When an employee in North Carolina reports an on-the-job injury to his or her employer, the employer will usually report it to the insurance carrier for investigation. At that point the insurance adjuster assigned to the claim will begin interviewing witnesses, including the injured worker. These adjusters typically call the injured worker on the phone and ask to take a “recorded statement” as part of the initial investigation of the case.
I have handled hundreds of workers’ comp cases over the past two decades, and based on my experience, I think that giving a recorded statement, without first consulting with a competent workers’ compesnsation lawyer, is a very risky thing for an injured employee to do. Here is why:
Keep in mind the insurance company’s goal–it is to make a profit. How does it make a profit? By investing reserves smartly, and by paying out as little as possible on claims. So the insurance company’s incentive is NOT to find out how you got hurt so that your claim can be paid. NO, the incentive is to find out some little fact that the carrier can use to justify denying your claim, and not paying anything on it. Remember, they are in business to make money.
What does this have to do with a recorded statement? Well, it is because you are not covered by workers’ compensation simply because you got hurt at work. Many on-the-job injuries in North Carolina are not covered because of the way the injury occurred. In the recorded statement, the injured worker has to be specific and detailed as to how he or she got hurt.
In order to be covered, you must get hurt in one of three ways:
You must be “injured by accident” which means that something unusual or out of the normal routine happened that caused your injury. Getting hurt while you are doing your normal job in the normal way is NOT an injury by accident, and is not covered by North Carolina workers’ compensation, unless you have an “STI.”
What is an “STI?” If you hurt your spine or get a hernia or rupture of some body part, you can be covered if you were injured because of a “specific traumatic incident” related to your work. A “STI” can be about anything– if you pick up a heavy box and feel something break in your lower back, or feel a hernia occur, then that is a covered injury, even though you pick up boxes every day and nothing unusual happened this time. So an “STI” supercedes the requirement of an “accident” when a back, neck, or hernia injury occurs.
The third way to sustain a covered injury is with an “occupational disease.” About 20 diseases are listed in the occupational disease statute, including such things as lead poisoning, asbestosis, and “bone felon.” There is also a catch-all provision that allows a work-related medical condition that develops over a period of time, such as carpal tunnel syndrome, to be covered, if your doctor believes that your work caused it and your work duties put you at a greater risk than the general public of developing the condition. Again, not every disease is covered, even if it was caused by your work duties.
Now, what I often see in a recorded statement is a somewhat vague and not specific description of how the person got hurt.
Here is a real-life example:
I handled a case recently in which the worker squatted down to check the air in the tire of a car. His foot slipped in some oil on the floor as he squatted and when it did, his knee was injured. His job required him to squat down a number of times per day to check tires. So, squatting down was a normal part of his job. Nothing unusual about it. What was unusual was the extra detail of the foot slipping. His treating knee surgeon explained that the foot slip put a sideways force on his leg as he squatted, and that sideways force caused the knee injury that required surgery.
But when he gave his recorded statement to the insurance adjuster, he did not mention that his foot slipped! He left out that detail because he did not know that it was important and the adjuster knew better than to ask for it. (Remember, the adjuster is not looking for a reason to pay your claim. The adjuster is pleased if you don’t give enough details, because then your case can be denied.) Because he did not mention this detail, he had to hire a lawyer and litigate the case. The record is closed and as I write this we are waiting on the decision from the North Carolina Industrial Commission. He got hurt 15 months ago, and if he had mentioned that one crucial detail in the recorded statement, his claim would have probably been covered without so much trouble.
This case illustrates the importance of being very clear and specific in the recorded statement, and why giving the statement will be bad for you if you don’t fill in all the details.
It makes sense for you to find out what is important before you talk to the adjuster, too. How do you find that out?
Well, that part is easy. Workers’ compensation lawyers such as the Bollinger Law Firm PC in Charlotte, NC will give an injured worker a free consultation and educate the injured worker on the applicable law.
If you get hurt at work, the smart thing to do is to get a free consultation from a Board Certified Specialist in Workers’ Compensation law, such as Bob Bollinger, before you return that call from the insurance adjuster. When you call the adjuster back, he or she will want to record the conversation. So be proactive and protect your rights. Don’t wait to see if they deny your claim before you talk to a competent workers’ comp lawyer.
The consultation with us is free, with no obligation on your part, and it could save you a year or two of hassle and hardship. If they deny your claim because you did not give all the details in the recorded statement, then you have dug yourself into a hole. You may be able to avoid that hole by getting a free consultation first, before you have that crucial recorded conversation with the insurance company.