While no two workers’ compensation cases are alike, all of them have one thing in common. When you file a claim for workers’ compensation benefits, the insurance adjuster will likely ask you to give a recorded statement, and then the adjuster will ask questions and you will answer them.
This blog addresses a critical question you will probably be asked that can make or break your North Carolina workers’ compensation claim: “Were you doing your usual work routine when this happened?”
What is Considered “Usual” or “Unusual”?
In North Carolina, 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 generally be the result of an unusual set of circumstances for you to obtain coverage. However, if the injury is the result of a usual activity that you routinely 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 typically 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.
How to Answer Insurance Adjuster’s Questions
When you sustain a work-related injury, it is important that you provide a detailed explanation about how your injury occurred. Omitting relevant facts could result in denial of your claim even if your employer or the workers’ compensation carrier initially 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 financial incentive the employer, and/or the workers’ compensation carrier, may have to deny your claim – especially if you have left out relevant factual information in a written accident report and/or a recorded statement. There are several ways that what you say in your workers’ comp recorded statement can trap you, so we recommend that you have an attorney present or on the phone with you when making this statement.
What to Watch for in the Recorded Statement
If you have been injured at work, the insurance adjuster may still request that you participate in a recorded statement even if you’ve been authorized to receive medical treatment for the work-related injury and/or have received compensation payments. North Carolina insurance claims adjusters know that if they are able to get you to agree that the injury was the result of how you usually performed the activity, then they may be able to legally deny the claim.
The Workers’ Comp Adjuster’s Open-Ended Questions
Adjusters sometimes ask fair open-ended questions during the recorded statement to try to get you to say nothing unusual happened.
It is important when asked an open-ended question by a workers’ comp insurance adjuster that you describe all possible unusual factors that may have resulted in your injury.
The Workers’ Comp Adjuster’s Trick Questions
On the other hand, some workers’ compensation adjusters seem to try to trap the injured employee. They might ask a leading question to try to get a specific answer in their favor.
Be truthful, but careful in how you answer this question. They may ask it several times and in several different forms during the recorded statement. It is important that you describe all possible unusual factors that may have resulted in your injury.
We recommend that you secure legal advice before going on record with an adjuster. A lot is at stake, and every word you use or do not use to describe a work-related injury can affect the outcome of whether your claim is ultimately accepted or denied.
Get a FREE Evaluation From an Experienced Workers’ Compensation Lawyer
The workers’ comp insurance company may have its own financial interests in mind instead of how to help you heal and get back on your feet. 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. Ideally, contact us or call us at 1-866-900-7078 before you proceed with a recorded statement.
Here at the Law Offices of James Scott Farrin, our workers’ compensation team has successfully helped thousands of injured employees.1 And we can fight for you, too.