Denied Claims

An injury at work can be sudden and severe, causing you to be out of work for an extended period of time. When injured on the job, many times there is little question about whether or not your injury is covered by workers’ compensation. Unfortunately, insurance companies are notorious for denying valid work injuries and occupational disease claims.

Workers’ compensation claims are complex, often requiring a lot of work to be done before you obtain any benefits. It is important to have an experienced lawyer by your side to help you through the process.

In North Carolina, an employer’s workers’ compensation insurer is required to either approve or deny a claim within two weeks of the written or actual notice of the injury. If your claim is denied, you must appeal the denial and file a Request for Hearing (Form 33). You should contact an attorney immediately to assist you with filing for a hearing.

Steps after your workers’ compensation claim is denied and a Request for Hearing is filed:

Mandatory Mediation – all cases are referred to a mediation before a hearing date is scheduled. This is an informal meeting between the opposing parties with a neutral third party attempting to help reach a settlement. Each party must submit evidence supporting their claim.

Hearing – Both parties will present evidence proving the initial denial was not correct, including lay witness testimony, medical records, and medical or vocational expert testimony by post-hearing depositions. Once the hearing is over and all the post-hearing evidence is received, the judge will issue a written decision called an Opinion and Award. If the initial judge denies the claim, then the injured employee can file an appeal to the Full Commission for a new decision.

Appeal –. The Full Commission does not take new evidence but reviews the evidence and the decision of the initial judge and then makes a new Opinion and Award.  Any party has the right to appeal the decision of the Full Commission to the North Carolina Court of Appeals.

If you have a Workers’ Compensation claim or have questions about your rights, Daggett Shuler is here to help you. We will be happy to answer your questions. Schedule a Free Case Evaluation. You will only pay an attorney fee if we help you receive benefits or a settlement and the Industrial Commission approves the attorney fee.

At Daggett Shuler, you can depend on us.