It is unfortunately all too common for employees to receive a denial for a workers’ compensation claim in North Carolina. This often leaves workers feeling frustrated and vulnerable, as medical bills and lost wages can easily start to accumulate. If you’re currently asking yourself, “How can one appeal a decision in a workers’ compensation case?”, it’s crucial that you consult a skilled attorney, like M. Reid Acree, Jr., who can help you understand your options.
A workers’ compensation attorney understands how important benefits are to recovery. Fortunately, in North Carolina, the workers’ compensation system allows employees to appeal claim denials; you just need to know what to do.
Why Would a Workers’ Compensation Claim Be Denied in North Carolina?
Just because a workers’ compensation claim is filed doesn’t mean it will automatically be accepted. However, if you have been denied benefits, you’re not out of options. You can contest the decision by filing a claim with the North Carolina Industrial Commission.
Unfortunately, there are several reasons why your claim could have been denied, including:
- Failing to report the injury on time
- Missing paperwork in your filing
- Being intoxicated at the time of the incident
- Violating company policy
- Engaging in actions like horseplay
- Failing to link the injury to the work incident
Should any of the above apply to your situation, it’s imperative that you hire a Mooresville workers’ compensation attorney to better understand how you can appeal the decision.
Appealing a Workers’ Compensation Case Decision in North Carolina
According to the North Carolina Commission, between 2024 and 2025, 300 appeals were filed with the Full Commission. If you need to appeal your claim denial, it’s important that you understand workers’ compensation laws and the rights they give you. An experienced workers’ compensation attorney can do just that.
The basic steps for appealing a workers’ compensation case decision in North Carolina include:
- You need to submit a ‘Request that Claim be Assigned for Hearing’ form to the NCIC to request a hearing. You can do this once you hire a lawyer, evaluate your initial denial letter, and have a better understanding of why you were denied.
- Before the hearing, it is usually recommended that you try mediation. You will enter into mediation with your employer’s insurance representative, and you can have your attorney present during these negotiations.
- After mediation, you need to wait for the mediator to forward their report to the NCIC. Only if you and your attorney cannot reach an agreement and settle will your case proceed to a hearing.
- If you must attend the hearing, your attorney will present evidence on your behalf. They will also need to cross-examine witnesses and question them before an NCIC Deputy Commissioner.
- After the hearing, you will wait for the Deputy Commissioner to tell you their decision.
It’s also important to know that in North Carolina, you’ll have up to two years from the date of injury to file a workers’ compensation claim. Additionally, much shorter deadlines may apply when appealing a denied claim.
What Happens If Your Workers’ Compensation Claim Is Denied Again in North Carolina?
If your appeal is denied a second time, which happens more often than you would expect, you’ll have 15 days to request another appeal. Should you disagree with the three-judge Full Commission, you may also have the opportunity to appeal through the North Carolina Court of Appeals. In addition, if you disagree with the North Carolina Court of Appeals, you can appeal to the North Carolina Supreme Court.
This is a challenging process that is often successfully navigated by an attorney who understands Mooresville workers’ compensation claims. M. Reid Acree, Jr. can help you investigate your claim and handle your workers’ compensation and insurer communications. With him on your side, you have a better chance of addressing any issues and securing a fair settlement.
FAQs
Q: What Are Valid Reasons to Appeal a Workers’ Compensation Decision?
A: There are a few valid reasons why you should appeal a workers’ compensation claim in North Carolina. Usually, if medical evidence is missing or misunderstood, facts are disputed, or your employment status is misclassified, appealing is advisable. It’s also worth appealing if your benefits have been reduced, calculated incorrectly, or terminated too early.
Q: How Long Does a Workers’ Compensation Appeal Usually Take in North Carolina?
A: In North Carolina, there is no set timeline for a workers’ compensation appeal to be finalized. This is because the length of an appeal varies based on the nature of the medical dispute, case complexity, and scheduling with the North Carolina Industrial Commission. However, some cases can be resolved more quickly when no hearing is required, and negotiations are finalized through mediation.
Q: Can a Workers’ Compensation Claim Be Denied in North Carolina Even If the Injury Is Legitimate?
A: Unfortunately, a workers’ compensation claim can be denied even if the injury is legitimate. This is usually the case if you have missing paperwork, reported your injury to your employer late, or there are disputes about whether the injury occurred at work. However, the denial doesn’t mean your claim lacks merit; it simply means it’s being challenged. An experienced lawyer can help you fight for your right to compensation after a denial.
Q: What Are the Odds of Winning a Workers’ Compensation Case in North Carolina?
A: It’s difficult to say what the odds of winning a workers’ compensation case are since every case is different. However, what an attorney will likely state is that your odds of success depend on how consistently your injury was reported, your medical evidence, witness testimony, and whether the rules surrounding procedures were followed. A strong lawyer can also make an immense difference in the outcome of your case.
Hire a Workers’ Compensation Lawyer in North Carolina Today
Navigating workers’ compensation laws can be incredibly challenging while you try to handle the financial and medical stress your injury comes with. M. Reid Acree, Jr., Attorney at Law, P.A., is on your side. Contact M. Reid Acree, Jr. to learn more about how our team can fight to secure compensation on your behalf.