Denied Workers’ Comp? First Steps to Appeal

On-the-job accidents can happen in any occupation. When they do, you could be left with injuries that are serious, requiring ongoing medical care while preventing you from working. If your injuries are severe, you may have lasting disabilities that affect your earning potential in the years to come.

North Carolina requires most employers to have workers’ compensation insurance to pay for medical care and other benefits for employees injured on the job. Obtaining the benefits can prove challenging if an employer disputes your claim. It is a good idea to get legal representation to help guide you through this process of appealing a denied claim.

Denied Workers’ Compensation Claims

North Carolina law requires businesses with more than three employees to provide workers’ compensation coverage. Injured workers collect millions of dollars in benefits each year. But statistics from the U.S. Department of Labor indicate that a significant portion of claims are denied. Reasons for a denied claim may include any of the following:

• Procedural errors on the part of the injured worker, such as failing to follow injury reporting requirements or submitting an incomplete claim form;
• Disputes over whether your injury is job related or over the circumstances under which it occurred;
• Failure to follow doctor’s instructions;
• Actions on the part of an employer or their insurer, such as not filing the correct forms or not adhering to time limits.

If your claim is denied, it is important to act fast to protect your rights to pursue an appeal.

Workers’ Compensation Appeals Process

The North Carolina Industrial Commission (NCIC) hears workers’ compensation appeals Once you report a job-related illness or injury to your employer and a claim is submitted, you will be notified within 14 days whether your claim has been accepted or denied.

In the event your claim is rejected, you will be notified as to the reasons for the denial. You will be informed of your right to appeal the decision. Filing an appeal is a complicated process. The following is a general outline of the process:

• Once you have received a denial, you are required to notify the Industrial Commission within 14 days of your intent to appeal.
• Once the NCIC receives your notification, you will be scheduled for a mediation conference. You may have an attorney represent you at the conference.
• You, your legal representative if you have one, and your employer’s insurance representative will meet with a mediator, who will make a recommendation based on the evidence presented in your claim. The mediator’s recommendation will be forwarded to the Industrial Commission.
• If you disagree with the mediator’s recommendation, you may request a hearing before an administrative judge.
• This hearing is similar to a trial, with testimony from witnesses and presentation of evidence by both sides. After reviewing the testimony presented, the judge will make a decision in your case.
• If the judge who hears your case denies your claim, you may request a hearing before a panel of three administrative judges.
• If you continue to disagree with the Industrial Commission’s decision, you may pursue the appeals process through the North Carolina Court of Appeals and then to the state Supreme Court.

Appealing A Denied Workers’ Compensation Claim

To be successful in filing an appeal of a denied workers’ compensation claim, one of the first and most important steps is to ensure you have a knowledgeable attorney aggressively representing your interests.

With your future dependent on the outcome, you should select a firm with knowledge and proven experience handling workers’ compensation cases. At Hardison & Cochran, our firm has attorneys on staff who are board-certified specialists in workers’ compensation law. They have obtained specialized training and legal knowledge in the application of the North Carolina Workers’ Compensation Act.

Other steps you can take in the event your workers’ compensation claim is denied include:

• Contacting your employer and their insurer to make sure the appropriate forms and information were submitted;
• Providing the insurer with additional information that might be helpful to your claim, such as medical reports and the names of witnesses to your accident;
• Contacting the Industrial Commission to be sure they have all relevant forms and documents;
• Keeping track of evidence in your case, such as statements from co-workers, medical bills and receipts, and prior year wage and tax statements;
• Following all doctor instructions regarding work and activity restrictions, including keeping all follow-up appointments and submitting to recommended treatments;
• Notifying your doctor of any new symptoms or side affects you may be experiencing;
• Maintaining your current contact information with the NCIC and your employer, and checking in regularly to stay up to date on any changes in the status of your claim.

Our Experienced North Carolina Workers’ Compensation Attorneys Can Help You Today

On-the-job injuries and illness affect your health as well as your financial security. If you are having difficulty obtaining benefits after a workplace injury, contact the law offices of Hardison & Cochran right away.

Our experienced North Carolina workers’ comp lawyers can guide you through the process of seeking workers’ compensation benefits. If you have already filed a claim and had it denied, having an experienced North Carolina workers’ compensation attorney is even more important. We can handle every aspect of the appeals process so you can focus on recovering from your injury. We serve clients in Raleigh, Fayetteville, Wilmington and throughout North Carolina. Call or contact our office online today to see how we can help you.