There are many reasons why your workers’ compensation claim could be denied. Some possible reasons for a claim denial include:

• The injury was not caused by a workplace accident or while on the job
• You missed important filing deadlines for workers’ comp claims
• There’s a mistake in your workers’ compensation paperwork
• There’s not enough evidence regarding the reported workplace accident

The denial of a workers’ compensation claim could mean major financial trouble for you and your household. You may not know how to cover your medical bills and living expenses, especially after a serious workplace injury leaves you unable to earn a wage. That’s where the North Carolina workers’ compensation attorneys at Ricci Law Firm Injury Lawyers can help.

Let’s take a look at common reasons why workers’ compensation claims are denied. We’ll then let you know what a workers’ comp attorney can do for you if your claim has been denied. If you need to speak with a workers’ compensation lawyer about your situation immediately, contact us today.

1. Denial Caused by North Carolina’s “Injury by Accident” Rule

In the state of North Carolina, injured workers must demonstrate that their injuries were caused by an accident while doing their job duties. An accident, in this context, is an unusual or unexpected event that occurred and caused the on-the-job injury while a worker was performing their usual duties.

Some workers’ comp claims are denied because there is no identifiable accident that caused the injury or occupational disease. This is one of many reasons why it’s so important to have a knowledgeable attorney on your side while filing for workers’ compensation benefits.

2. You Did Not File the Workers’ Compensation Claim within the Specified Deadlines

There are two important deadlines in North Carolina when it comes to workers’ compensation claims:

• You need to report your injury to your employer in writing within 30 days of the on-the-job accident or the diagnosis of an occupational disease
• You need to file a workers’ compensation claim within two years of the workplace accident or the diagnosis of the occupational disease

If you do not take action within either of these limits, you will not be able to file a workers’ comp claim. If you attempt to file a claim after these deadlines, your workers’ comp claim will be denied automatically.

Say you properly reported the incident to your employer within the 30-day time limit. Even though you have a little under two years to then file for workers’ compensation benefits, it’s best to get the process started as soon as possible. Speaking with an attorney familiar with North Carolina workers’ compensation laws will help you avoid time-consuming mistakes and receive your benefits sooner rather than later.

3. You Did Not Fill Out the Paperwork for Your Workers’ Compensation Claim Correctly

Typos and other mistakes on paperwork are another common reason for workers’ compensation denial. Insurance companies will look for any errors, discrepancies, or other issues with the submitted paperwork as an excuse to deny your claim. In these situations, you’ll need to resubmit the paperwork correctly, which will delay your ability to receive benefits. The bills will continue to pile up while you wait for your benefits.

This is another reason to speak with a North Carolina workers’ compensation attorney as soon as possible after your on-the-job injury. The team at Ricci Law Firm Injury Lawyers can help you avoid mistakes while filling out the paperwork and make sure you’ve included all the necessary materials to support your claim.

With knowledgeable attorneys from our law firm on your side, you won’t have to wait as long for the process to be completed, and you can avoid all kinds of minor mistakes.

4. There Is Not Enough Evidence to Support Your Workers’ Compensation Claim

In some cases, the insurance company will state that there is enough evidence to support your workers’ compensation claim. They may say that it is not clear that the reported accident was technically an accident, or that there isn’t a causal relationship between the workplace accident and the injury that’s been reported. Maybe there are no witnesses to corroborate the claim. The insurance company may even state that there is not enough evidence to show that the injury happened at the workplace.

These kinds of denials require close attention to the finer points that the insurance provider has made, as well as an acute understanding of North Carolina’s workers’ compensation laws. Ricci Law Firm Injury Lawyers can use our experience with workers’ comp denials to dispute what the insurance company has said and point out the evidence that supports your claim.

5. There Are Contradictory Statements About the On-the-Job Injury/Accident

Related to the above issue with the evidence, the insurance company may claim that there are contradictions in your claim about the workplace accident. There may be another witness who doesn’t agree with the claim, or perhaps a dispute over the nature of the medical diagnosis. This is another situation in which having a skilled attorney on your side is so important. The team at Ricci Law Firm Injury Lawyers will be your advocate in these situations.

There’s another aspect to this point that we should also highlight.

Sometimes the insurance company will try to make you say something that contradicts your original statements about the work accident. If they can get you to contradict your claim or downplay the severity of your injuries, they will use that against you to reduce how much workers’ comp you can receive or deny your claim entirely.

Because of this, we advise workers to always have an attorney present when speaking with any insurance representative. At Ricci Law Firm Injury Lawyers, we can be your point of contact with the insurance company. When they contact you, tell them to contact us. We’ll be on top of all communication with the insurance company and help you avoid any traps they may set as an excuse to deny your claim.

