What Happens if My Workers’ Compensation Claim Is Denied?

Many injured employees mistakenly try to handle their workers’ compensation case on their own, especially if it seems “straightforward” to them. The North Carolina Workers’ Compensation Act is designed to help workers, but that does not mean it is easy to navigate, or that you should not seek legal counsel when you have been hurt because you could make a mistake that could lead to a denial of your claim for benefits.

If your workers’ compensation claim is denied, however, you do have legal options available to you. An experienced Charlotte, NC workers’ compensation lawyer can help.

Request a hearing to appeal a decision

If your claim is denied, your first step is to file for a full evidentiary hearing before a Deputy Commissioner of the North Carolina Industrial Commission (NCIC). Before your hearing, you, your attorney, a mediator, and an attorney for the insurance company will sit down and attempt to settle your case. If you reach an agreement, then the hearing can be cancelled. If you do not reach an agreement, the hearing moves forward.

What if I lose at the hearing?

After the hearing, the Deputy Commissioner will inform you whether or not you are entitled to benefits. If you are, then your claim moves forward. If you are not, then you have 15 days to request a review of the ruling before the Full Commission.

Reasons why your claim may be denied at the hearing

Our experienced work injury lawyers review the reasons for the denial. We look to see if the denial is based on:

• A legal interpretation. Some cases are decided based on legal issues, such as whether the employee:
  • Gave timely and proper notice of the accident;
  • Was an independent contractor rather than an employee;
  • Sustained the injury outside of work; or

Did not sustain an injury by accident.

• A medical interpretation. For example, the hearing officers may decide based on the testimony of treating physicians that:
  • The injury or disability was not caused by the work accident;
  • The employee was not disabled from available suitable employment; or
  • The employee failed to treat appropriately
• Other reasons depending on the case

In all denied cases by a North Carolina Deputy Commissioner, the employee has the right to appeal the decision to the full North Carolina Industrial Commission. There are strict deadlines for filing the appeal and for filing written briefs in support of the appeal (the employer can also file a written brief against the appeal). The appeal is decided by three commissioners who will hear arguments from both sides. T

After the full NCIC makes an opinion, further appeals to the state appellate courts can be filed.

The best thing you can do if you are injured at work is call an experienced Charlotte, NC workers’ compensation lawyer immediately. At Warren & Kallianos, PLLC, our premier work injury lawyers fight to show your injuries or illness are work-related. We fight to ensure you return to work when you’re ready and no sooner. If your claim is denied, we’re ready to file a viable appeal. We’ve helped numerous employees obtain a just work injury recovery. Call us to arrange an appointment at our Charlotte, North Carolina office by phoning 704-377-7777, or use our contact form.