Workers’ compensation provides financial settlements to employees injured on the job. This type of compensation can ease an individual’s financial burden after an injury, which typically includes medical expenses and lost wages. These settlements cover medical costs and can provide up to $1,184 a week in lost wages.
Workers’ compensation claims aren’t always approved, though. A workers’ compensation claim can be denied for a variety of reasons. Knowing the potential reasons for denial is useful; it can provide you with insight into the claim approval process, and help you prepare for filing a claim. These are the 7 most common reasons workers’ compensation claims are denied in N.C.
You Didn’t File Your Claim on Time
Workers’ compensation claims are time-sensitive. In North Carolina, you are required to report the injuries associated with your claim within 30 days. Failure to comply with the deadline could jeopardize your case, and result in a denial.
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You Are an Independent Contractor
The North Carolina Industrial Commission (NCIC) notes that employers are not exempt from providing workers’ compensation, even if they consider their employees as independent contractors. In disputed cases where an employee’s employment status comes under question, the NCIC will review their scope of employment. The NCIC will have the final say on whether a person is an independent contractor or employee. During a review, they’ll examine:
- How involved the employer is in the contractor’s work
- Any other factors relevant to the case
However, there are specific situations where independent contractors are not covered by workers’ compensation. Truckers that meet the following criteria are typically not the responsibility of their employer:
- They personally operate their vehicle
- They are individually licensed by the U.S Department of Transportation
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Your Injury Didn’t Occur at Work
Workers’ compensation is relegated strictly to accidents that occurred in the workplace. Accidents that occurred outside of work don’t make you eligible for workers’ compensation. The National Safety Council reports that common work injuries include:
- Exposure to radiation, noise, or electricity
- Injuries from repetitive motion or overexertion
- Contact with work equipment, like a meat slicer, or handsaw
Workers’ compensation coverage can be disputed, though. If you believe that your injuries warrant coverage you can initiate an appeal or mediation. You’re entitled to legal representation during these processes.
Your Injury Didn’t Stem From a Specific Accident
The North Carolina employee handbook notes that “an injury that occurs while performing regular job duties in the usual and customary manner is not covered”. This clause means that injuries that didn’t stem from a specific accident may not be covered by workers’ compensation.
There are a few caveats to this rule, though. They include:
- Back injuries: Back injuries don’t need to be linked to a specific accident. They must have occurred within a set window of time, though.
- Hernias: Hernias can be covered by workers’ compensation if they meet eligibility requirements, regardless of if they stemmed from a specific accident or not.
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Your Accident Involved Inebriation
Accidents involving inebriation are not covered by workers’ compensation in North Carolina. The relevant statute states that no compensation is payable to a claimant if:
- “His intoxication, provided the intoxicant was not supplied by the employer or his agent in a supervisory capacity to the employee”.
- “His being under the influence of any controlled substance listed in the North Carolina Controlled Substances Act, G.S. 90-86, et seq., where such controlled substance was not by prescription by a practitioner”.
Your Employer Disputes Your Claim
Employers can dispute workers’ compensation claims. These disputes can occur for a variety of reasons. Your employer may:
- Doubt that you were injured at work
- Not believe that your injuries were serious
- Dispute your status as an employee, and suggest that you’re an independent contractor
Disputes are typically settled through the mediation process. During mediation, a selected or appointed mediator will oversee the dispute. Both parties involved in mediation can have a say in mediator selection. The NCIC notes that between 70% to 75% of mediations end with a settlement.
Your Employer Isn’t Carrying Workers’ Compensation Insurance
Failure to carry workers’ compensation insurance can complicate claims. In North Carolina, businesses with three or more employees are required by law to carry workers’ compensation insurance. Failure to do so can result in the following penalties:
- Stiff fines
- A Misdemeanor charge
- A felony charge
If your employer isn’t carrying workers’ compensation insurance, you should report this breach of conduct to the NCIC immediately. Injured claimants whose employer is in violation of insurance regulations can submit Form 18 and Form 33 to the Commission. Form 18 acknowledges the presence of a workplace injury, and Form 33 is a hearing request.
Speak With a Workers’ Compensation Attorney
If your workers’ compensation claim was denied, we can help. Our team can guide you through mediation or the appeals process. We’ll ensure that you meet all your relevant deadlines.
Workers’ compensation claims involve a thin margin of error. You’ll need to effectively communicate with both your employer and their insurer. This process is time-consuming and stressful. We can manage your case so you can get some much-needed rest. We’re available 24 hours a day seven days a week. Call our offices for a no-obligation case review. You’re entitled to legal representation.