When you get injured on the job in North Carolina, you can file a workers’ compensation claim to cover your medical expenses and lost wages. However, not all workers’ comp claims proceed smoothly. Your employer’s insurance company might dispute your injuries or deny your claim. A workers’ compensation trial (or hearing) may sometimes be necessary to resolve disputes. If you receive a denial, you need to understand why your workers’ comp case is going to trial and what options you may have.
Reasons Workers’ Comp Cases Require a Hearing
When your workers’ compensation claim is denied, you can request a hearing with the North Carolina Industrial Commission by submitting Form 33. In a hearing, your attorney will present evidence and arguments supporting your claim. If your claim is still denied at the hearing, your attorney can escalate the appeal to the Full Commission and then the NC Court of Appeals.
Here are just a few reasons why you may need to request a workers’ compensation hearing:
Denied Claims
The most basic reason for needing a hearing is when the insurance company denies your eligibility for benefits. This might be the case if the insurer is arguing that you are an independent contractor or your condition is not the result of a work injury. If you receive a denial, you can request a hearing where a Deputy Commissioner will assess the issue and make a decision.
Settlement Disagreements
Many workers’ compensation cases end in a settlement. Your attorney and the insurance company will negotiate for a settlement based on the nature and severity of your injuries. If the insurer won’t make a fair offer, you may have to take the case to trial for a resolution.
Legal and Factual Disputes
When you submit a workers’ compensation claim, you must provide exhaustive documentation of your injuries. Insurance companies might dispute the facts of the case and the evidence you present. For instance, they might disagree on how the accident happened or the extent of your injuries. At a hearing, the Deputy Commissioner will make a determination on any disputes.
Incomplete or Inadequate Medical Evidence
One of the most common reasons for a claim denial is a lack of medical evidence. Medical evidence, such as diagnostic tests, imaging results, lab reports, doctor’s notes, and discharge paperwork, is crucial for proving the existence of your injuries and their claimed extent. A workers’ compensation case can go to trial if there are disputes about the legitimacy of your medical evidence or conflicting expert medical testimony.
Discontinuation of Benefits
The insurance company might terminate your workers’ compensation benefits if it believes you have reached the point at which further medical intervention will not improve your condition and you are able to return to work. You can file a hearing to request that the insurer reinstate your benefits if you believe the company discontinued them incorrectly.
How Often Do Workers’ Comp Cases Go to Trial?
Workers’ compensation cases can be resolved through an accepted claim, a settlement, or a hearing. Hearings are typically reserved for cases involving major disputes about injury severity or settlement amounts.
Most claims end in accepted claims or settlements because trials take significant time and money. Both parties would generally prefer to minimize conflict and settle without going through legal proceedings. When a workers’ comp case goes to a hearing, it is often because both sides believe they have a strong argument for their position and don’t want to back down.
Pros and Cons of Going to Trial
The advantages of going to trial include:
- A hearing gives you an opportunity to present and argue your case to the Deputy Commissioner. This can be beneficial in atypical situations where normal assessments are inadequate to demonstrate your injury severity.
- A workers’ comp trial provides finality. Decisions from a hearing are legally binding, so a trial can provide a definitive resolution to your case.
- A hearing gives you the chance of a favorable outcome. Your attorney might recommend a trial if you have a particularly strong case that has a good chance of winning.
- When you file for a hearing, you may be required to attend mandatory mediation. Mediation provides an alternate form of dispute resolution and a chance to resolve the case before the hearing.
Disadvantages of going to trial include:
- A hearing and the related proceedings can extend the timeline of your workers’ compensation claim, which can be difficult as bills continue to build up.
- You have less direct control over the outcome of the hearing process than you do the settlement process.
- If you have a weak case, a hearing can result in a claim denial. Inconsistencies in testimony or evidence can decrease the chances of a successful hearing.
- Some information from workers’ comp hearings, such as awarded amounts, is public knowledge. In contrast, settlements and mediation results are not public knowledge, so your privacy about your case remains intact.
Regardless of the circumstances, it’s always beneficial to have a workers’ comp lawyer at your side in a hearing. An attorney can advise you on whether your case would benefit from attending a hearing. They can review all your documentation, gather additional requested evidence, and practice interview questions and answers. They can also represent you during the hearing to pursue the most favorable outcome.
Our Raleigh Workers’ Compensation Lawyers Are Ready to Help You
Whether you are considering filing a workers’ compensation claim or need to prepare for a workers’ comp hearing, an attorney in your corner can be a vital asset. The attorneys at Younce, Vtipil, Baznik & Banks, P.A. have over 90 years of combined experience and an established record of securing several multi-million-dollar workers’ compensation settlements and verdicts. Although each case is different and past results cannot guarantee future outcomes, we have successfully represented clients in many workers’ comp hearings, including:
- The North Carolina Court of Appeals affirmed the award of benefits for a technician at General Electric who couldn’t work due to contact dermatitis after General Electric denied the claim, even though they conceded it was unquestionably a result of his employment (Hawkins v. General Electric Company).
- The North Carolina Court of Appeals affirmed the award of benefits for an employee who suffered injuries in an on-the-job auto collision when the taxicab company he worked for tried to argue that he was an independent contractor (Mills v. Triangle Yellow Transit).
- The Full Commission of the North Carolina Industrial Commission awarded benefits to an employee when the temporary agency denied their shoulder injury and argued that the employee refused suitable employment (Gutierrez v. Coast Personnel Services).
- The North Carolina Court of Appeals affirmed the award of benefits after a crime scene investigator’s claim for continuing low back treatment and wage loss was denied (Colvin v. Wake County).
With our knowledge, experience, and state-of-the-art case tracking system, we can handle every aspect of your claim. Don’t take our word for it — here’s what one satisfied customer had to say about our work:
“The entire staff made me feel welcomed. They worked hard to ensure they had everything they needed for my case. I would definitely refer them.” – N.J.
Contact our office online or call today for a free consultation with a workers’ compensation attorney in Raleigh, NC.
About the Author
Joseph R. Baznik
Joseph Baznik is an attorney at Younce, Vtipil, Baznik & Banks P.A. who specializes in workers' compensation and personal injury. Joseph speaks both English and Spanish fluently. He is licensed to practice law in the State of North Carolina and the U.S. District Court for the Western District of North Carolina.
