Disagreements between two disputing parties are unavoidable in workers’ compensation claims. Concord workers’ compensation disputes are quite common and generally center around an insurer’s efforts to limit the amount of medical care or income benefits injured workers may receive after suffering compensable injuries at work.
If you’ve had your workers’ comp case denied, the personal injury attorneys at 1Charlotte Law Firm in Concord can evaluate your case to determine whether or not you can appeal your denial of benefits. Get in touch with us the moment you discover your employer isn’t willing to pay up or you suspect a denial. Call (phone) now to schedule a meeting with our legal team today. Please note that our initial consultation is free, so you do not have to worry about paying any fees.
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Causes of Workers’ Compensation Disputes
Here is a look at some of the most common causes of workers’ comp disputes in Concord, North Carolina:
The Employee’s Employment Status
In North Carolina, companies that employ over three people are required to carry workers’ compensation coverage and provide the relevant benefits. However, some employers during a workers’ comp dispute will try and challenge an employee’s employment status and argue that they were working as independent contractors and not employees to avoid setting a claim. In some instances, aggrieved workers can have such denials invalidated by presenting evidence upon appeal that proves their employment conditions meet North Carolina’s legal definition of an employee.
Outside Scope of Employment
For workers whose injuries are due to intoxication or whose injuries are self-inflicted through intentional misconduct, insurance adjusters might determine that their injuries happened outside the scope of employment and refute their claim for benefits.
Lack of Causation
A claim might be denied simply because an insurance adjuster doesn’t see any valid connection between the injury(s) a worker reported and the workplace accident. In most cases, submitting extra medical evidence and acquiring a second medical opinion clarifying the nature of injuries could help an injured worker receive benefits on appeal.
Workers injured at work in North Carolina have 30 days to notify their employers of their injuries. As an injured worker, your claim might be denied if you fail to comply with the set reporting requirement, which dictates that you need to submit a written notification of your injuries. Workers’ comp adjusters will most likely refuse claims made months after an injury that was never declared.
Insurance adjusters often deny requests for workers’ comp benefits because some claims are incomplete or don’t have enough medical information to prove claimed injuries.
What to Do If Your Workers’ Compensation Claim is Denied in North Carolina
If your claim was denied, you have two years from the day it was denied to schedule a hearing before North Carolina’s Industrial Commission by filing a Form 33 Request for Hearing. At the hearing, you’ll be required to prove why you think the denial was unethical.
If, after you request a hearing, your claim still is denied, you still reserve the right to dispute the negative outcome. The next step here would be to appeal the Industrial Commission’s findings to North Carolina’s Court of Appeals. It’s worth noting that you have 15 days from the day of the hearing to file the necessary document – i.e., Form 44.
Appealing a denied claim can be a bit complicated, which is why you are advised to have a lawyer take you through the process. If you need help appealing your claim, call 1Charlotte workers’ compensation attorneys today for legal counsel and representation.
Common Workers’ Compensation Disputes
The following situations lead to workers’ compensation disputes in North Carolina:
These disputes often involve questions of medical opinion and facts concerning the treatment of injured workers. In most cases, the outcome of these disputes wholly relies on the physician’s inclination to fight for a worker’s treatment. Medical dispute examples include:
- Denied services such as assisted living arrangements
- Denied therapy
- Denied surgery
These are disputes in which attorneys can be most helpful. Claim dispute examples include:
- Compensability – involves determining whether or not a workers’ illness or injury meets North Carolina’s coverage eligibility requirements
- Average Weekly Wage Disputes – discrepancies about surrounding how much a victim should receive while they are on workers’ comp
- Disability – involves determining whether or not a worker has lost income due to their work-related illness or injury.
North Carolina’s Workers’ Compensation Dispute Process
If directly resolving a dispute with the insurer is not feasible, then the only option you have will be to escalate the matter. Dispute resolution options in North Carolina vary depending on the jurisdiction, the insurance company, and the nature of your case. Available dispute resolution options include:
This is where a neutral third-party voluntarily helps employees, employers, and insurers resolve workers’ comp disputes, and is generally used to avoid litigation, which can be time-consuming and expensive.
If the involved parties still can’t reach an agreement, a formal hearing tends to be the next step. Hearings aren’t that different from court trials – the only difference is that instead of being presided over by a judge, they are heard by the state’s workers’ comp board.
If the plaintiff still isn’t satisfied with the verdict reached during a hearing, he or she has the right to appeal the matter and have it heard in a state court.
Our Lawyers Are Experienced With Concord Workers’ Compensation Disputes
If you’re finding it hard to get workers’ compensation benefits, consider getting in touch with the Concord workers’ compensation attorneys at 1Charlotte today for legal counsel and guidance. Our attorneys are experienced in matters related to workers’ compensation and will fight to ensure your needs are heard and your claim is honored. Call (phone) now for a free review of your workers’ compensation claim dispute.