Lawyers for Denied Workers' Compensation Claim in North Carolina

Common Reasons for Danied Workers Compensation Claim

Employees who suffer injuries in North Carolina may have the right to receive workers’ compensation benefits such as paid medical care from their employer. Although North Carolina law guarantees benefits for work-related injuries and occupational illnesses, businesses and their insurance carriers sometimes dispute workers’ comp claims.

Some of the most common reasons for a workers’ compensation claim denial include the worker’s employment status, the fact that the employee’s injury or illness did not arise in the course of employment, the untimeliness of the worker’s claim, or the lack of sufficient information to determine coverage eligibility.

However, many injured workers use the appeals process to continue pursuing workers’ comp benefits after an initial denial of their claims, such as filing an appeal with the North Carolina Industrial Commission (IC). Successfully contesting a workers’ comp claim denial may require legal assistance from a knowledgeable attorney.

A workers’ compensation lawyer with Hardison & Cochran can obtain evidence of a workplace accident to support your claim, request an administrative appeal, and advocate for your right to paid medical treatment and wage loss benefits. For over 30 years, our firm has helped injured employees across North Carolina, and we can do the same for you. If you have had your workers’ compensation claim denied, get experienced legal representation to fight for the money and benefits available through North Carolina’s workers’ compensation law.

Contact our office today for a free consultation with a workers’ compensation attorney from Hardison & Cochran and learn more about your options after a denial of your claim.

10 Common Reasons for Denial of Workers’ Compensation Claims

Employees injured at work may find it challenging to understand why their employer denied their workers’ compensation claim. Employers do this for various reasons, and each case is unique. Some of the most common reasons for denial of a workers’ compensation claim include the following:

The Worker Was Not an Employee

Depending on the relationship between an injured worker and a company, the company may deny the injured worker’s claim because the company did not employ the worker. The company might argue that it retained the worker as an independent contractor, gig worker, or volunteer or that the worker works for another business contracted by the company. Typically, an injured worker may only seek workers’ comp benefits from a business or company that employs them.

The Injury Was Not Work-Related

An employer may deny a workers’ compensation claim by arguing that the employee’s injury or illness did not arise in the course and scope of employment. For example, an employee who gets hurt while traveling to work or leaving work to go home may not have the right to workers’ comp benefits. However, injuries that occur in other circumstances, such as while traveling to a client site, an out-of-town work function, or attending an employer-mandated event outside regular work hours, may constitute part of the worker’s employment and entitle them to workers’ comp benefits.

Failure to Report the Injury on Time

North Carolina workers’ compensation rules require injured employees to report a work injury to their employer no later than 30 days after it happens. A worker who waits more than 30 days to report a work-related injury may jeopardize their workers’ comp eligibility.

The Worker Did Not Seek Medical Treatment Promptly

A worker who delays seeking medical attention for a work injury may jeopardize their workers’ compensation claim. When an injured employee does not act quickly to seek treatment, their employer may suspect that the employee’s injury did not occur in the course and scope of employment but rather resulted from non-work-related trauma or a pre-existing degenerative condition.

The Worker Is Already Receiving Benefits for Another Disability

An employer might deny a workers’ compensation claim if it determines that the injury arises from a preexisting injury or disability for which the employee already receives financial benefits through the employer or a group disability insurance plan.

The Worker Intentionally or Recklessly Caused Their Injury

Employers may have the right to refuse a workers’ compensation claim for an injury an employee intentionally inflicts upon themselves. Employers may also deny claims for injuries that arise from the employee’s reckless behavior, such as working while under the influence of alcohol or drugs or engaging in horseplay at work.

The Worker Obtained Unapproved Medical Care

In North Carolina, employers can select the doctor to oversee an injured worker’s treatment. Alternatively, employers may have a list of approved medical providers that workers can select from to seek treatment. An injured worker who obtains treatment for a work injury from an unapproved provider (except for emergency treatment) might have their claim denied by the employer.

The Worker Filed a Claim After Leaving the Company

If an injured worker files a workers’ compensation claim with a former employer after starting a new job, the former employer may try to argue that the injury arose while the worker was at their new job.

Insufficient or Inconsistent Information

Employers or insurers might deny claims if a worker fails to provide sufficient information to prove the compensability of the claim or if the worker’s information contains irregularities. In this situation, a worker might overturn the initial denial of their claim by filing a request for reconsideration or internal appeal and supplying additional information that addresses the deficiencies or inconsistencies in their original claim.

The Employer’s Insurance Company Denies the Claim

Unfortunately, some employers or workers’ compensation insurers may wrongfully deny workers’ claims, hoping that an injured worker will drop their claim so the employer or insurer can avoid liability to pay workers’ compensation benefits.

Related: Top Reasons Why Your Workers’ Comp Claims Are Denied

What To Do When Your Workers’ Compensation Claim Is Denied?

If your initial claim for workers’ comp benefits was denied, you may still have options for pursuing the benefits you need for your injury. You can take the following steps to prepare to challenge the denial of your workers’ compensation claim:

  • Review the denial letter you received from your employer or the insurance company. The letter will explain the reason(s) for denying your claim. Understanding why your employer or the insurer denied your workers’ compensation claim will help you prepare a strategy to contest the denial of your claim.
  • Gather additional information and records that support your workers’ comp claim, including any documents that supplement the basis of your claim or refute the employer’s or insurer’s reasons for denying your claim.
  • Continue treating your work injury. If you stop treatment or rehabilitation, you might give your employer or the insurance company a basis to argue that you’ve recovered from your injury.
  • Gather copies of your medical records and pay stubs, to document your injuries and calculate the lost wage benefits you may receive.

An experienced workers’ compensation lawyer can help you understand the appropriate steps to take. Contact a workers’ comp lawyer with Hardison & Cochran as soon as possible to discuss the steps you can take to pursue workers’ comp benefits. These steps could involve pursuing formal workers’ compensation proceedings with the North Carolina Industrial Commission.

Deadlines for Filing Your Workers’ Compensation Appeal

If you’ve suffered a work-related injury or illness, you should familiarize yourself with the deadlines for filing a workers’ comp claim. You must report your on-the-job injury to your employer within 30 days of getting hurt. You should forward written notice of your injury or illness to your supervisor or employer’s human resources department.

You must also file a formal claim with the North Carolina Industrial Commission within two years of the date you suffered your work injury or illness. If you file your claim form after this deadline, you risk losing your right to pursue your claim with the IC.

After pursuing a formal hearing with the Industrial Commission, you will receive a determination letter approving or denying your workers’ comp claim. If a Commissioner has denied your claim, or if you wish to contest some part of the Commissioner’s ruling, you must file a request for reconsideration by the Commissioner or an appeal for rehearing before the entire Industrial Commission within 15 days. If a Commissioner denies reconsideration or the Industrial Commission upholds the denial of your claim on appeal, you have 30 days to send the Industrial Commission a notice of appeal to the North Carolina Court of Appeals.

How to Choose a Workers’ Compensation Lawyer in North Carolina

If your employer has denied your claim for workers’ compensation benefits, you need a workers’ compensation lawyer to help you fight back and contest the denial of your claim. Choosing the right attorney can make a significant difference in the outcome of your NC workers’ compensation claim and the benefits you receive. Navigating the workers’ comp system can be challenging, but you don’t have to do it alone.

For over 30 years, our experienced legal team at Hardison & Cochran has advocated for the rights of injured workers throughout North Carolina, and we can do the same for you. Our Raleigh workers’ compensation lawyers have the experience, resources, and skills to help you pursue the benefits you deserve. Contact our office today for a free case review with a workers’ compensation attorney.