If your North Carolina workers’ compensation claim is denied, you should file the proper documents notifying the North Carolina Industrial Commission (NCIC) of your intent to appeal. You would then follow additional steps as you navigate the workers’ compensation appeals process. Regardless of the reason for the denial, you can appeal the denial if you disagree with the decision.
It is not uncommon for legitimate workers’ compensation claims to be wrongfully denied. If you think your North Carolina workers’ compensation claim was wrongfully denied, you should act quickly to protect your right to benefits through the appeals process.
In This Article
- You Must Receive a Denial Within 14 Days of Notifying Your Employer of the Injury
- What Happens If My North Carolina Workers’ Compensation Claim Is Denied?
- Why Was My North Carolina Workers’ Compensation Claim Denied?
- How Long do I Have to Appeal a Workers’ Compensation Denial in N.C.?
- Our North Carolina Workers’ Compensation Attorneys Can Help if Your Claim has Been Denied
You Must Receive a Denial Within 14 Days of Notifying Your Employer of the Injury
After you sustain an on-the-job injury, you must submit Form 18 – Notice of Accident to Employer within 30 days of the accident. Once your employer has written notice of the injury, they have only 14 days to notify you that your claim has been denied, according to G.S. § 97-18. In this case, you will receive Form 61 – Denial of Workers’ Compensation Claim.
However, you may also receive Form 63, which provides workers’ compensation benefits while giving the employer up to 90 days to complete their investigation. If you receive this form, your employer has an additional 90 days to deny your claim, or the claim is considered affirmed.
After you receive notice of your denial of workers’ compensation benefits, you should cease communication with both your employer and their insurer and work quickly to appeal the decision.
For a legal consultation, call 828.286.3866
What Happens If My North Carolina Workers’ Compensation Claim Is Denied?
If your North Carolina workers’ compensation claim is denied, you could take the following steps to contest the decision:
- Notify the NCIC of your intent to appeal by filing your claim (Form 18) with the Commission.
- Request a hearing by submitting Form 33 – Request that Claim be Assigned for Hearing with the NCIC.
- Participate in mediation as required by the Commission to attempt to reach an agreement with your employer.
- Wait for the mediator’s recommendation on the matter to be forwarded to the NCIC.
- Prepare for the hearing if you cannot reach an agreement or disagree with the mediator’s recommendation.
- Attend the hearing, where you will present evidence and participate in questioning and cross-examination before an NCIC Deputy Commissioner.
- Wait for the Commissioner to render a decision. Then, you will have 15 days to request an appeal with the three-judge Full Commission if you disagree.
If you disagree with the Full Commission’s decision, you could pursue your appeal through the North Carolina Court of Appeals. If you still disagree with the decision, you could appeal to the North Carolina Supreme Court. However, you may want to consult with an attorney at any point during the appeals process to ensure you follow the proper steps to appeal and protect your workers’ compensation rights.
Why Was My North Carolina Workers’ Compensation Claim Denied?
Insurance companies are well-known for denying legitimate workers’ compensation claims in North Carolina. They may deny your claim for any number of both valid and invalid reasons, including:
- Claims that your injury did not happen because of a workplace accident
- Failure to provide notice of the accident to your employer within the deadline
- Allegations that you didn’t follow the treatment plan provided by your doctor
- Contending that you were under the influence of an intoxicating substance at the time of the accident
- Disputes concerning your injuries
- Claims that the injury pre-existed the accident
- Challenging your employment status by stating you are an independent contractor
Regardless of the reason for denying your North Carolina workers’ compensation claim, you should take quick action to appeal the decision if you think your employer or its insurer made a mistake based on the facts of your case.
How Long do I Have to Appeal a Workers’ Compensation Denial in N.C.?
You can file an appeal once you receive an official denial from your employer. Although you have up to two years to file an appeal, you will want to file your appeal sooner rather than later due to the extensive preparation required for a successful appeal.
Depending on the circumstances of your injury, the reason for the denial, and the strength of your claim, you may need to complete several different steps of appeal.
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Our North Carolina Workers’ Compensation Attorneys Can Help if Your Claim has Been Denied
If you feel your North Carolina workers’ compensation claim was wrongfully denied, you have options to appeal the decision, but you must take specific steps. The workers’ compensation attorneys at Farmer & Morris Law, PLLC, can help with your appeal, taking the proper steps to dispute the decision and fighting for the compensation you deserve.
Call us today at (828) 286-3866 for more information on how we could help you appeal your workers’ compensation claim denial.