Injured workers expect their wages and medical bills to be covered by workers’ compensation insurance. Yet these benefits aren’t automatic even if you qualify for coverage. Many North Carolina employees who’ve been hurt on the job or developed an occupational disease are denied benefits.

So what should you do if your workers’ compensation claim gets denied? And where should you even start with the appeal and review process? If you’re feeling overwhelmed by the process, you’re not alone. The laws and these processes can be confusing, which is why our workers’ compensation lawyers in North Carolina are ready to help.

Let’s consider why your claim might have been denied and review some of your options to obtain the benefits you deserve after a serious workplace accident. For answers to any additional questions about workers’ compensation, contact our law offices in North Carolina. When it comes to help with workers’ comp denials, the attorneys at Ricci Law Firm Injury Lawyers are on top of it.

Why Did My Workers’ Compensation Claim Get Denied? 

There are many reasons why your workers’ compensation claim was denied. Below is a brief rundown of the most common causes of denied workers’ comp claims that our lawyers have encountered:

• North Carolina’s “Injury by Accident” Rule – An unusual or unexpected event needs to have occurred and contributed to your injury or occupational disease. If there was no on-the-job accident, your workers’ comp claim could be denied.
• You Missed Key Deadlines While Filing for Workers’ Compensation – Workers must report their injury or illness to their boss or supervisor within 30 days of the accident or diagnosis. They then have 2 years from the date of injury or diagnosis to file a workers’ comp claim. Failing to meet either of those deadlines can result in a denied claim.
• You Made a Mistake Filling Out the Paperwork – Typos, misspellings, lack of required documentation, blank required fields, or other paperwork mistakes can lead to your workers’ comp claim being denied.
• There’s Not Enough Evidence to Support Your Claim – It may be ruled that there is not enough evidence to demonstrate that your injury or illness occurred as a result of an on-the-job accident.
• There Are Inconsistencies About Your Work Injury Claim – Contradictory evidence or witness statements could result in a denied workers’ comp claim. This is why consistency is crucial in all of your supporting documentation.
• The Injury Is Due to a Pre-Existing Condition – For some injured workers, their claim could get denied because of a pre-existing injury or medical condition. However, the state does recognize that pre-existing conditions could be aggravated or worsened because of a workplace accident.
• You Didn’t Follow the Recommended Medical Treatment – If you’re checked out by your doctor but do not undergo the treatment they recommended, your claim may be denied because you seem to be able to function okay without medical care.
• The Injury Was Caused by Horseplay or Fighting on the Job – If you were messing around with co-workers or got into a physical altercation of some kind, this could put your workers’ compensation claim in jeopardy.
• Drugs or Alcohol Were Involved in the Workplace Accident – If the use of alcohol, narcotics, or any controlled substances contributed to a workplace accident, your workers’ comp claim will be denied.

Remember that the denial of a workers’ compensation claim is not the end. You can still receive workers’ compensation benefits if you appeal the decision.

No matter the reason your workers’ comp claim was denied, it’s best to consult one of our attorneys about what happened. The team at Ricci Law Firm Injury Lawyers can help you explore your options following the initial denial of your claim.

What Are My Options If My Workers’ Compensation Claim Has Been Denied?

Workers have a few ways to appeal the denied claim to the North Carolina Industrial Commission (NCIC).

Start By Filling Out Form 33

The entire review process begins by filling out and submitting Form 33 (Request That Claim Be Assigned for Hearing). This form can be submitted by mail or online.

Form 33 must be filed within 2 years of your workplace injury or your formal diagnosis of an illness or occupational disease.

Visit the NCIC forms page to access PDF, electronic, and Spanish-language versions of Form 33.

Mediation, Deputy Commissioner Hearing, Full Commission Hearing

These are the most common options to appeal a denied workers’ compensation claim:

• Mediation with the Insurance Company

• Hearing with an NCIC Deputy Commissioner

• Appealing a Deputy Commissioner’s Decision to the Full Commission

 

Let’s cover these options below, with a general overview of what you should know. We can provide a much more detailed rundown of these options during the consultation process.

What Should I Know About Mediation with the Insurance Company?

After filling out Form 33, most denied workers’ compensation cases will proceed to mediation. During mediation, the claimant and the insurance company will have an opportunity to resolve the issues surrounding a denied claim.

Many workers’ comp claims that were initially denied wind up being approved through mediation. If your claim is still denied after mediation, you can continue to seek a review of your case.

What Should I Know About the Deputy Commissioner Hearing?

If mediation is not successful and your workers’ compensation claim remains denied, you can move on to a hearing with a Deputy Commissioner. A Deputy Commissioner is essentially a judge for the North Carolina Industrial Commission who reviews and adjudicates matters related to workers’ compensation, including the approval of denied claims.

Evidence, medical testimony, and witness testimony are presented to the Deputy Commissioner as part of the hearing process. The Deputy Commissioner will then issue a decision after the hearing is completed.

What Should I Know About Appealing to the Full Commission?

If the Deputy Commissioner denies your claim, you can appeal that decision to the Full Commission.

Evidence and testimony are presented to three Full Commissioners with the North Carolina Industrial Commission. If two of the Full Commissioners disagree with the Deputy Commissioner’s previous decision, your workers’ compensation claim can be approved.

