What to do if Your Workers’ Compensation Claim is Denied?

workers'-compensation claim-denied-redress

If you suffer an injury at your workplace or during the course of your work in Charlotte, NC, you can seek compensation under the workers’ compensation insurance. However, not all workers’ compensation claims are successful. Your employer or the insurance company offering workers’ compensation benefits may find errors with your application or otherwise have objections. This can lead them to reject your claim.

The good news is that a claim denial is not the end. You still have plenty of legal options you can pursue following the denial. But it is important to first understand the common reasons why workers’ comp claims are denied in the first place.

Common Reasons for Workers’ Comp Claim Denial

Some of the most common reasons cited by employers and insurers when denying workers’ compensation claims include:

Late Application

By law, you are required to report a workplace injury at the earliest. Initially, you must report the injury to your employer within 30 days. If you are delayed, the employer can use this as an excuse to reject the claim. Likewise, the employer is usually responsible for reporting your injury to the relevant entity. If the employee fails or refuses to do so, you must use a Form 18 to report your injury directly to the Industrial Commission.

State Guidelines

North Carolina, like all other states, has clear guidelines on what qualifies as an injury or illness for the purposes of workers’ compensation insurance. If your injury or illness does not meet these guidelines, the insurer can refuse your claim on these grounds.

Causation

One of the most important steps in a workers’ compensation claim is to prove that your injury was caused by your work. This is a tricky part. An insurer may argue that you were off-duty at the time or indulging in deliberate misconduct. These objections can be used to argue that your injury doesn’t meet the requirements for workers’ comp benefits.

Appealing a Workers’ Comp Denial

If your workers’ compensation claim has been denied, you can appeal the decision. Under North Carolina laws, you must notify the Industrial Commission of your intent to appeal within 14 days.

Mediation Conference: Once you notify the Commission, a mediation conference is arranged. At this conference, you sit down with your lawyer and the representative of your employer’s insurance company. The purpose of mediation is to reach an agreement in an informal discussion.

Administrative Law Judge: If mediation fails, you can request a hearing before an administrative law judge (ALJ). This is a full legal hearing, much like a formal trial in a court. Both sides present their opening statements, arguments, and closing statements. Relevant evidence and witnesses are also presented before the judge. If you request an ALJ hearing, you must seek the help of a reliable workers’ comp lawyer to prepare for the hearing.

Full Commission Panel: If the ALJ also refuses your claim, you then have recourse to appeal against the decision. Your claim then goes to a panel of three administrative judges of the Commission. This panel generally doesn’t accept new evidence or arguments. Instead, the panel simply reviews whether the relevant laws were followed during the ALJ hearing. If the Commission also turns down your claim and upholds an ALJ denial, you can then take your claim outside the Commission.

North Carolina Court of Appeals: At this stage, your compensation claim enters the civil courts. When you take your case to the court of appeals, a proper trial and hearing is scheduled. It can take the court a while to decide on your claim. If the court upholds the Commission’s denial, you can take your appeal at successfully higher courts all the way until the Supreme Court. If the highest court of the state also rejects your claim, the verdict is final. However, if the Supreme Court rules in your favor, you will receive the full extent of benefits.

Hiring a Reliable Workers’ Compensation Attorney in Charlotte, NC

If your workers’ compensation claim in Charlotte, NC has been denied by an employer or insurer, we can help you. Here at Ted Greve & Associates, our lawyers have a long experience of handling workers’ comp claims. We work with you to appeal a denial at the initial level and then through the ALJ and Commission levels all the way up to the Supreme Court. We believe that if your injury was truly work-related, you deserve the benefits. Call us today to schedule a free session with our lawyers.

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