What to Do If Your North Carolina Workers’ Compensation Claim Is Denied

Sometimes, an employer or insurer may deny a workers’ comp claim. If your North Carolina workers’ compensation claim is denied, you can file a formal claim with the North Carolina Industrial Commission to appeal the denial and request a hearing. The Industrial Commission will hold a hearing to consider evidence, testimony, and arguments to decide your workers’ compensation benefits eligibility.

Hiring an experienced workers’ comp attorney can provide vital assistance when you’re pursuing an appeal with the North Carolina Industrial Commission. They can help you understand the reasons for the denial of your claim, prepare a compelling case for your appeal, and guide you through the legal process to challenge the denial of your claim.

What Are Some of the Reasons Your Claim Could Be Denied?

Employers and workers’ compensation insurers may deny employees’ claims for various reasons. Some of the most common reasons for claim denials include:

• The employee did not suffer a work-related injury or occupational illness – Employers and insurers may deny workers’ compensation claims by arguing that the employee’s injury or illness happened while they weren’t at work or performing work duties.
• The employee’s injury or illness does not prevent them from continuing to work – Employers and insurers may deny an employee’s claim for disability benefits because the employee’s treating physician has not restricted them from working or the medical evidence does not show that the employee has suffered a disabling injury or illness.
• The employee didn’t file their claim in time – Employees who wait to report a work injury or occupational illness to their employer risk having their workers’ compensation claim denied as untimely filed.
• The employee provided inadequate notice – An employer or insurer may deny a workers’ compensation claim because the employee didn’t follow procedures for giving proper notice, preventing the employer or insurer from investigating the claim.
• The employee didn’t provide sufficient evidence to support their claim – An employer may deny a workers’ comp claim if there isn’t enough evidence that the employee sustained a work-related injury or illness.
• The employee’s work accident occurred while the employee was under the influence – Employers can deny workers’ compensation claims that arise from injuries that occur due to the employee’s intoxication or drug use.
• The employee’s injury occurred due to misconduct – Employers can also deny workers’ comp claims when employees get hurt while engaging in “horseplay” at work.
• The employee failed to comply with treatment – Employers and insurers may close workers’ comp claims when employees don’t follow the recommended medical treatment and rehabilitation.
• The employee does not have an employment relationship with the employer – An employer may deny having an employer-employee relationship with an injured worker, such as in the case of an independent contractor.

How Do You Appeal a Workers’ Compensation Claim Denial?

You can take the following steps to appeal your employer’s denial of your workers’ compensation claim:

• First, review your employer’s or the workers’ compensation insurer’s denial letter. It should explain the reason(s) for the denial of your benefits claim. Understanding why they denied your workers’ comp claim can help you gather the information and evidence needed to appeal the denial.
• Next, get records and evidence supporting your appeal, such as incident reports, accident scene photos and videos, eyewitness statements, and medical records.
• File a formal claim and request a hearing with the North Carolina Industrial Commission. A formal workers’ compensation hearing can allow you to contest the denial of your claim.
• Attend mediation between you and your employer to try to settle the dispute.
• If mediation is unsuccessful, attend the workers’ compensation commission hearing with your attorney. Here, you will present evidence, testimony, and arguments to contest your employer’s denial of your workers’ compensation claim.
• If the deputy commissioner denies your claim, you can appeal their decision to the full Industrial Commission.

Appealing a denial of a workers’ compensation claim involves complex procedures. Having a workers’ compensation attorney to represent you during an appeal can ensure that you thoroughly pursue your legal options to challenge the denial of your claim.

How Long Do You Have to Appeal a Workers’ Compensation Denial in NC?

Under North Carolina’s workers’ compensation law, you typically have two years to file a formal claim with the Industrial Commission to appeal a denial of benefits. Filing a claim more than two years after suffering a work injury or developing an occupational illness may result in losing the right to recover benefits. This makes it critical to talk to a workers’ compensation lawyer as soon as possible after suffering injuries at work and receiving a denial of your claim.

How Many Times Can You Appeal Your Workers’ Compensation Claim?

The workers’ compensation appeals process in North Carolina may involve several stages:

• First, you may have the opportunity to pursue an administrative appeal of a denied workers’ comp claim with the insurer.
• After exhausting any internal appeals process, you can pursue a formal workers’ compensation claim with the North Carolina Industrial Commission to appeal a denial of your claim. By pursuing a claim through the Industrial Commission directly, you can request a hearing with a deputy commissioner.
• If the deputy commissioner rules against you, you can appeal their decision to the full Industrial Commission.
• When the full Commission upholds the denial of your workers’ compensation claim, you may further appeal to the North Carolina Court of Appeals.
• If the Court of Appeals affirms the denial of your workers’ compensation claim, you can petition the North Carolina Supreme Court to hear your appeal. However, the North Carolina Supreme Court can decline to hear your appeal.

Contact a North Carolina Workers’ Compensation Lawyer

The denial of a workers’ comp claim can be a stressful and upsetting roadblock in your effort to recover the benefits you’re owed after a workplace injury or illness. If your employer has denied your workers’ compensation claim, hiring experienced legal counsel can protect your rights and interests.

At The Law Offices of John Drew Warlick, P.A., we have three generations of workers’ comp attorneys and decades of experience helping injured workers in North Carolina get the benefits they are owed. Past clients call our attorneys “compassionate and authentically professional” with “an outstanding ability to listen” and “creativity and dedication to solving” legal problems.

Contact us today for a free consultation to discuss your legal options for pursuing an appeal of your denied workers’ compensation claim.

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