Category: Workers’ Compensation

What’s the difference between a Form 60 and a Form 63?

Workers' Compensation

These are the two forms which defendants use to accept a claim before the Industrial Commission. A Form 60 is an outright acceptance of the claim. It’s difficult for an insurance company to get off the hook if they’ve filed this. As a result you are more likely to see an adjuster file a Form 63.

Technically, a Form 63 is supposed to be used if an adjuster isn’t sure if a claim is compensable. She has 90 days to investigate the claim and then deny it if she needs to. If she takes no action within 90 days the claim is accepted. There are two things to look out for. If you have a Form 60 it may be very limited – they are only accepting your low back, not your hips, legs, or upper back for instance.

Additionally, a Form 63 is often misused as a 90-day trial. If your case looks like it’s going to be expensive the claim is going to be denied without regard to the actual facts of how you got hurt. We’ve actually had an adjuster testify to that tactic, under oath, before the Industrial Commission.

What am I supposed to do with a Form 19?

Just hang onto the Form 19. The Form 19 is the acknowledgement from your employer and/or their insurance company that you’ve reported a claim. If you haven’t set up a file at home for all your workers comp stuff, now is a good time to do so. If you haven’t received a Form 60 or a Form 63, follow up with your employer or the adjuster and ask for one.

What’s so important about a Form 18?

Workers' Compensation

A Form 18 is the form you use to formally open a file at the Industrial Commission. Just because your employer or the adjuster is sending you to a doctor doesn’t mean they’ve accepted the claim. And it doesn’t mean you have a claim on file with the Industrial Commission. More often than you’d think an injured worker reports his claim to his employer, gets some medical treatment, and returns to work. After a while the injury is acting up and bothering him but when he tries to go back to the doctor his adjuster denies the claim saying that a Form 18 was not timely filed with the Industrial Commission. The fact that everyone “knew” about the claim doesn’t always make a difference. The Industrial Commission needs that Form 18. This is the only irrefutable way to have a claim established.

My employer told me to file this claim on my health insurance. What’s wrong with that?

Workers' Compensation

Here’s a great “lawyer answer”… it depends. What we worry about is when an employer tries to avoid telling their workers’ compensation carrier about a claim. It’s sort of like getting into a fender bender in a parking lot. You may be tempted to pay the other guy $500 to get his car fixed and keep everyone’s insurance company out of it. While that works with dents on fenders it’s not so clear that it works with internal injuries on workers.

If it gets you medical treatment more quickly and efficiently than waiting around for an adjuster we’re all in favor of putting the bill on health insurance. But if your boss isn’t reporting the claim to the adjuster this could be a big problem. We’ve seen it happen dozens of times: when the doctor takes you out of work you’ve got no income coming in. You chase down a workers’ compensation adjuster who in turn chases down your employer and asks why this wasn’t immediately turned in for handling. At that point your boss can admit he tried to handle it in house. Or he can blame you for everything.

Sadly, we’ve seen a lot of injured workers get the short end of a stick just because they tried to help the company out. You really need to think this through carefully. Our rule of thumb is that it is usually fine if it speeds up treatment and it’s your idea. We’re less thrilled by it when the employer is telling you to do it right off the bat.

I’m not sure my employer has workers’ compensation insurance. How do I find out?

Workers' Compensation

Call us. We can help track this down. Every employer is required to advise the Industrial Commission of this although many do not. Smaller companies are prone to skipping this and certain business types like construction, home health agencies, and small trucking companies seem to neglect this as well. By law they are all required to keep that information posted where all employees can see it regularly. Any employer who has three or more employees regularly working is required to carry workers compensation insurance.

If you’re employer is making it difficult to find out who their carrier is you may well have a problem on your hands. It certainly suggests that they aren’t keen on complying with North Carolina law. And that makes your situation all the more precarious.