How to Appeal a Workers’ Compensation Claim Denial
When you get hurt at work, you may expect to receive workers’ compensation benefit payments to help with your recovery. However, your employer or its insurer may deny your claim, either due to a genuine belief that you do not qualify for workers’ comp or to avoid paying you benefits.
Fortunately, North Carolina’s workers’ compensation system allows you to appeal a claim denial. The system grants you several opportunities for an appeal, which may enable you to pursue the benefits that will help you recover from a work-related injury or illness.
How Long Does the Insurance Company Have to Accept or Deny My Claim?
Under the North Carolina Workers’ Compensation Act, you must report a work injury to your employer within 30 days of getting hurt. Once your employer receives notice of your work injury, it must accept or deny your claim within 14 days. However, your employer may issue a conditional acceptance of your claim, allowing them an additional 90 days to investigate and definitively accept or deny the claim.
What Are Some Reasons for Denying a North Carolina Workers’ Compensation Claim?
Even though you may have suffered an injury on the job, your employer or its workers’ compensation insurer may deny your claim. Some of the reasons why an employer or insurer might deny a workers’ comp claim include:
- You did not suffer a work-related injury or illness.
- Your injury or illness came from a pre-existing condition rather than a work-related cause or aggravation.
- You do not qualify as an employee.
- You suffered an injury at work while under the influence of alcohol or drugs or while engaging in horseplay.
- You failed to submit a claim in time.
- You failed to submit sufficient supporting evidence or documentation.
- You did not comply with medical treatment recommendations.
How Do I Appeal a Workers’ Compensation Claim Denial?
When your employer denies your claim, you can file a Form 33, Request That Claim Be Assigned for Hearing, with the North Carolina Industrial Commission (NCIC) to appeal the denial. You should also serve copies of your Form 33 to your employer and its workers’ compensation insurer.
After filing your Form 33, the Industrial Commission will schedule mediation sessions between you and your employer. During mediation, a neutral third party will manage discussions between you and your employer to settle your dispute over your workers’ compensation claim.
If you cannot resolve your dispute via mediation, the NC Industrial Commission will schedule a formal hearing on your claim before a deputy commissioner. During the formal hearing, you and your employer can present documents, witness testimony, and other evidence supporting your claims. After the hearing, the deputy commissioner will issue a written order ruling on your claim.
If the deputy commissioner rules against you, you may appeal the decision to the entire Industrial Commission, which has three commissioners. They will review your case to determine whether the deputy commissioner committed a procedural or legal error that warrants revisiting your claim.
From there, you can appeal to the North Carolina Court of Appeals if the Industrial Commission upholds the denial of your claim. The Court of Appeals will require you to submit a written brief supporting your appeal to argue how the Industrial Commission erred in denying your workers’ comp claim. The Court of Appeals may also schedule oral arguments where you or your attorney can argue your case directly to the court and answer the judges’ questions.
If the Court of Appeals rules against you, you can petition the North Carolina Supreme Court to hear your appeal – although the Supreme Court can decline to hear it.
How Long Do I Have to Appeal a Workers’ Compensation Denial in NC?
Once you receive notice of your employer’s denial of your workers’ compensation claim, you typically have two years from the date of your work injury to request a formal hearing with the North Carolina Industrial Commission. However, you should not wait to appeal a denial of your workers’ compensation claim. Any delay in your appeal will put off recovering workers’ compensation benefits and may jeopardize the success of your appeal.
When appealing a decision of a deputy commissioner or the full Industrial Commission, you typically have 15 days to file a notice of your intent to appeal.
How Many Times Can I Appeal My Workers’ Comp Claim?
The workers’ compensation appeals process has four levels:
- First, you can appeal your employer’s denial of your workers’ comp claim by requesting a formal hearing before a deputy commissioner of the North Carolina Industrial Commission.
- If the deputy commissioner rules against you, you can appeal their decision to the full Industrial Commission.
- You can further appeal an adverse decision of the NCIC to the North Carolina Court of Appeals.
- If the appeals court rules against you, you can petition the North Carolina Supreme Court to hear your appeal. However, the North Carolina Supreme Court has discretion whether to hear appeals of workers’ compensation decisions.
Do I Need a Workers’ Compensation Lawyer for My Appeal?
A workers’ compensation appeal requires you to establish how your employer or the NC Industrial Commission erred in denying your claim. A workers’ compensation lawyer can help by thoroughly reviewing your case and identifying grounds for an appeal, such as evidence your employer or the Industrial Commission overlooked. A lawyer can also craft a compelling argument to support your appeal and convince the Industrial Commission or the courts to grant your workers’ compensation benefits claim.
Contact a North Carolina Workers’ Compensation Lawyer
If your workers’ compensation claim was denied, you may still have the right to recover the benefits you need for a work-related injury or illness. Contact The Law Offices of John Drew Warlick, P.A. today for a free, no-obligation consultation with a workers’ comp attorney to discuss your options for appealing your claim denial.
