- February 9, 2024
Being injured on the job can be a physically and emotionally devastating experience. In addition to the pain and recovery process, you may face lost wages and mounting medical bills.
In North Carolina, workers’ compensation provides crucial financial support and medical coverage for injured workers. However, receiving these benefits is not always straightforward, and receiving a denied workers comp claim can add to the stress and hardship you’re already facing.
If you’ve encountered a denied workers’ compensation claim in Charlotte, it’s important to understand your options and take the necessary steps to pursue your rightful benefits. Our Charlotte workers comp lawyers are here to help you get the benefits you deserve.
Common Reasons for Denied Workers Comp Claims
Facing a denied workers comp claim in Charlotte can be overwhelming. Here’s a breakdown of common reasons for denial and how to address them.
Insufficient Evidence
- Work-related connection: Clearly document how the injury occurred and its link to your job. Witness statements and accident reports help.
- Medical gap: Ensure detailed diagnoses and treatment plans connect to the work incident.
- Follow-through: Adhere to medical recommendations and document compliance.
Formalities and Deadlines
- Report promptly: Don’t delay notifying your employer and filing claims within 30 days.
- Double-check paperwork: Avoid errors and complete forms accurately.
- Attend appointments: Show cooperation by attending hearings and medical appointments.
Contested Causation
- Pre-existing conditions: Gather medical evidence showing the work injury significantly worsened the condition.
- Alternative explanations: Refute claims with specific details and evidence.
- Intentional acts: Ensure your claim is free from suspicion of self-inflicted actions or intoxication.
Employer Disputes
- Differing accounts: Secure witness testimonies and consistently document your version of events.
- Non-cooperation: Report uncooperative employers to the IC. Their lack of cooperation can strengthen your case.
Remember, each claim is unique. Consulting an experienced attorney can help you address specific details and build a strong appeal.
Navigating the Appeal Process
Facing a denied workers comp claim can be daunting, but understanding your options and taking strategic steps can help you secure the support you deserve. Here’s a deeper dive into the appeals process, specifically tailored to Charlotte and North Carolina.
Requesting Reconsideration
Before launching into a formal appeal, consider requesting a reconsideration from the insurance company. This allows them to re-evaluate your claim based on additional information or evidence you submit.
- Gather any missing documentation, new medical reports, or witness statements that strengthen your case.
- Clearly explain the discrepancies you believe led to the denial and how the additional evidence resolves them.
- Submit your request for reconsideration within 30 days of receiving the denial notice.
Remember, reconsideration is not a guarantee, but it can be a good first step, especially if the denial was due to technical issues or missing information.
Form 33 and the North Carolina Industrial Commission
If reconsideration is unsuccessful or not an option, the next step is filing a Form 33 with the North Carolina Industrial Commission (IC). This officially initiates your formal appeal and brings your case before a deputy commissioner.
Time is crucial. File your Form 33 within 14 days of receiving the denial notice. Late filing risks forfeiting your appeal rights.
The IC will schedule a pre-trial conference with you, your attorney (if you have one), the insurance company representative, and a mediator. This meeting aims to settle the dispute without a formal hearing.
Be prepared to discuss your case and potentially reach a compromise. However, you are not obligated to settle if the offer is inadequate.
Preparing for the Hearing
If settlement negotiations fail, your case will proceed to a formal hearing before the deputy commissioner. This is your opportunity to present your case, witness testimonies, and medical evidence.
- Gather and organize your evidence: medical records, accident reports, pay stubs, witness statements, and any other documents supporting your claim.
- Prepare detailed witness statements: Ensure your witnesses understand the key points and procedures of the hearing.
- Practice your testimony: Be clear, concise, and factual in your presentation. Anticipate potential questions and prepare clear answers.
- Hire a Charlotte workers comp lawyer: An experienced workers’ compensation attorney can navigate the legal complexities, handle the paperwork, and effectively represent you during the hearing.
The Hearing and Beyond
During the hearing, both sides will present their arguments and evidence. The deputy commissioner will then issue a written decision. If the decision favors you, you begin receiving your benefits.
If the decision upholds the denial, you have 15 days to file an appeal with the full commission. This involves submitting legal briefs and potentially attending further hearings before a panel of three commissioners. This is governed by Rule 701 of the North Carolina Industrial Commission.
From the full commission’s decision, you can further appeal to the North Carolina Court of Appeals, and beyond to the Supreme Court. However, these levels rarely overturn decisions unless significant legal errors are found.
The appeals process can be complex and time-consuming. Be prepared for delays and potential back-and-forth negotiations. Seeking legal counsel can significantly increase your chances of navigating the system successfully and securing your rightful benefits.
Call Our Charlotte Workers Compensation Lawyers
When facing a denied workers comp claim, it’s highly recommended to consult with an experienced workers’ compensation lawyer. An attorney can:
- Review your case and assess its merits.
- Guide you through the complex legal process.
- Gather evidence and prepare your arguments.
- Represent you at hearings and negotiate with the insurance company.
- Appeal unfavorable decisions to higher levels of the IC.
You have rights as a worker in North Carolina. If you’ve been injured on the job and your claim has been denied, don’t give up. Hiring a Charlotte workers’ compensation lawyer can significantly increase your chances of overcoming a denial and receiving the benefits you deserve.
Contact our law firm at 704-706-2689 for a free consultation.
