If you’re an injured worker in North Carolina, filing a Workers’ Comp claim is just the beginning of the process. After filing the claim, the North Carolina Industrial Commission (NCIC) may deny it. However, this doesn’t mean you have to accept that decision as your last resort. With some effort and knowledge, you can appeal the decision and potentially receive the benefits you’re due.
Below is a comprehensive guide to workers’ comp appeal in NC. We’ll cover how to file an appeal, how long you have to do so, and what evidence you’ll need to back your claim. We’ll also advise on who can help you with your appeal and how to prepare for any hearings or mediations along the way. Let’s dive in!
Overview Of The North Carolina Workers Comp Claims Process
The North Carolina Industrial Commission oversees workers comp claims in North Carolina. If you’re filing a workers’ compensation claim in North Carolina, remember three main steps.
First, you’ll need to file your initial workers’ compensation claim with the North Carolina Industrial Commission. This can be done online or via mail. Once you’ve filed your claim, the Commission will review it and determine whether it should be accepted.
If your claim is accepted, the Commission will assign an adjuster who will work with you and your employer to reach a settlement agreement. If a settlement can’t be reached, your case may go to a hearing where a Commissioner makes a final decision.
Finally, if you don’t agree with the decision made at the hearing, you may have the right to file an appeal with the North Carolina Court of Appeals. To do so, you must file an Application for Review within 30 days of receiving notice of the hearing decision from the Industrial Commission.
What to Do if Your Claim Is Denied
If your claim is denied in North Carolina, you should begin to take action immediately. Denials happen for many reasons, such as a lack of evidence or because the claim was made outside of the statute of limitations.
No matter why your claim is denied, you can file an appeal. But it’s important to note that the appeal process can be complex, and getting it wrong can result in a denial of your case.
Here are some key steps that you should consider when filing an appeal.
- Research 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 North Carolina Industrial Commission (NCIC).
- Gather 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. Attorneys help ensure that claims are properly filed, and evidence is presented efficiently and effectively.
The Steps Involved in Filing an Appeal
Appealing a denied workers’ compensation claim can seem daunting, so let’s break it down into simple steps.
Step 1: Understand Your Denial Letter
The first thing you need to do is read your denial letter thoroughly and make sure you understand why your claim was denied. This is key because it’s the basis for the next steps in the appeals process — if you don’t know why your claim was rejected, you won’t be able to argue your case effectively.
Step 2: Choose an Attorney
Once you have determined why your claim was denied, it can be beneficial to seek legal help from an experienced attorney specializing in workers’ compensation cases.
They’ll be able to analyze your situation, determine what evidence you need to present in court and guide you on what evidence will be most effective. They will also provide legal representation during the appeals process if necessary.
Step 3: Prepare Your Appeal
Now that you have decided to appeal the decision and have chosen a lawyer, it’s time to start preparing for the hearing. You’ll need to collect all relevant documents, such as medical reports, witnesses’ testimony, and any other evidence that shows why your claim should be accepted. Your attorney can help review everything and ensure all necessary paperwork is in order when filing the appeal.
At this point in the process, it’s also important to remember that time is of the essence — North Carolina law sets a strict deadline of two years from when you first filed your claim to file an appeal. So make sure not to let any time go by if you decide to appeal!
Going Before the Industrial Commission
If you decide to go to the Industrial Commission with your worker’s compensation claim, there are a few things to remember.
The Industrial Commission is a tribunal of three members who will examine all the evidence and decide on your worker’s compensation claim. All three members must agree on the decision, which can take some time.
You can present your case in person or do it remotely, depending on what is more comfortable for you. In-person appeals are generally held in Raleigh, while remote hearings can be done via video or teleconference.
When presenting your case, you’ll need to include supporting documentation and any relevant witness testimony that supports your claim. Your attorney will help you prepare the best possible case and will be there during the hearing to present evidence and make arguments on your behalf.
Remember that if you don’t feel comfortable going before the Industrial Commission—or if you’re unsure about how to proceed—you can always try filing an appeal through mediation first as an alternative option.
Understanding the Possible Outcomes of the Appeal Process
When it comes to workers compensation claim appeals in NC, there are a few possible outcomes. Understanding these options is important to know what to expect when filing an appeal.
One possibility is that your appeal will be denied. In this instance, the appeal board has decided that your claim is not eligible for the benefits you applied for. If this happens, you may be able to request a reconsideration or resubmit your request with additional information or documentation.
If your appeal is approved, the board has accepted and approved your claim for payment of benefits. This means that you will receive the compensation you requested and any additional medical costs associated with the injury or illness you suffered as a result of your job.
Sometimes, however, the board may decide to approve an appeal partially. In this case, the worker may still receive some compensation but not all of what was requested. The amount of compensation awarded in this situation can vary depending on the specifics of each case. After reviewing all relevant evidence and documentation provided by both parties, the board will decide.
It is important to keep in mind that when filing a workers compensation claim appeal in NC, no matter which outcome occurs after filing and processing your paperwork, it is wise to contact an attorney who can review all relevant information and help guide you through the process so that you get full compensation for your injury or illness.