Effective resolution of a workers’ compensation claim begins by successfully navigating the injury reporting requirements of the NC Workers’ Compensation Act. Failure to do so can result in significant difficulties and issues throughout the life of the claim. Straightforward internal practices should be implemented to ensure accurate and proper claim reporting.

Requirements under the Act

The Act sets out the requirements for reporting workplace injuries in N.C.G.S. 97-92; “Employers must keep a record of all injuries, fatal or otherwise, received by employees in the course of their employment,”. Under Rule 104, an employer is required to file a Form 19 when the claimant is absent from work for more than one day or the medical compensation paid on the claim exceeds $4,000.00. The Form 19 requires information like the name, nature, and location of the business, and the name, wages, and occupation of the injured employee. Most importantly, the form requires the date and hour of the injury and when the supervisor first knew of the injury. If there is not a witness to the accident and the employer is simply describing the accident as the employee described it, make note of that in the description of injury section of the form.

An employer must provide the employee with a copy of the Form 19 when it’s filed along with a Form 18.

The Form 19 is simply notification of an injury or occupational disease and does not satisfy an employer/insurer’s obligation under the Act to respond to an employee’s Form 18. Once a Form 18 is filed with the Commission, an employer/ insurer has 30 days from notice by the Commission of that claim to either:

1. accept the claim for medical and indemnity compensation via Form 60,
2. deny the claim via Form 61, or
3. accept the claim for indemnity and/or medical compensation via Form 63, Section 1 or 2, respectively.

If a Form 63 is filed, an insurer then has 90 additional days from the date the employer had notice of the claim to investigate before accepting or denying the claim in part or in full. As a result, if an employer was aware of an injury early on, the insurer is bound by the employer’s notice and may not have additional time to investigate the claim.

Failing to Report

Failing to meet the reporting or acceptance/denial requirements could lead to monetary sanctions assessed by the Industrial Commission. Employers could face up to a $25 dollar fine for not reporting an injury to the Commission, and insurers can face “reasonable sanctions” from the Industrial Commission for failing to accept or deny a claim. This is typically a $400 fine assessed by the Commission. This penalty is extremely difficult to get out of, and thus, making a compensability decision within the 30 days after the acknowledgement of the Form 18 filing is important.

Effective Reporting Procedures

Employers should take measures to ensure that they have standard procedures for reporting work-place injuries and that supervisors are well-trained on those procedures. Supervisors need to know that accuracy and timeliness are key factors when reporting an injury. When an employee is injured at work, supervisors should take care to ensure that the employer’s internal accident report notes the date, time and location of the injury, the mechanism of injury, the exact body part(s) injured (including left, right, lower back, etc.) Ideally, the accident report should identify any witnesses to the incident and the employer should corroborate the witness information in a separate, written statement that is also signed and dated by the witness. Capturing and documenting as much information as possible on the front end of a claim will go a long way to ensure that employers/insurers are not paying for treatment or benefits that are not related to a work injury.