While no two workers’ compensation cases are alike, all of them have one thing in common. When you make a claim for workers’ compensation benefits, the workers’ compensation insurance adjuster will likely ask you to give a recorded statement, whereby the adjuster will ask questions and you will answer them.
This blog addresses a critical question you will probably be asked: “Were you doing your usual work routine when this happened?”
How to Answer Adjuster’s Questions
When you sustain a work-related injury, it is important that you provide a detailed explanation as to how your injury occurred. Leaving out relevant factors could result in denial of your claim even if your employer or the workers’ compensation carrier authorizes you to receive medical treatment and compensation payments.
The North Carolina Workers’ Compensation Act allows your employer and the workers’ compensation carrier to make these payments from up to 90 days after receiving notice of your injury.
The more serious your injury is or becomes, the greater the likelihood the employer, and/or the workers’ compensation carrier, may potentially deny your claim if you have left out relevant factual information in a written accident report and/or a recorded statement.
What Is Considered “Usual” or “Unusual”?
If you have sustained an injury to a body part other than your back as a result of a specific incident at work, the injury must be the result of an unusual set of circumstances for you to obtain coverage. If the injury is the result of a routine activity that you usually do at work, it may not be covered. For example, an auto repairman may routinely get down on one knee to change a tire. If, on a particular occasion, he kneels in the same manner as he routinely does and sustains a meniscus tear to his knee, the injury will probably not be covered.
Insurance companies are for-profit businesses. And some may look for any reason to try to deny some claims. Leaving out factors that show that the circumstances resulting in your injury were unusual at the time of the injury may result in an initial denial of your claim or a denial within 90 days of the notice of your claim.
Typically, even after an injured employee may have been authorized to receive medical treatment for a work related injury and/or received compensation payments, the workers’ compensation adjuster will request that you participate in a recorded statement. The adjuster knows that if they are able to get the injured employee to agree that the injury was the result of how the employee usually performed the activity, then the adjuster can legally deny the claim.
Adjusters sometimes ask fair open ended questions such as, “What, if anything, unusual occurred that resulted in your injury?” It is important when asked this question that you describe all possible unusual factors that may have resulted in your injury.
On the other hand, we have seen some adjusters set out to trap the injured employee. For example they might ask a leading question such as, “Isn’t it true that you were doing your usual job routine when you were injured?” Be truthful, but careful in how you answer this question. They may ask it several times and in several different forms during the recoded statement. Again, it is important when asked this question that you describe all possible unusual factors that may have resulted in your injury.
We believe it is safer that an injured employee secure counsel for advice before going on record with an adjuster. A lot is at stake. Every word you use or do not use to describe a work related injury can determine the outcome of whether your claim is ultimately accepted or denied.
If your claim is denied because you left out relevant facts in a written accident report or in a recorded statement, we urge you to seek legal counsel. Here at James Scott Farrin, we have successfully helped thousands of injured employees.1
Get a FREE Evaluation From an NC Workers’ Compensation Lawyer
Sadly, your workers’ comp insurance company may have their own financial interests in mind instead of helping you heal and get back on your feet.
With experienced workers’ comp attorneys who deal with these issues every day, including six North Carolina Board Certified specialists in workers’ compensation law, we do have your best interests in mind. Before you proceed with a recorded statement, contact us or call us at 1-866-900-7078.