Choosing to file a workers' compensation claim is not an easy decision to make. Once you decide to file a claim, you then have to go through all the effort of making sure it is done properly all while dealing with your work-related injuries and their impact on your life. After investing so much time and effort, it can be difficult to discover that your claim has been denied.
Even though having a workers' compensation claim denied can be a serious blow to your morale, it is important to know that you have options. It is not uncommon for claims to be denied the first time they are filed, but workers have the ability to appeal that decision. However, before you begin the appeals process, the first step is figuring out why the claim was initially denied.
Common reasons for denial
There are many reasons a workers' compensation claim can be denied, but most can be addressed when the decisions are appealed.
There are many aspects of a workers' comp claim that need to be done within a specific time frame. For example, a work-related injury in North Carolina must be reported to your employer in writing within 30 days of the accident/the point at which you became aware of the injury.
If it's reported more than 30 days after the injury occurred, you may lose the right to a claim. Additionally, the claim itself needs to be filed within two years of the injury. If it is filed later than this, it can be denied.
It is possible that an employer will dispute your claim in some way. For example, they may claim that the injury was not actually work-related or that it resulted from reckless/irresponsible behavior on your part.
The employer and the insurance provider may also claim that there is not enough evidence to prove that the injury was a result of a work-related incident or of the working environment. In these situations, any medical examinations and records become more important.
Appealing claim denial
After you have received notice of your claim being denied, you need to submit a Request That Claim Be Assigned To Hearing form (Form 33) to the North Carolina Industrial Commission. After you have done this, you case may be mediated. If you do not settle the case in mediation, it can move to a formal hearing that is very similar to a trial.
These legal hearings and activities can be intimidating and confusing for most people. Because so much can depend on the outcome of the process, it is highly recommended that you go through it with the assistance of an experienced and knowledgeable legal professional. They will be able to work with you to achieve the best possible outcome.