Do I Have Other Options If My Workers’ Comp Claim Continues to Get Denied?

Yes. If your workers’ compensation claim is denied by the Full Commission, you can continue to appeal your claim all the way to the North Carolina Supreme Court.

Very few workers’ compensation cases proceed to this point. If your case does, however, our NC workers’ comp lawyers can discuss further appeals and what you can expect. We’re ready to advocate for you and your rights as a worker.

Do I Really Need to Hire a Workers’ Compensation Attorney for My Denied Claim?

Yes. It can take a lot of time and effort to evaluate the reason why your claim was denied and to then seek mediation or a subsequent hearing should mediation fail. As we’ve noted above, the process can stretch on for weeks, months, or even years.

The Benefits of Hiring a Workers’ Compensation Lawyer

After an on-the-job injury, you should focus on rest and recovery, which is what happens when you hire an attorney.

Rather than doing all the research and paperwork yourself and presenting your case before the North Carolina Industrial Commission on your own, you should have a lawyer on your side to do this. Your workers’ comp attorney will be familiar with the entire process, understand how to negotiate with insurance companies, and how to frame your case in a compelling way in hearings.

Contact Our Workers’ Comp Attorneys About Your Denied Claim

If you’re an injured worker, you shouldn’t go it alone. Ricci Law Firm Injury Lawyers can offer answers, keep you informed of your best interests, and stay on top of your claim. To speak with experienced attorneys about your denied workers’ comp claim, contact our North Carolina law offices.

How Long Could an Initial Denial Delay Payment of Workers’ Compensation Benefits?

This depends on when the claim is eventually approved and when you filed for workers’ compensation.

If you’re able to receive approval during the mediation process, it can delay benefit payments by several weeks. For cases that go to the Deputy Commissioner, payments can be delayed by several months. In cases that go to the Full Commission, payments might be delayed by a year or more. Further appeals beyond that mean additional delays.

This is yet another reason why it’s important to file for workers’ compensation benefits as soon after your injury or illness as possible. Getting the process underway immediately means that you receive benefits sooner even if you have to appeal a denial of claim multiple times.

If you wait for the end of the two-year deadline to file a workers’ compensation claim in North Carolina, you’ll have to shoulder so many injury-related expenses on your own.

Can I Be Reimbursed for Out-of-Pocket Costs While My Workers’ Comp Claim Was Denied?

Yes, you can be reimbursed for out-of-pocket expenses if your denied workers’ compensation claim is eventually approved. The amount you’ll be due will depend on when the workplace injury occurred, what kinds of benefits you receive, and how long the approval or appeal process has taken.

At Ricci Law Firm Injury Lawyers, our attorneys will make sure you receive the reimbursement so that you no longer have to deal with any financial setbacks or debt related to your work injury and recovery.

Can I Also File a Third-Party Claim After a Workplace Accident?

Yes, you might be able to file a third-party claim to seek compensation after a serious on-the-job injury. This will depend on the cause of the accident, the contributing factors in the accident, and the available evidence in your case.

What Is a Third-Party Claim?

A third-party claim is a personal injury lawsuit against a party that caused or contributed to an on-the-job injury. This third party cannot be your employer or a co-worker. Instead, this third party could be a contractor who did faulty work, the maker of a power tool or heavy machinery that malfunctioned, or a negligent driver who hit your vehicle while you were driving as part of work hours and a task for your employer.

Can I File a Third-Party Claim in Addition to a Workers’ Comp Claim?

Third-party claims can be filed in addition to a workers’ compensation claim, which can help injured employees receive more compensation to aid in making a full recovery.

Many injured workers are not even aware that they can file a third-party claim after they’ve been in a workplace accident. This additional compensation can help address the new cost of living after an accident that workers’ compensation falls short of covering.

If you’ve been seriously injured at work and wonder if you should also file a third-party claim, our team of attorneys can help. In addition to workers’ compensation claims, Ricci Law Firm Injury Lawyers has helped countless people with personal injury lawsuits in North Carolina. We’ll let you know if it’s worthwhile to file a third-party claim and guide you through the litigation process.

Why Should I Contact Ricci Law Firm Injury Lawyers About My Workers’ Comp Denial?

The team at Ricci Law Firm Injury Lawyers has proudly served the people of North Carolina since 1998. Workers throughout the Tar Heel State know that our law firm is on top of it—we’re trusted and well-established, and we have a history of getting results.

The attorneys at our law firm have over 150 years of combined experience. We’ll use our extensive knowledge of North Carolina workplace and personal injury laws to your advantage, and always explain what’s happening in your case in a language you can understand.

To best serve workers throughout North Carolina, we have multiple office locations throughout the state. This includes several offices in Eastern North Carolina, multiple offices serving workers in the Research Triangle, and offices in Fayetteville and Charlotte. We’ve got the state covered, and we’re ready to hear from you.

How Can I Learn More About Appealing a Denied Workers’ Comp Claim in North Carolina?

Don’t feel discouraged if your workers’ compensation claim has been denied. There are many options available to help you receive benefits after a serious on-the-job injury. The team at Ricci Law Firm Injury Lawyers is here to make sure you understand these options and guide you through the process.

To speak with experienced workers’ compensation attorneys near you, contact our North Carolina law offices today. Our lawyers are ready to help after your benefits were denied.