What to Do If Your Workers' Comp Claim is Denied

claim-denied

If you are injured on the job in North Carolina and then receive a letter stating that your workers’ compensation claim has been denied, you should discuss the situation with an experienced workman’s compensation attorney who knows the law. A free consultation with a worker’s compensation attorney is a quick way to inform yourself of your legal rights.

Many injured employees with valid workers’ compensation claims receive denial notices or have their claims disputed by their employer or the employer’s insurance adjustor. Overturning a denied workers’ compensation claim in North Carolina requires perseverance, knowledge of the appeals process and an understanding of the type of evidence needed to support your claim.

It is helpful to speak with a workers’ compensation attorney if you have received a notice of denial of your claim. An experienced workers’ compensation lawyer can review the reasons your claim was turned down and discuss your best options for appealing a denied claim and pursuing benefits. An experienced attorney can help you through the complicated workers’ comp process.

Reasons You May Be Denied Workmans’ Comp

There are a number of reasons your workers’ compensation claim may be denied.

  • Employment Status — Most employers in North Carolina with more than three employees are required to provide workers’ compensation benefits. Some employers will challenge your employment status and contend that you were an independent contractor rather than an employee to avoid paying an injury claim. In some cases, these denials can be overturned upon appeal by providing evidence showing that your conditions of employment met the legal definition of an employee, as defined by North Carolina law.
  • Inadequate Information — An insurance adjustor may deny your request for workers’ compensation benefits because your claim is incomplete or lacks the medical information to prove your workplace injury. A knowledgeable attorney can review your application and determine what additional supporting information is needed.
  • Missed Deadline — North Carolina requires that injured employees notify their employer of an injury caused by a workplace accident within 30 days. A claim may be denied if an injured worker failed to comply with the reporting requirement for written notification of a workplace injury. Workers’ compensation insurance adjustors are more likely to dispute benefit claims that are made weeks or months after the fact without any prior notice of the injury.
  • Off-Site Injury — A claim may be denied if your employer or the insurance adjustor believes that your injury did not occur on the job. An injury must occur while you are performing work-related duties in the scope of employment to be recognized as a workplace injury. Injuries that occur while commuting to work generally are not covered.
  • Outside Scope of Employment — If you were injured while impaired or intoxicated or your injuries were self-inflicted as a result of intentional misconduct on your part, the insurance adjustor may find that your injury occurred outside the scope of employment and deny your claim for benefits. These determinations by an employer or insurance adjustor may be appealed.
  • Lack of Causation — A claim may be denied because the adjustor does not see a valid connection between the workplace accident and the injury the worker has reported. Often, obtaining a second medical opinion and submitting the additional medical evidence clarifying the nature of the injury can help a worker obtain benefits on appeal.

The reasons for denials of claims are as varied as the types of injuries that can occur in a workplace. If you think your workers’ comp claim was wrongly turned down, you may appeal the decision and seek to have the denial overturned. It is important to discuss with a qualified attorney the next steps to take if your claim has been denied.

NC Workers’ Comp Appeals Process

If your workers’ compensation claim has been denied and a reasonable settlement cannot be reached through negotiation, you have a right to appeal. You should have an attorney advising you or you will be at a disadvantage dealing with others who are familiar with the appeals process.

Your attorney will discuss with you whether to file a request for a hearing. The hearing is held before a deputy commissioner of the N.C. Industrial Commission, the government agency that enforces the Workers’ Compensation law in the state. At the hearing, you can present medical evidence showing how the injury occurred at work and how it has affected your life and ability to work.

If you disagree with the deputy commissioner’s finding, you can appeal the decision to a panel of the Industrial Commission.

If you wish to appeal the ruling of the Industrial Commission, you can appeal the decision to the N.C. Court of Appeals.

Why Hire a Raleigh Workers Compensation Lawyer?

The process of appealing a denied work injury claim is a complicated legal procedure. It includes paperwork deadlines, collecting and presenting medical evidence and appearing at a hearing before a judge. Injured workers are often uncertain about their legal rights and responsibilities related to workers’ compensation.

Your company’s workers’ compensation adjustor will most likely have lawyers or experienced personnel presenting evidence of why your claim should be denied. You have a better chance of success if you have an experienced workers’ compensation attorney who knows the law fighting for you.

An attorney can investigate your claim, handle the communications with the workers’ compensation insurer and help you consider all the issues pertaining to a settlement such as your rights to future benefits if your condition changes.

Our lawyers at Younce, Vtipil, & Baznik, P.A., have decades of experience handling North Carolina workers’ compensation appeals. Attorneys Robert C. “Chip” Younce Jr. and David E. Vtipil are both board certified specialists in worker compensation law. Board certification by the North Carolina State Bar signifies that an attorney has attained additional training and passed a written examination in a particular area of law. Board certification is a designation that only a small percentage of attorneys in North Carolina have. We apply our experience and knowledge to help clients pursue the benefits they need. Contact us for a free claim review and discussion of your legal options.