My Workers' Comp Claim Was Denied - Now What?
Work injuries can create significant disruptions in your life and interfere with your plans, putting you in a difficult financial position. North Carolina law is supposed to protect injured workers, but many times an employer or insurance company will unjustly deny a valid claim for benefits, leaving the injured worker and his or her family without the money they need to pay medical bills or even cover monthly expenses. If this happens to you, it’s crucial that you take the time to speak to a lawyer immediately.
At Stewart Law Offices in North Carolina, our Charlotte workers’ comp lawyers can carefully review your case to see if there are options available for appealing a denial of benefits. We don’t charge for the initial consultation, so there is no risk for calling the moment you suspect a denial or discover your employer may not be willing to pay.
Reasons a Charlotte Workers’ Comp Claim May Be Denied
Workers’ compensation cases are not actually lawsuits. They are insurance claims that are governed by specific state laws. In North Carolina, there are many reasons why an insurance carrier may deny a work injury claim.
Here are just some of the reasons a workers’ comp claim may be denied:
- Deadlines – In North Carolina, you will need to report your injury to your employer within 30 days of the incident (or within 30 days of discovering a condition that developed on the job). The North Carolina Industrial Commission is a government agency that regulates and oversees workers’ comp claims in the state. Once notice is given, you will have two years from the date of your injury to complete and turn in a Form 18 to the Industrial Commission, seeking benefits for your injury. This may seem like a lot of time, but many people miss these deadlines entirely.
- Incorrect job classification – Sometimes benefits are denied because the employer claims you are not actually an employee. Many people who are paid as contractors are actually eligible as employees. Work comp rules are not the same as tax rules.
- Not on the job at the time – One of the biggest reasons for denials is the employee allegedly was not on the job at the time of the injury. Maybe the employer is claiming you were off the clock, on a break, or taking a significant deviation from your work duties when the injury happened.
- Evidence issues – Other times, there may be a lack of evidence, no witnesses or videos available, or a dispute about whether an injury really happened the way the employee claims.
- Paperwork problems – Of course, there are also times when workers make mistakes filing their paperwork. These simple mistakes can be very costly in the end.
- Drugs or alcohol – If the injury was partly due to the employee’s use of drugs or alcohol on the job, then employers may deny the claim.
What If My Employer Fails or Refuses to Report an Injury?
As a preliminary matter, it’s important to distinguish between your duties and your employer’s duties:
- You are responsible for notifying your employer.
- Your employer is responsible for notifying the Industrial Commission.
If your employer is going to deny your claim, it must do so in the correct way. A denial should be made using Form 61, which specifically and clearly lays out the exact reasons for the denial.
If your employer simply ignores you or refuses to acknowledge that you have a claim, then you will need to take the matter before the Industrial Commission to get a determination. This is where an experienced Charlotte work injury lawyer can really help you navigate the process.
First, you’ll file a claim with the Industrial Commission. If your employer chooses not to participate, respond, or defend the matter, a skilled attorney can help you move your case forward and get a formal hearing before the Commission, where a decision can be made, with the goal of forcing your employer and the insurance company to pay.
What If My Charlotte Workers’ Comp Claim Is Denied?
So, you may be wondering: “What happens if my workers’ compensation claim is denied?” You have the option to request a hearing and appeal a denied claim.
Within two years of your denial, you can file your Form 33 Request for Hearing, and schedule a hearing before the Industrial Commission. At the hearing, you (and your attorney) will be required to demonstrate why you believe the denial was improper.
There are a number of legal and factual arguments you can make, and an attorney from Stewart Law Offices, can help you craft a strong case for compensation.
How to Appeal a Denied Workers’ Comp Claim
What if my workers’ comp claim is denied after the hearing? In addition to requesting a hearing, you also have a right to appeal a bad outcome. You can appeal the Commission’s findings within 15 days of your hearing by filing a Form 44.
Keep in mind that workers’ compensation claims are governed by administrative law, which means the majority of the process is handled through a state government agency, rather than a judicial court and a judge. Also, because workers’ compensation is based strictly on statutes, the administrative agency will stick to the statute very closely and only deviate or make exceptions in very limited situations.
Lastly, you will not have a right to take your case before a traditional court or judge unless you have exhausted all possible remedies through the administrative routes. So, even if you strongly suspect that an appeal to the Commission will still result in another denial, you must do it if you wish to preserve your possible right to appeal to a civil court. That process is called a judicial review. It is fairly uncommon, but the option exists in certain situations.
How a Charlotte Workers’ Compensation Lawyer Can Help
After a serious work injury, you can be left without income and with mounting pressure from medical bills and other expenses. Likewise, you may be concerned about losing your job, your health benefits, or even your home and retirement. An experienced attorney can help you by making sure you meet all the necessary deadlines and complete all paperwork properly. Likewise, an attorney from Stewart Law Offices, will know how to appeal a denied workers’ comp claim so that you preserve your rights at every step in the process.
Here are some of the steps our law firm can take to help:
- Assist in getting medical care – Although your employer actually has a lot of power to decide who provides your medical care, you are entitled to a second opinion, and you can usually request a change of doctor. These things can make your medical treatment a bit complicated, but our attorneys are used to dealing with these matters, and we can advise you on getting a second opinion to keep the process fair.
- Investigate the injury – Some injuries are clear, but others may require a bit of investigation. For instance, even a specific event like a fall can lead to disputes over whether you were actually on the job, whether you were fooling around, and whether you are an employee or contractor.
- Represent you before the Industrial Commission – Although a Commission hearing is an administrative process that is somewhat less formal than a traditional court proceeding, it’s still a complicated legal process. There will be a commissioner, a defense lawyer representing your employer, and possibly a vocational expert all present. If you go into a hearing unrepresented, you are the only person in the room who is doing it for the first time. This is never a good position to be in.
- Handle your appeals – While most cases are resolved through a settlement or initial hearing, some cases do have to get appealed. Some even get taken before a traditional court for review. Depending on the facts of your case, an experienced Charlotte workers’ comp lawyers from Stewart Law Offices, may be able to help you at each stage to protect your rights and seek the full benefits you deserve.
Contact a North Carolina Workers’ Comp Lawyer Today
If you are suffering from work injuries in Charlotte, NC, don’t delay getting the help you need. Chances are you will continue to have questions and concerns about the process, how you are being treated, and what is proper in a workers’ comp case. Once you have an attorney, you will have the guidance you need at your fingertips.
Please call us today to schedule a free one-on-one consultation with a knowledgeable South Carolina workers’ comp lawyer. Someone from our team will be able to answer your questions and get started on your claim right away.