What to do if Your NC Workers' Compensation Claim is Denied

woman looking at denied workers comp claim

If you have suffered an illness or injury on the job, workers’ compensation coverage can help you access the medical care and financial support you need to recover. Most employers in North Carolina are required to carry workers’ comp insurance that pays benefits to eligible employees who get hurt at work, regardless of who was at fault for the injury.

Unfortunately, many injured workers are frustrated to learn that their workers’ compensation claims have been denied. Workers’ comp requirements are complex, which means a claim may be rejected for any number of reasons. The good news is that a denial does not mean the end of the line for your claim.

The knowledgeable workers’ compensation attorneys of Poisson, Poisson & Bower, PLLC, can help you fight back by filing a request for hearing with the North Carolina Industrial Commission (NCIC). We will guide you through every step of the process and help you pursue the benefits you deserve. Contact us today for a free case review to find out more about what you can do if your workers’ compensation claim is denied.

Common Reasons for Claim Denials

Some of the most common reasons used by employers and insurance providers to deny North Carolina workers’ compensation claims include allegations that the worker:

  • Did not suffer an injury by accident or occupational disease at work or while performing job-related tasks
  • Failed to notify the employer of the injury in writing within the 30-day period required by North Carolina law
  • Suffered injury due to being intoxicated, impaired, or engaged in horseplay at work
  • Never received treatment for injuries or did not receive treatment from an approved medical provider
  • Failed to follow doctor’s orders to treat a work-related injury
  • Failed to file all workers’ compensation claim paperwork on time
  • Had a pre-existing condition at the time of the work-related injury

What You Need to Know About a Workers’ Compensation Appeal

If your workers’ compensation claim is denied, it’s important to act quickly. In most cases, you should receive a response within 30 days of submitting your workers’ comp claim. The response will notify you as to whether the claim was accepted or denied.

If your claim was denied, the notification letter should provide the specific reason or reasons for the denial. It should also inform you of your right to contest the decision and provide instructions for initiating the hearing process.

No two cases are alike. Filing for a hearing can be complicated even at the best of times. However, the general process of contesting a workers’ comp claim denial in North Carolina typically involves:

  • Notifying the NCIC of your intent to file a request for a hearing disputing the denial of your claim
  • Participating in discovery, where you ask questions and request documents from your employer and your employer asks questions and requests documents from you
  • Scheduling a mediation conference, during which you should be represented by an attorney
  • Meeting with your employer’s insurance representative along with a mediator, who will attempt to assist the parties in resolving the issue in dispute or even the entire case
  • If the parties are unable to resolve the case at mediation, attending the hearing, which will be similar to a trial, where each side will have the opportunity to present testimony and evidence to support their argument
  • Filing an appeal to a panel of three administrative judges if you disagree with the decision of the judge who hears your case
  • If you also disagree with the three-judge panel’s decision, pursuing the appeals process through the North Carolina Court of Appeals or even the state Supreme Court

It is in your best interests to have a respected workers’ compensation lawyer on your side before you file your request for a hearing in order to ensure that everything is handled correctly. Your employer and the insurance company will have attorneys working hard for them. You should, too.

What to Expect in a Hearing with the N.C. Industrial Commission

If an impartial mediator can’t help you settle your workers’ comp claim dispute with your employer or the insurance provider, your next step will likely be a hearing with the N.C. Industrial Commission. Most NCIC hearings take place within 60 days of a failed mediation attempt.

During a hearing, your claim will be sent before a deputy commissioner at the NCIC, who will act as a judge. Deputy commissioners hear contested workers’ comp cases at the trial level, typically in a standard courtroom setting, where all involved parties have the opportunity to present testimony and other forms of evidence. After trial, a deputy commissioner will issue a formal, written decision based on the facts of the case.

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

Working with an experienced North Carolina workers’ comp lawyer can significantly increase your chances of securing the benefits you need. An attorney at Poisson, Poisson & Bower, PLLC, can help you by:

  • Communicating with your employer or the insurance carrier on your behalf
  • Estimating the value of a full and fair workers’ comp settlement
  • Identifying and gathering medical or work-related evidence to support your claim
  • Recommending and arranging treatment with the right medical providers
  • Interviewing medical experts for information about your condition and prognosis
  • Interviewing eyewitnesses, co-workers, and others who can provide information about your work environment and daily activities
  • Investigating your employer’s history of workplace safety and training
  • Negotiating and structuring a favorable settlement that considers medical treatments or lost wages related to your injuries
  • Representing you at mediation conferences, in hearings and on appeal
  • Providing professional advice regarding any settlement offers you receive

Talk to a North Carolina Workers’ Compensation Appeal Attorney Now

Work-related accidents can happen in any industry. An on-the-job injury may leave you with severe, long-term medical consequences that can hurt your ability to work or support yourself in the future. If you suffered a work-related injury in North Carolina, a seasoned workers’ comp lawyer can help you fight for the full benefits you deserve.

At Poisson, Poisson & Bower, PLLC, our board-certified workers’ compensation specialists are here to help you every step of the way. Contact us today for a free, confidential consultation to speak with a dedicated member of our team.