No matter who you are, the denial of a workers’ compensation claim can be an awful blow when you’re dealing with the financial and physical burdens of a workplace injury in North Carolina. The unfortunate reality is that countless workers across the country find themselves asking, “What do I do if my workers’ compensation claim is denied?” While the scenario is frustrating, there are still options out there for you.
Hire a Workers’ Compensation Lawyer to Fight for You
Under North Carolina law, injured workers have the right to appeal denials of their workers’ compensation claims. With an attorney on your side like M. Reid Acree, Jr., you can confidently navigate the appeals process knowing you have a powerful legal advocate by your side. Countless employees are denied benefits upon their initial requests, but with the right legal help, you can fight for what you’re owed.
Why Are Workers’ Compensation Claims Denied in North Carolina
Before you can look into the process of filing an appeal with a Concord workers’ compensation lawyer, it’s important to understand some of the reasons why a claim could be denied. Some of the most common reasons workers’ compensation claims are denied in North Carolina include:
- You failed to report your workplace injury promptly, which is required underC. Gen. Stat. § 97‑22.
- You had insufficient medical documentation that links your illness or injury to work-related injuries.
- It was uncovered that you had a pre-existing condition, were engaging in horseplay at the time of the incident, or were intoxicated.
- You filed an appeal that had mistakes, or you committed a procedural error like submitting an incomplete form.
- An insurer or employer doesn’t believe the injuries you sustained were caused by your workplace accident.
What to Do If Your Workers’ Compensation Claim Has Been Denied in North Carolina
In North Carolina, workplace injuries are relatively common. For example, in the state’s private industry, about 68,600 individuals reported nonfatal illnesses and injuries in 2023. In addition, these injuries resulted in about 40,900 individuals being away from work, restricted in their activities, or transferred.
Despite how common these cases are, many people don’t fully understand the workers’ compensation claim process, let alone the appeals process. Fortunately, an attorney like M. Reid Acree, Jr. can help detail the process and applicable workers’ compensation laws. You should take the following steps after receiving a denial:
- Look Over the Denial Letter. The first thing you need to do after receiving a denial letter for a workers’ compensation claim is to evaluate it. When you read the insurance company’s letter, it should outline specific reasons for the denial, which will give you a starting point for your appeal. If you understand these reasons, you can develop a strong appeal that addresses each point of contention raised by the insurer.
- Hire a Workers’ Compensation Lawyer. After you’ve had a look at the denial letter, it’s important to hire a workers’ compensation lawyer who can help you understand your rights and the legal avenues available to you. They can also help you identify the potential weaknesses in an insurance company’s decision, gather evidence to support your claim, and represent you in court if needed.
- File Your Appeal. After you have spoken with an attorney and put together a plan of action, you need to initiate the appeals process formally. This means you need to file Form 33, which is known as “Request That Claim Be Assigned for Hearing.’ You will file this form with the North Carolina Industrial Commission, which will officially notify the NCIC of your intention to appeal.
- Prepare for Mediation. It’s important to know that, in a workers’ compensation dispute, your case won’t proceed immediately to a hearing. Instead, the NCIC will suggest or require that you enter mediation first. During mediation, you would work with a mediator who would be a neutral third party to resolve the dispute without a formal hearing.
- Attend a Hearing. If mediation talks fail, you need to prepare for and attend a hearing. During the hearing, which is similar to a court trial, you and the insurance company will present your sides of the story with supporting evidence and legal arguments. As with mediation, it’s essential to present proof, respond truthfully to arguments, and question an insurer’s witnesses. Your workers’ compensation attorney can do this on your behalf.
FAQs
Q: What Percentage of Workers’ Compensation Claims Are Denied in the U.S.?
A: According to national data, about 20% of workers’ compensation claims are initially denied. However, exact rates vary by state and industry, with some industries experiencing higher denial rates than others. It’s essential to consult a workers’ compensation attorney in Concord to assess the likelihood that your appeal will be denied a second time.
Q: How Long Do I Have to Report a Work Injury in North Carolina?
A: In North Carolina, you only have 30 days to report a workplace injury to your employer. Unfortunately, if you fail to report a workplace injury within this timeframe, this can be used against you during the appeal process. This is because the insurance will have had grounds to deny your initial claim, and they will work to uphold this verdict.
Q: What Should You Not Say to a Workers’ Compensation Adjuster in North Carolina?
A: There are a few things you shouldn’t say to a workers’ compensation adjuster, which your attorney can help you better understand. For example, you shouldn’t say anything that minimizes your injury, nor should you state anything that contradicts medical records. You also shouldn’t talk about any delays that existed in reporting your injury. In addition, it’s important not to agree to unscheduled follow-up statements or speculative comments, as these can be used against you.
Q: What Evidence Can Strengthen a Workers’ Compensation Claim in North Carolina?
A: There is quite a bit of evidence that can be used to strengthen a workers’ compensation claim in Concord, such as detailed medical records, timely accident reports, and witness statements. Additionally, evidence that can help is documentation that connects your injury to your job. An attorney can help you identify the evidence that will have the most effective impact on your case.
Your North Carolina Workers’ Compensation Lawyer
M. Reid Acree, Jr., Attorney at Law, P.A., can help you appeal your workers’ compensation denial and fight for your right to benefits. Contact the firm today to learn more about how we can help.