If you were injured at work, you have the right to seek Workers’ Compensation benefits. Sounds simple, right? In reality, the process can be complex. Insurance companies sometimes deny claims or delay treatment approval. Employers may even dispute that your injury happened on the job.
When a claim is delayed or denied, the financial impact can be serious. You may face unpaid medical bills and lost wages while unable to work. As experienced Workers’ Compensation attorneys, we’ve seen many unfair denials — and we’ve helped clients overturn them by knowing exactly what the law requires insurers to do.
Understanding Injured Workers’ Rights in North Carolina
Here are key rights and filing rules that insurance companies often don’t want injured workers to know.
1. You can request an independent medical examination (IME) at any time — even if your claim is denied.
If the employer’s chosen doctor doesn’t fairly assess your injury, you can ask for another opinion. Submit a written request to your employer. They may approve and pay for it, or you might need to pay initially.
If your employer refuses or can’t agree on a doctor, you can ask the North Carolina Industrial Commission to step in. The Commission may order your employer to pay for the second opinion or authorize necessary treatment. For denied claims, you have options under G.S. 97-18(c).
2. The insurance company has 30 days to decide on your claim.
Once you file, the insurer must accept, deny, or ask for more time within 30 days. They can also start payments within 14 days without admitting liability, as outlined in G.S. 97-18.
3. The insurer has 7 days to pre-authorize medical treatment.
If you’re seriously injured, you need quick medical care. The insurance company must approve payment for that care within 7 business days. If they fail to do so, they automatically waive their right to contest the treatment under G.S. 97-25.3, unless an extension is agreed upon.
4. The insurer’s pre-authorization agent must confirm receipt of your request within 2 days.
This confirmation must follow state requirements under G.S. 97-25.3(a)(2).
5. Some treatments don’t need pre-authorization.
These include:
- Emergency medical care
- Diagnosis or treatment of a condition where liability hasn’t yet been determined
6. Insurance companies make mistakes.
Even with systems in place, insurers don’t always follow the law. You have the right to hire a Workers’ Compensation attorney to review your case. If the insurance company or your employer failed to comply with state law, those errors could strengthen your claim.
Injured in a Work Accident in Raleigh?
At Hardison & Cochran, we help injured workers pursue justice in Raleigh and across North Carolina. If your employer disputes your claim or the insurer denies your benefits, we know how to respond and fight for your rights.
Call us today to discuss your legal options. We’ve fought — and won — against large insurance companies on behalf of injured employees. We’re on your side.
Contact an experienced Workers’ Compensation attorney today to get started.
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