What to Do If Your Work Comp Case Is Denied

Your employer must ensure that you’re provided with a safe environment for work. If for some reason you get sick or injured in the course of your work, you’re entitled to compensation. It’s called worker’s compensation insurance, or work comp in the alternative.

Work comp is an alternative to suing your employer for negligence. Instead of commencing a lawsuit, you’d be required to file a compensation claim at your employer’s work comp insurance company. You can only file this claim if you’re an employee of the company with the worker’s comp insurance and if your injury happened while you were at work.

Unfortunately, filing a compensation claim isn’t a guarantee that you’d get damages for your injury. There are several reasons why you may be denied compensation. We’d take a look at these reasons and let you in on what to do if your work comp case is denied.

Why Your Work Comp Case May Be Denied 

Your employer’s work comp insurance company may refuse to honor your compensation claims in any of the following instances:

  • The Injury or Claimant Isn’t Covered in the Insurance  

Work comp Insurance doesn’t cover every kind of injury. It doesn’t cover mental/psychological health challenges and stress or injuries from commuting to or from the workplace. Claims brought under these headings would be dead on arrival. You also have to be an employee of the company with the work comp insurance. A contractor isn’t an employee for this purpose.

  • Lack of Evidence 

An insurance company wouldn’t just take your word for it. They’d carry out their independent investigations to be sure that the injury meets all their compensation requirements. They need evidence to determine this. Your claim may be denied if there isn’t enough evidence to support it or if there’s some doubt as to the circumstances leading to the injury.

  • The Claim Was Filed Out of Time 

If you wish to pursue a work comp claim, you should report your injury to your employer as soon as possible. Different states stipulate various deadlines within which work comp injury must be reported. In North Carolina, you should submit your report within 30 days of the occurrence of the injury. In the case of sickness, the report should be within 30 days after the discovery of it. Many claims are denied because the claimants missed the deadlines.

  • Issues With Paperwork  

You should be careful when filing your paperwork. Any mistake on it can lead to your claim being denied.

  • The Employee Caused the Injury 

Work comp insurance covers work-related cases that happened during an employee’s regular work activities. If it can be shown that the injury was due to doing something contrary to your work ethics or description, your claim may be denied. For example, if you were fighting, drunk, or inflicted the injury on yourself somehow, your work comp claim will be thrown out.

  • The Injury Wasn’t Obtained on the Job 

Your injury must be obtained while on the job and not anywhere else.

Steps to Take If Your Work Comp Case Is Denied 

If you feel that you’ve met the criteria for compensation and your claim was denied, you could either ask for a review or appeal the decision.

  • Ask for a Review 

When you ask for a review, you’re asking the insurance company to re-examine the claim in the hope that they’d reach a different conclusion. Claimants would typically ask for a review of the insurance company neglected to consider a material fact in their investigation. At the review hearing, you’d be requested to show why the denial was in error.

  • Appeal the Decision 

You can decide to appeal the insurance provider’s decision if you’re not satisfied with the denial. An appeal is like a lawsuit, except that a state agency handles it and not a judge. In the appeal, you’d be allowed legal representation, and the state agency would rely heavily on administrative statutes.

  • Judicial Review

You can file your claim before a judge, but only if you’ve exhausted all the administrative options available to you. A courtroom is a place of last resort and not of the first instance in work comp cases.

Conclusion 

If you’re in search of a workers comp lawyer in Charlotte, NC,  you’re in luck. We have highly experienced work comp lawyers in North Carolina that would help you get all the help you need for your work comp case. We’d investigate the injury and offer you the best representation before the industrial commission and in appeals. Contact us now; let’s get started.

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