- February 19, 2022
- Workers' Compensation
If you get injured in North Carolina, you have the right to file a workers’ comp claim. You can usually do this with the help of a North Carolina workers’ compensation lawyer. However, sometimes, you might receive a letter stating that your workers’ compensation claim has been denied. The denial might be due to a dispute of your claim by your employer or the insurance adjuster.
In such situations, most workers are confused about the next step. Sometimes, you can overturn a denial, but it usually requires perseverance. You will also need knowledge of the process and the different types of evidence necessary to support your claim. In this article, our Charlotte workers’ compensation lawyers will walk you through all you need to know about how to handle a workers’ comp claim denial in North Carolina.
Reasons Your Workers Compensation Claim Was Denied
There are several reasons why your employers’ insurance adjuster might have denied your claim; below are some of them.
Employment Status
When an employer in North Carolina has more than three employees, they must provide them with workers’ compensation benefits. Some employers might dispute your workers’ compensation claim because you are an independent contractor rather than an employee. In some cases, your North Carolina workers’ compensation lawyer can overturn the denial when there’s evidence your employment conditions meet the legal definition of an employee.
Inadequate Information
Sometimes, the insurance adjuster might deny your claim because there’s not enough information. For example, your claim may not include adequate medical information to prove your injury. If your claim is incomplete, it allows the insurance adjuster to overturn your claim. A knowledgeable North Carolina workers’ compensation lawyer can review your application and inform you of the information you need to prove your claim.
You Missed the Deadline
North Carolina requires that injured employees notify their employer of any workplace injury within 30 days. The insurance carrier might dispute your claim if you don’t comply with this requirement and your employer fails to inform them of your injury in time. This is even more probable if you make the claim months after the injury without prior notice of the damage.
Lack of Causation
You could also get your claim denied if the insurance adjuster doesn’t see a connection between the workplace accident and the injury. Sometimes, the best way to overturn the denial is to seek a second medical opinion and submit evidence linking your injury to the workplace.
It’s Outside the Scope of Employment
If you sustained your injury while impaired or intoxicated, your employer might dispute your claim. If the injuries were self-inflicted because of your intentional misconduct, the insurance adjuster might deem your damage outside the scope of employment. This would lead to a denial of your claim, depriving you of your benefits. You could appeal this with ample evidence that your injury falls within the scope of employment.
The Claim Appeal Process
If you experience a denial of your workers’ compensation claim or cannot reach a reasonable settlement, you have the right to appeal. You need to reach out to a North Carolina workers’ compensation lawyer for advice. Your workers’ comp attorney will explain the ideal time to file for a hearing. They will also put you at an advantage because they understand the appeal process.
The hearing is always held before a North Carolina Industrial Commission’s deputy commissioner. The industrial commission enforces the workers’ compensation law in the state. At the hearing, you will provide evidence of your injury and how it affects your ability to work and your ability to work. You can also appeal the decision to a panel of the industrial commission if you disagree with the deputy commissioner’s verdict.
Why Hire Our Charlotte Workers’ Compensation Lawyers?
The process of filing an appeal for your workers’ compensation claim denial is complicated. There are paperwork deadlines, medical evidence to collect, and you need to appear in front of a judge. Most times, injured workers are clueless about their legal rights and don’t know how they can get the workers’ compensation benefits they deserve.
Your North Carolina workers’ compensation lawyer can help investigate your claim. We will also handle all the communications with the workers’ compensation insurer and consider all the issues affecting your claim. Our Charlotte workers’ compensation attorneys possess decades of experience which we would apply to help you get your rightful compensation. So contact us today to review your workers’ comp claim and get your proper settlement.
