What Should I Do If My Workers' Comp Claim Is Denied?

Receiving a denial for a workers' compensation claim can be disheartening and stressful. However, a denial is not the end of the road and you have several options at your disposal to fight back. Let's discuss what you should do if your workers' compensation claim is denied in North Carolina.

What Should I Do If My Workers' Comp Claim Is Denied?

Wondering, "What Should I Do If My Workers' Comp Claim Is Denied" Workers' compensation is a system designed to provide benefits to employees who are injured on the job. However, it is not uncommon for claims to be denied for various reasons. This can leave injured workers feeling frustrated and unsure of their next steps.

1. Understand The Reason For Denial

Your denial letter should include a reason for the denial. This might range from missed deadlines to insufficient evidence proving that the injury was work-related, lack of medical treatment, or a pre-existing condition. Understanding this reason is crucial for your next steps.

2. Consult With An Experienced Workers' Compensation Attorney

Workers' compensation laws can be complex and challenging to navigate. Therefore, it is beneficial to consult with a workers' compensation attorney who specializes in workers' compensation cases. An experienced attorney can provide you with guidance and representation throughout the appeals process, increasing your chances of a successful outcome.

3. File An Appeal

In North Carolina, if your workers' compensation claim has been denied, you have the right to appeal the decision. The first step in the appeals process is to request a hearing before the North Carolina Industrial Commission (NCIC). This request must be made in writing using Form 33, "Request that Claim be Assigned for Hearing," within 14 days of receiving your denial.

During this hearing, you will have the opportunity to present evidence, including medical records and witness testimonies, to support your claim. The deputy commissioner will review the evidence and issue a decision.

4. Request Full Commission Review

If the decision by the deputy commissioner is not in your favor, you can further appeal to the Full Commission. To do this, you must fill out Form 44, "Application for Review," within 15 days of receiving the deputy commissioner's decision. The Full Commission review is generally based on the record of the hearing before the deputy commissioner and the legal arguments made by both parties.

5. Take The Matter To Court

If the Full Commission also denies your appeal, you can take the matter to the North Carolina Court of Appeals. Note that this step may be more complex and time-consuming, but it is the final option within the state.

6. Get Medical Treatment

Despite the denial of your claim, it's crucial to continue receiving medical treatment for your injuries. This can provide more evidence of your condition and its effects on your ability to work. Be sure to keep all your medical records and receipts.

7. Document Everything

From the moment you're injured, documentation is key. Keep a detailed record of everything: your initial injury, all subsequent medical treatments, communication with your employer and the insurance company, and your symptoms and how they impact your daily life. This information can be used as evidence to support your claim.

Contact The Law Offices of John M. McCabe Today

It's worth noting that each workers' compensation claim is unique, and the specific actions you should take can depend on the nature of your case. While this blog post offers some general guidance, it's not a replacement for legal advice. When you're wondering, "What Should I Do If My Workers' Comp Claim Is Denied," always consult with a workers' compensation lawyer. Remember, a denial is not the end of the line, and there are resources and options available to you.