What Happens If My Workers’ Comp Claim Is Denied In North Carolina?

Was your workers’ compensation claim denied or undervalued? You could still have a chance to get the full benefits you need. You can push back and demand the recovery you deserve by filing request for hearing at the NC Industrial Commission.

The Form 33 and litigation process in North Carolina is complex, but you do not have to handle it alone. A workers’ compensation lawyer from Kornbluth Ginsberg Law Group, P.A., can review your file and your denial letter, explain your legal options, and help you take the right steps towards getting the benefits you may deserve.

Our team of attorneys handles workers’ comp hearings (trials) across North Carolina and know how to deal with insurance disputes, medical evidence, hearing procedures, and other issues in the process.

Contact us now or call us 24/7 at 919-980-9895 for a free consultation with an experienced North Carolina workers’ compensation attorney. We want to listen to your story, analyze your situation, explain your legal options, and handle all the legal details for you. Our Durham office is conveniently located at 3400 Croasdaile Drive, Suite 300. We are here to help you.

Why Would a Workers’ Compensation Claim Get Denied in NC?

A workers’ compensation claim denial can happen for several reasons. One common reason is a missed deadline to report the work injury. You must tell your employer about a work injury within 30 days to receive benefits. If you wait too long, the insurance company might deny your claim.

Another possible reason involves insufficient medical evidence. You need to show that your injury happened at work or because of your job. If your doctor does not mention that your injury is work-related in your medical records, or if you wait too long to get treatment, the insurance company could reject your claim.

Paperwork mistakes also lead to denials. For example, if you file the wrong form, leave out key details, or submit your claim to the wrong place, it might not go through. Denials can also happen if an employer claims the injury did not occur on the job or says your condition existed before the accident.

Insurance companies also reject workers’ compensation claims by alleging that injured workers were ineligible because they were independent contractors, not employees. Insurers might also deny a claim for benefits on grounds that the injured worker was impaired by alcohol or drugs or that the injuries were intentional.

Can My Employer Deny My Workers’ Comp Claim?

Your employer can dispute your workers’ compensation claim, but they cannot make the final decision. Only the North Carolina Industrial Commission (NCIC) has the authority to ultimately approve or deny claims.

Employers might try to challenge a claim by saying your injury did not happen while you were working. They might also claim you did not report the injury on time or claim you were not a covered employee. Such disputes can delay the process and might lead to a denial by the insurance company.

However, even if your employer disagrees with your claim, you still have the right to file an hearing request with the NCIC. If the NCIC finds that you are entitled to benefits, your employer and their insurer must comply, whether they agree or not.

What to Do If Workers’ Comp Benefits Are Denied or Undervalued

If the insurance company denies your workers’ compensation claim or offers less than you think you deserve under the law, you do not have to accept that decision as final.

You can take these steps to protect your rights and start building a stronger case:

• As soon as possible, get help from our lawyers who handle workers’ compensation appeals in North Carolina.
• Read the denial letter carefully and look for the reason the insurance company gave.
• Make note of important deadlines so you do not miss your chance to appeal.
• Ask your doctor for updated medical records that clearly link your injury to your job.
• Keep a copy of all information you send or receive related to your claim.
• Avoid talking to the insurance company without legal representation.
• Stay off social media, especially if your posts show anything about your daily activities.
• Let your employer know right away if your condition gets worse.
• Ask co-workers or witnesses to write down what they saw when the injury happened.

How to Fight a Workers’ Compensation Claim Denial in North Carolina

If the insurance company denies your workers’ comp claim in North Carolina, you can fight the denial and ask for a fair review by filing an appeal.

Here is a basic outline of the process of appealing a workers’ compensation decision:

• File a Form 33. To start the process, file a Form 33 with the NCIC. This form tells the Commission you want a hearing.
• Go to mediation. After you file Form 33, the Commission might ask you to attend a mediated settlement conference. These are meetings where both sides try to settle the case. If you cannot reach an agreement through mediation, your case will move forward. For the vast majority of cases, a mediation will only be ordered if both sides of the case have legal representation. It would be unwise to try and mediate a case on your own. If your case does get ordered into mediation, call a lawyer and get help.
• Attend a hearing. If mediation fails, a Deputy Commissioner will hold a hearing where you and the insurance company will present evidence and witnesses. After the hearing, the Deputy Commissioner will issue an Opinion and Award that outlines their decision. A hearing is a long and complicated process, and you should not go into it without a seasoned workers’ compensation attorney to prepare the case and fight for you.
• Appeal to the Full Commission. If you disagree with the Commissioner’s decision, you can file a second appeal. You have 15 days from the date you receive the decision to file a notice of appeal to the Full Commission. You will then submit a Form 44 and a written brief (argument) within 25 days after receiving the hearing transcript. This step involves complex legal requirements and knowledge of NC case law. You will need a lawyer at this stage.
• Further appeal options. If the Full Commission denies your claim, you can appeal again to the North Carolina Court of Appeals. This step involves complex legal requirements, strict court rules, and an extensive knowledge of the law. You will need a lawyer at this stage.

Why Legal Help Matters in a Workers’ Comp Appeal

A denied workers’ comp claim appeal takes time, planning, and attention to detail. You must meet strict deadlines, file the correct forms, and present strong evidence. If you miss a step, the Industrial Commission could throw out your case.

People who try to handle the process alone often end up feeling overwhelmed and making preventable mistakes that cost them their benefits.

Our workers’ comp appeals attorneys can handle each part of the process for you. We can gather medical records, prepare legal arguments, and speak on your behalf at mediation and during hearings. If the insurance company fights back, your lawyer can challenge their claims and protect your interests. Professional legal help can give you a much better chance of getting the benefits you are owed.

Talk to a North Carolina Workers’ Compensation Lawyer Today

If you are dealing with a denied workers’ compensation claim, now is the time to speak with someone who will take your case seriously. At Kornbluth Ginsberg, we treat every client the way we would want to be treated – with honesty, respect, and straightforward answers.

We know how stressful this process can be, and we are here to help you move forward. Contact us today or call us 24/7 at 919-980-9895 for your free consultation. We will take the time to learn about your case and explain how we can help you seek the workers’ compensation benefits you deserve.