Steps To Take After Your Workers’ Compensation Has Been Denied in Wilmington, NC

compensation claim with denied stamp

It’s stressful enough to be injured at work, but it’s even worse to have your legitimate claim for workers’ compensation benefits denied. If you find yourself in this situation, it is natural to be worried about your livelihood and unsure about what to do next. 

You need the North Carolina workers’ compensation attorneys at Poisson, Poisson, & Bower, PLLC, to fight for you.

For more than 40 years, we’ve fought to help the injured workers in Wilmington and surrounding areas of North Carolina seek the workers’ comp benefits they’re entitled to. We work with our clients to understand their needs and concerns and help them find the medical care and wage replacement they need during a challenging time. 

Contact us today to find out what we can do for you during a free initial consultation.

Can a Wilmington Employer Deny a Workers’ Compensation Claim?

Not every injury an employee suffers while working is a compensable injury – one that their employer has to pay benefits for. Injuries employees may receive compensation for include those resulting from accidents that arise out of and in the course of employment. If an employer has reason to believe that a claim is not one an employee should be compensated for, the employer may deny the claim under North Carolina law

Common Reasons Workers’ Compensation Claims Are Denied in Wilmington

North Carolina law says that an employer may deny an employee’s claim for compensation if the employer, acting in good faith, does not have sufficient information to determine that the employee deserves compensation. The workers’ compensation act does not define good faith, but the term typically refers to acting honestly. 

The North Carolina Workers’ Compensation Act requires your employer to provide you with written notice if they deny your workers’ compensation claim. Additionally, this written notice must provide you with a detailed statement of why they are denying the claim and inform you that you have the right to request a hearing to challenge their decision.

An employer might deny a workers’ compensation claim for reasons such as:

  • The employer believes the employee is suffering from a pre-existing condition.
  • The employer believes the employee is faking or exaggerating the injury.
  • The employer believes that the incident could have happened anywhere.
  • The employee has insufficient evidence of their injury and its cause.
  • The employer claims that you are an employee of another company.

An employer may claim that the employee has a pre-existing injury and that the injury they are now suffering is not related to their employment, especially in cases of repetitive injuries. Occasionally, although not often, an employer may actually tell the employee that it simply does not believe the employee’s account of the incident.

The standard for a compensable injury is that the injury must arise out of and in the context of the employment. This standard is subject to many fact-based arguments in workers’ compensation cases. The standard concerns the time, place, and circumstances of the accident, all of which need to be established in your favor if you are to successfully appeal a denied claim. It is critical to have help from a committed team of North Carolina workers’ compensation attorneys.

Cases where the employer claims the injured employee is actually the employee of another company often involve an employee who is a temporary or loaned worker on construction sites where multiple contractors are working.

Steps To Take When Appealing a Workers’ Compensation Claim Denial

When you’ve been injured on the job, you’re entitled to benefits that reimburse you for medical bills and offset a portion of your lost wages. If your claim is denied, it’s crucial that you take the following steps to appeal the decision:

  • Make sure you have notified your employer of the accident in writing. Notifying your employer is an essential step toward compensation for a work-related injury. While you may have told a supervisor about the injury, it is important to notify your employer in writing. You must do this within 30 days. Even if the employer denied your claim or told you it was not covered, you must provide written notification.
  • Apply for a hearing with the workers’ compensation commission within 14 days of the denial. You are entitled to appeal a denied claim, but you must notify the North Carolina Industrial Commission of your intent to do so. Once you have requested a hearing, the commission will set a date for the hearing. The hearing may involve a single member of the commission acting as a judge.
  • Talk to a North Carolina workers’ compensation attorney. The stakes are high, so it is vital to contact a workers’ compensation lawyer who can thoroughly investigate the facts of your claim and work to give you the best chance of success before a member of the commission. If the claim is denied at the initial hearing, you may apply to have the full commission hear the case.

How a Lawyer Can Help If Your Workers’ Compensation Claim Has Been Denied

If you have been injured at work, you’re likely worried about how to pay for medical bills, make up for lost wages, and pay your bills. The last thing you need on top of all this is to have to plead your own workers’ compensation case. You need North Carolina Workers’ Compensation attorneys who know the timelines, the burden of proof, and how to build a compelling case on your behalf.

Talk to a North Carolina Workers’ Compensation Appeal Attorney Now

At Poisson, Poisson, & Bower, PLLC, we understand what you’re going through after having your workers’ compensation denied. We know that employers and their insurers don’t always do the right thing, which can have serious consequences for injured employees. 

Let us fight for you during this difficult time. We are prepared to investigate the facts of your case and build a strong argument on your behalf, giving you the best odds of winning your workers’ compensation appeal.

Contact us today for a free consultation. Do not delay, as there’s a tight deadline, and time is of the essence.