe going to a doctor they didn’t choose, undergoing painful treatments, meeting with nurses, etc. But this is a legal case, and the burden to produce evidence is on the injured worker for most things. Sometimes regular, everyday things that injured workers do will just look bad in court. Injured workers seeking workers’ comp benefits, or wanting to keep the ones they have, ought to keep that in mind too.

For example, lets learn about Joe Jr. Joe Jr. drove a bus for five years before he hurt his back. He was injured when he hit an 80-year-old driver who turned left in front of the bus. Joe wasn’t surprised to learn that he would have to bring a lawsuit against the elderly driver’s insurance company. He wasn’t surprised when he was suspended by the bus company after the accident, even though he was not at fault. He figured that the company would follow procedure and take him for a drug test. Joe Jr. knew from what others said that he would have to go to the company doctor for any medical treatment for his back. What he didn’t expect was a form in the mail threatening to cut off his compensation because the insurance company said they had discovered he was working.

Joe’s dad, Joe Sr., owned a body shop. Joe Jr. was raised working on cars and when his father needed a hand, he lent one. Joe Jr. wasn’t supposed to lift more than 50 pounds, according to the company doctor, and at his dad’s body shop he didn’t even get close to the limit. Joe Jr. liked hanging around with his dad watching TV and using the shop’s computer to look for jobs. He was floored when he finally opened an envelope from a lawyer he’d never heard of, giving him 17 days to respond to the Industrial Commission or have his workers’ comp benefits stopped.

Joe Jr. is a big believer in rules. He’s played by them for years – going to work every day on time, never making a fuss. He got excellent reviews from his supervisors and was never written up. He was not doing any work with his father or anyone else. So when he gets the notice that his claim is in jeopardy, he is dumbfounded. How could he be treated this way? He did everything right. It just isn’t fair.

Nothing in workers’ comp is fair.

This is a lawsuit, just like the one he is going to have against the other driver’s insurance company, and Joe Jr. is going to have to act like it.  Joe Jr. is supposed to be looking for work and reporting any work he does to the defendants. If asked, he has to complete a Form 90 that says that if he does work while receiving workers’ comp, it could be considered as fraud. He should know that people may be watching him and recording and writing down his every move. Videos of his activities may be shown in court and may be shown to the doctors. Fair? No. Part of the evidence? Yes.

What should Joe Jr. do? He needs help to respond to the attempt to stop his benefits. He should see an attorney who knows how to answer these accusations. There should be evidence admitted that supports his claim that he did not work when he was spending time at the body shop. There should be evidence admitted that Joe Jr. was looking for work. Because even if he wins this round, it may be appealed. Joe Jr. doesn’t want to be in a courtroom alone, either with his workers’ comp claim, or the personal injury lawsuit.

Joe Jr. needs to be very careful about coordinating his two cases because the workers’ comp insurance company has the right to get the money back that it paid. There are ways that a worker’s personal injury claim can really work to an injured worker’s advantage. But Joe needs a lawyer to help.

The best thing Joe Jr can do at this point is:

• Following through with looking for work
• Responding to the attempt to stop his compensation
• Understanding that he has to fight for his claim.

This is an excerpt from Attorney Valerie Johnson‘s book, Workers Comp 101. Her experience has taught her that it’s not always easy for an injured worker to figure out what workers’ comp is supposed to do and the kinds of benefits that workers’ comp can provide. This book can help you know what to do to get your medical treatment is paid and to get money for food on your table and gas in your car. You will see how some employees got it wrong and nearly failed, so that you can get it right.  Download the book for free now!