What Happens When Your Workers’ Comp Gets Denied?

On Behalf of | Dec 15, 2020 | Workers' Compensation |

North Carolina workers rely on their employers to provide financial help when suffering a work injury. The North Carolina Industrial Commission (NCIC) oversees the Tar Heel State’s workers’ compensation program, helping residents through debilitating injuries and ensuring fair treatment under the law.

Sometimes though, insurance carriers or businesses may deny an employee’s claim. In these situations, it may be necessary for the injured party to appeal the decision. How do workers’ compensation appeals work?

Common reasons for a denial

Insurance companies look to deny as many claims as possible to save money. There is little incentive for a carrier to spend thousands on a single person when they can deny the claim and hope they do not appeal. However, they cannot deny a claim without reason.

When denying a claim, your employer’s insurance company will send a denial letter with detailed reasoning behind the denial. The most common reasons carriers deny employee coverage are:

  • Failure to report or file on time: An employee must report the injury and file their claim soon after the incident.
  • Disputed claim: A carrier will not provide coverage if the client disputes the claim.
  • Not a compensable injury: Many plans do not cover all injuries, like those related to stress.
  • Failure to receive treatment: If an employee did not receive medical treatment for their injury, they would not receive medical coverage.
  • Insufficient evidence: Without proof of the incident in the form of witness testimony, security footage or medical records, a carrier cannot award coverage.

How to appeal

If your employer’s carrier denied your claim, you may appeal the decision. North Carolina residents only have 15 days to appeal the decision, so act now. Some denials may only need further information from your doctor, while others may be more complex. The most effective way to make sure you submit a comprehensive appeal is alongside a local attorney familiar with North Carolina workers’ compensation laws.

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