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Contact the Law Offices of James Scott Farrin 1-866-900-7078

One Key Question Can Make or Break Your Worker’s Comp Claim

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.

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.

*Each case is unique and must be evaluated on its own merits. Prior results do not guarantee a similar outcome.

Contact Information

Raleigh Law Office

4325 Lake Boone Trail, Suite 100
Raleigh, NC 27607
Phone: 919-834-1184
Toll Free: 1-866-900-7078

Durham Law Office

280 South Mangum Street, Suite 400
Durham, NC 27701
Phone: 919-688-4991
Fax: 800-716-7881

Fayetteville Law Office

2915 Raeford Road, Suite 204
Fayetteville, NC 28303
Phone: 910-488-0611
Toll Free: 1-866-900-7078

Charlotte Law Office

1001 Morehead Square Drive, Suite 350
Charlotte, NC 28203
Phone: 704-599-1078
Toll Free: 1-866-900-7078

New Bern Law Office

1505 South Glenburnie Rd, Unit P
New Bern, NC 28562
Phone: 252-634-9010
Toll Free: 1-866-780-3422

Greenville Law Office

702 G Cromwell Dr.
Greenville, NC 27858
Phone: 252-355-5205
Toll Free: 1-866-780-3227

Greensboro Law Office

300 N. Greene Street, Suite 850
Greensboro, North Carolina 27401
Phone: 336-665-7072
Toll Free: 1-866-900-7078

Goldsboro Law Office

214 South William Street, Suite 3
Goldsboro, NC 27530
Phone: (919)-731-2581
Toll Free: 1-866-900-7078

Henderson Law Office

514 Dabney Drive, Suite 200
Henderson, NC 27536
Phone: 252-492-4600
Toll Free: 1-866-900-7078

Roanoke Rapids Law Office

709 Julian R. Allsbrook Highway
Roanoke Rapids, NC 27870
Phone: 252-537-9670
Toll Free: 1-866-900-7078

Rocky Mount Law Office

3202 Sunset Avenue, Suite B
Rocky Mount, NC 27804
Phone: 252-937-4730
Toll Free: 1-866-900-7078

Sanford Law Office

703-B South Horner Boulevard
Sanford, NC 27330
Phone: 919-775-1564
Toll Free: 1-866-900-7078

Wilson Law Office

2315 Airport Blvd Suite A
Wilson, North Carolina 27896
Phone: 252-246-9090
Toll Free: 1-866-900-7078

Winston-Salem Law Office

301 N. Main Street, Suite 2409-C
Winston-Salem, NC 27101
Toll Free: 1-866-900-7078