Workers’ compensation is a crucial safety net that offers wage replacement and medical benefits to employees who have been injured on the job. However, the path to securing these benefits can sometimes be fraught with challenges, particularly when you get a denied workers comp claim.
Appealing the denial is complicated, but you don’t have to face this challenge alone. offering insights on how to navigate the process. Our North Carolina workers compensation lawyers can help you.
The Basics of Workers’ Compensation in North Carolina
The North Carolina Industrial Commission’s Claims Administration Section is tasked with processing workers’ compensation injury reports and claims forms. While the commission does not offer legal advice, it does provide databases that contain information on an employer’s insurance coverage in the state, as well as data on Workers’ Compensation and Tort cases.
Legal Framework
The North Carolina Workers’ Compensation Act, Chapter 97 of North Carolina General Statutes, is the governing law for workers’ compensation in the state. The Act is divided into several articles, each addressing different aspects of workers’ compensation.
Reasons Behind Claim Denials
Claim denials can occur for a variety of reasons. Here are some of the most common:
- Deadline Missed: Filing deadlines can be missed due to clerical errors or late submission of paperwork.
- Non-Work-Related Injury: Injuries sustained while engaging in activities unrelated to work, such as sports or hobbies, are not covered.
- Injury Occurred Outside of Work Hours: Injuries that occur when an employee is not on duty are typically not covered.
- Insufficient Medical Treatment Prior to Filing a Claim: If a worker receives medical attention but does not adhere to the doctor’s recommendations, this can lead to a claim denial.
- Delayed Injury Reporting: Injuries that occur at work should be reported promptly. Delayed reporting can result in a claim denial.
Appealing A Denied Workers Compensation Claim
If your workers’ compensation claim is denied, it’s important to remember that you have the right to challenge the decision.
Appeal Process:
The appeal process in North Carolina involves several critical steps:
- Inform the North Carolina Industrial Commission (NCIC): You must file your claim (Form 18) with the Commission to inform them of your intent to appeal.
- Request a Hearing: Submit Form 33 – Request that the Claim be Assigned for Hearing with the NCIC.
- Participate in Mediation: The Commission may require you to participate in mediation to attempt to reach an agreement with your employer.
Consideration When Filling an Appeal
The appeal process can be intricate, and it’s crucial to get it right to avoid a denial of your case. Here are some key steps to consider when filing an appeal:
- Understand Your Rights and Obligations: Ensure you understand what is needed to prove your case during an appeal. It’s essential that you understand any deadlines or requirements that must be met to move forward with your claim.
- File Your Appeal: Filing the appropriate paperwork is necessary to start the appeals process, so ensure all documents are properly filed with the NCIC.
- Collect Evidence: The NCIC may require additional evidence before deciding on your case, so ensure all documentation and reports related to your injury are readily available for review.
- Seek Legal Counsel: It’s wise to seek legal advice from an attorney with experience in Workers’ Comp law in North Carolina when appealing a denied claim.
The Impact of Denied Workers’ Compensation Claims
If your workers’ compensation claim is denied, you may be responsible for any medical bills incurred as a result of your on-the-job injury. This can be a significant financial burden, especially if you are unable to work while you recover. Additionally, the denial of a workers’ compensation claim can lead to disputes with your employer.
It’s also important to note that you cannot bring a claim for workers’ compensation benefits after leaving your job. This is true regardless of whether the employee or the employer ended the relationship. However, you cannot be fired because you reported an injury to your employer.
Call Our North Carolina Workers Compensation Lawyers Today
Dealing with denied workers’ comp claims in North Carolina can be a complex process, but with the right knowledge and resources, it’s possible to navigate these challenges. Remember, it’s crucial to act quickly, understand the reasons for denial, and seek professional legal help when necessary.
Contact North Carolina Workers Compensation Lawyers at 919-328-2336 to get help now.