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claim-deniedThousands of North Carolina workers suffer job-related injuries every year. Many of them have trouble getting the workers’ compensation benefits they need. In many cases, an employer or insurance company will deny a workers’ comp claim to save money, even when the claim is valid. They do so because appealing a denied workers’ comp claim can be a cumbersome, lengthy process, causing many workers to simply give up. But with an experienced attorney by their side, many of these workers could have received the benefits they were entitled to.

How Our Workers’ Compensation Lawyers Can Help if Your Claim Has Been Denied

If an insurance company denies your workers’ comp claim, the dedicated and experienced workers’ compensation lawyers with Younce, Vtipil, Baznik & Banks, P.A. can guide you through the appeals process. We can gather evidence to support your claim, prepare for hearings, and present your case in the best light possible. We aim to turn your denial into approval so you can focus on your recovery and get your life back on track.

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What Are the Reasons for Denying a Workers’ Comp Claim?

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There are several reasons why an employer or their insurance company might deny your workers’ comp claim. Some common reasons include:

  • The injury or illness isn’t work-related– Insurers might argue that your injury or illness didn’t occur in the course of your employment or that it happened outside of work hours or during a non-work-related activity since these conditions disqualify you for workers’ compensation benefits.
  • The injury or illness isn’t severe enough– Insurers may argue that your injury or illness isn’t severe enough to warrant time off work or medical treatment. They may contend that you can continue working without limitations.
  • The claim was filed after the deadline– Workers’ compensation laws impose strict deadlines for reporting injuries or illnesses and filing claims. If you miss these deadlines, the insurer may deny your claim on the grounds of untimeliness.
  • You didn’t follow the proper reporting procedures– Failing to report your injury or illness to your employer according to the required procedures and within the specified timeframe may lead an insurer to deny a claim. Insurers may argue that your employer wasn’t given adequate notice to investigate the matter.
  • Your employer disputes the extent of your injury or illness– Your employer’s insurer might try to argue that your injury is not as serious as you say it is, claiming that you’re exaggerating or misrepresenting the facts. They may argue that your work restrictions or medical treatment aren’t necessary or justified.
  • Your injury occurred because of a pre-existing condition– Insurers might deny a workers’ comp claim if they believe that a pre-existing condition contributed to or caused the injury or illness. They might argue that the current injury is unrelated to your job and instead stems from your previous injury.
  • There is insufficient medical evidence of your injury– An insurer might use a lack of medical documentation supporting your injury or illness as an excuse to deny your claim. They could argue that there isn’t enough evidence to prove the injury or illness is work-related or severe enough to warrant compensation.
  • You engaged in fraud or misrepresentation– Insurers can deny a claim if they suspect fraud or misrepresentation. This could include cases where the worker provides false information about the injury or illness, exaggerates the extent of the injury, or fabricates a work-related accident.
  • You were intoxicated or under the influence of drugs– Workers’ compensation laws protect employers from liability for injuries caused by intoxication. Your employer’s insurer might deny your claim if it believes drug or alcohol consumption contributed to your injury.
  • You did not comply with medical treatment– Failing to follow prescribed medical treatment or attend scheduled appointments may result in a claim denial. The insurer might argue that your non-compliance is hindering your recovery and that you’re not taking the necessary steps to improve your condition.

Some employers and their workers’ compensation carriers try to deny valid claims on any grounds they can think of. They hope that by denying your claim, you will give up. But you don’t have to. You have the right to appeal your claim and assert your rights under the workers’ compensation system.

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"I don’t know how to begin to thank you for all of the hard work you did on my worker’s compensation case. From day one you had this ease about you. I was able to relax knowing that my legal situation was being handled. If at anytime I or anyone I know need legal counsel, I will be sure to contact your firm." - Monique S.

How to Appeal a Workers’ Compensation Claim Denial

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Don’t lose hope if your workers’ compensation claim gets denied. You have the right to appeal the decision. Here’s a step-by-step guide on how Younce, Vtipil, Baznik & Banks, P.A. can help you do it:

  • Review the denial letter– The denial letter should provide the specific reasons for the denial
  • File a written request for a hearing– You’ll need to submit a written request for a hearing with the North Carolina Industrial Commission within a specific timeframe. Our attorneys will help you navigate this process.
  • Gather evidence– Compile medical records, witness statements, and other relevant evidence to support your claim. Our lawyers will work with you to build a strong case.
  • Attend the hearing– You’ll present your case before a deputy commissioner, and they will either uphold the denial or approve your claim. Our attorneys can help you prepare for the hearing and represent you throughout the process.
  • Appeal the decision if necessary– If the deputy commissioner denies your claim, you can appeal the decision to the full commission. You can also submit additional appeals through the state court system if the commission continues to deny your claim. Our lawyers can continue to support and guide you through this process.
Younce Vtipil Baznik & Banks personal injury law team

Talk to Our Raleigh Workers’ Compensation Lawyers Today

If you were hurt at work and are an employee, you may be entitled to workers’ compensation benefits to pay for your medical care, a portion of your lost wages, and more. Don’t let a workers’ comp claim denial stand in the way of the benefits you deserve. The North Carolina workers’ compensation lawyers with Younce, Vtipil, Baznik & Banks, P.A. are ready to fight for your rights and appeal the decision. Call us today at (919) 661-9000 or visit our contact page for a free consultation. We provide hands-on treatment, care, and personal attention. Let us put our dedication and experience to work for you.

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