How To Appeal A Denied Claim
North Carolina’s workers’ compensation law is designed to help injured workers recover the full cost of medical expenses and a portion of their wages if they are injured on the job and unable to work for a period of more than seven days.
A worker who is injured on the job should report the injury to his or her employer and file a claim with the North Carolina Industrial Commission. Fault does not play a role in qualifying for workers’ compensation benefits.
There are a number of ways that an injured employer can benefit from the services of a workers’ compensation attorney; one of the most common is getting help appealing a denied claim.
A Knowledgeable And Assertive Advocate
An employer’s insurance company may deny a workers’ compensation claim for any number of reasons. It may not have the proper medical documentation, it may not feel the injury is serious enough to require medical treatment, it may not feel the injury is directly related to work activity, or it may feel the injury is not serious enough to prevent you from returning to work.
Vincent Law Firm, P.C., has a long track record of helping injured workers appeal denied claims and receive the benefits they deserve. I have been helping injured parties in these cases for over 30 years. Every case is unique, of course, and the legal strategy for your workers’ compensation denial will depend upon the facts of your case. Over the course of my career, however, I have seen almost every imaginable reason for a denial and developed effective arguments to reverse that decision.
If a hearing before an Administrative Law Judge (ALJ) is necessary, I will prepare you for what to expect and coach you on how to respond to the questions you will be asked. Being fully prepared will help you become your own best advocate.
Frequently Asked Questions About Workers’ Compensation Appeals
Here are some of the questions I get frequently from Outer Banks workers about appealing denied workers’ compensation claims in North Carolina.
How long do I have to appeal a denied workers’ compensation claim in North Carolina?
You have 18 years from the date of your workplace injury to file an initial claim with the North Carolina Industrial Commission, but appeal deadlines for denied claims operate under much shorter timeframes. When the insurance company denies your claim or terminates benefits, you typically must request a hearing before the Industrial Commission within two years of the denial or the date benefits stopped.
Missing these deadlines can permanently bar your right to pursue compensation, regardless of how legitimate your injury is or how unfair the denial is. Time limits become particularly critical when insurance companies deny ongoing medical treatment or cut off wage replacement benefits, as delays in appealing these decisions can leave you without income or necessary care.
How can I improve my chances of a successful appeal?
Successful appeals require thorough documentation and credible testimony supporting your claim. Obtain detailed medical records from all treating physicians, including diagnostic test results, treatment notes and opinions connecting your condition to workplace activities. Follow all prescribed treatment plans and attend every scheduled appointment, as gaps in care allow insurance companies to argue your injuries are not serious or work-related.
Keep detailed records of how your injury affects daily activities, work capacity and quality of life, documenting specific limitations and pain levels. Gather witness statements from coworkers who observed your accident or can verify your job duties and physical demands. Avoid social media posts showing physical activities that contradict your claimed limitations, as insurance companies monitor online activity seeking evidence to discredit injury claims.
Can my employer fire me for appealing a denied workers’ compensation claim?
North Carolina law prohibits employers from retaliating against workers who file workers’ compensation claims or appeal denied benefits. Terminating employment, reducing hours, demoting or otherwise punishing employees for pursuing legitimate compensation rights constitutes illegal retaliation that can result in additional lawsuits beyond your workers’ compensation appeal.
However, employers can still terminate employment for legitimate business reasons unrelated to your claim, such as poor performance, misconduct or economic layoffs affecting multiple positions. If you believe termination was retaliatory, document the circumstances surrounding your firing, including timing relative to your appeal and any statements suggesting retaliation.
Contact Vincent Law Firm, P.C.
Even when a workers’ comp claim is initially approved, there often comes a point when the insurance company and the injured worker are at odds. The insurance company may undervalue your injuries, deny medical treatment that you feel is necessary, or cut off your benefits because it feels that you have reached maximum medical improvement (MMI) and can return to work. Having a knowledgeable, experienced workers’ compensation lawyer in your corner assures that you make every argument available to you.
If you are at odds with your employer’s insurance company or medical professionals, contact Vincent Law Firm, P.C. I offer a free, no-obligation consultation. Call 252-489-2200. I will review the facts of your case and provide a candid assessment of what you can expect. And remember, you will not pay attorney fees unless I recover compensation for you.
I work with clients throughout the Outer Banks and beyond, including residents of Dare County, Camden County and Currituck County.