6. The Work-Related Injury Is Due to a Pre-Existing Medical Condition

The presence of a pre-existing medical condition or injury can complicate your workers’ compensation claim. Insurance companies will take any opportunity to deny coverage, and may suggest that the reported injury was not the result of work or any job-related duties.

The state of North Carolina recognizes how pre-existing conditions can be aggravated or accelerated by work accidents or exposure to various substances at the workplace. That means workers should not be afraid to seek workers’ compensation benefits even if they have a pre-existing condition related to the injury they suffered.

At Ricci Law Firm Injury Lawyers, we believe that your medical history should not jeopardize your present needs or your future financial situation. We can help you understand how a pre-existing condition could affect your workers’ comp claim, and we will make sure that the reality of your injuries and your health are taken into account while seeking benefits.

7. You Did Not Follow the Medical Treatments Recommended by Your Doctor

If you’ve been diagnosed with a work-related injury or a health problem, it’s crucial that you follow your doctor’s orders. You should proceed to use any prescribed medications or follow through with recommended procedures, and keep a detailed record of your treatment experience.

If you lack prescriptions, paperwork, bills, or documentation of your treatment, insurance companies will try to deny your claim. They might insist that your failure to follow through with treatment shows that the injuries sustained were not as serious as reported.

There may be many reasons why records are missing or you simply didn’t undergo treatment. In the latter case, you may have wanted to seek a second opinion or you did not feel the suggested treatment sufficiently addressed the extent of your injuries or the lingering effects of your injuries.

Whatever the case may be, the North Carolina workers’ compensation attorneys at Ricci Law Firm Injury Lawyers are on your side. We can help locate supporting documents related to your treatment. If there are issues with your doctor or their recommended treatment, we can help. Our attorneys will identify medical specialists who can get you the treatment you need to properly address your on-the-job injury or occupational illness.

8. The Workplace Accident Occurred as a Result of Fights or Horseplay on the Job

Physical altercations on the job can make workers’ comp claims extremely difficult. If you’re injured in a fight during work hours or some other form of roughhousing or aggressive behavior, you might have your claim denied even if you were just a bystander to the incident. If the incident was friendlier in nature, like horseplay, there’s still a chance that your claim may be denied.

The dynamics between co-workers are complex. Just because there was a fight or some horseplay does not rule out eligibility for workers’ compensation benefits. It’s best to speak with our North Carolina workers’ comp lawyers about what happened. As we go over the details with you, we can let you know if you’re eligible for benefits and what potential hurdles you may encounter while filing your workers’ compensation claim.

9. The Workplace Accident Occurred as a Result of Alcohol or Drug Use

If an injured worker is found with drugs or alcohol in their system at the time of a workplace injury, their claim will likely be denied. The use of these substances at work is prohibited, and insurance companies will cite the worker’s intoxication as the reason the accident occurred.

Circumstances aren’t always what they may seem from the outside. There may be all kinds of reasons for alcohol or other substances to be found during a drug test. No matter what happened during the workplace accident, it’s worth reaching out to our attorneys to get a legal professional’s honest opinion about what happened and what steps you should take next. At Ricci Law Firm Injury Lawyers, we will listen without judgment and offer sound advice.

What Should I Do If My Workers’ Comp Claim Has Been Denied?

If you’ve been denied workers’ compensation benefits, you need to consult an attorney from Ricci Law Firm Injury Lawyers as soon as possible. Don’t delay. The longer you wait to speak with an attorney, the longer it will take for you to receive compensation if you are still eligible for benefits.

Our team will discuss your workplace accident, the extent of your injuries, and review the reason your claim was denied. From there, we can determine the best path forward to help you seek compensation for your medical bills and other costs of living.

How Can Ricci Law Firm Injury Lawyers Help with My Workers’ Comp Claim?

The team at Ricci Law Firm Injury Lawyers has over 150 years of combined experience in accident lawsuits and work injury claims. We will carefully review your claim, the denial, and all available evidence to assist with the appeal process. We will also be the point of contact with the insurance company. That will take pressure off of you so you can focus on healing and planning for the future.

In assessing your workers’ compensation claim, our team can also determine if you’re able to file a third-party claim against a negligent party who contributed to your workplace accident. This means the potential for additional compensation to address the realities of your life after the on-the-job injury or work-related illness.

Every step of the way, we’ll be able to provide detailed answers to all of your questions about workers’ compensation laws and how the claims and appeals processes work. When it comes to workers’ compensation cases in North Carolina, our law firm is on top of it so our clients don’t have to be.

Filing for Workers’ Compensation? Contact Ricci Law Firm Injury Lawyers for Help

Whether your workers’ compensation claim has been denied or you’re not sure if you qualify for workers’ compensation, Ricci Law Firm Injury Lawyers is here to help. To set up a consultation, contact our North Carolina law offices today. We look forward to hearing from you and will get back to you as soon as possible.