What Happens If My North Carolina Workers’ Compensation Claim is Denied?
If you get injured at work in North Carolina, there are specific steps you need to follow. First, it’s important to report the injury to your employer. After that, you should fill out a form called Form 18, also known as a “Notice of Accident.” This form needs to be submitted to the North Carolina Industrial Commission. You should also send copies of the form to your employer and the company’s Workers’ Compensation insurance carrier.
Once you file the claim, the Workers’ Compensation insurance company representing your employer will create a file for your case. They will then start investigating the claim to determine if it qualifies for compensation. A compensable claim means that your accident and injury are covered by the Workers’ Compensation Insurance.
After investigating all the details of the accident and injury, the insurance company will ultimately decide whether to accept or deny your Workers’ Compensation claim. If they choose to deny the claim, they will submit a Form 61 to the North Carolina Industrial Commission. This form will explain the reasons for their denial.
In a situation where your claim is denied and you still want to pursue benefits, you will need to request a hearing with the North Carolina Industrial Commission.
Once the hearing is requested by either you or your legal representative, a mediation will be scheduled. In North Carolina, mediations are mandatory before appearing in front of an Industrial Commission Deputy Commissioner.
If the denied claim doesn’t reach a resolution during mediation, within 2-3 months, the claim will likely proceed to a hearing in the county where the injury occurred.
During the hearing, a Deputy Commissioner will listen to testimony from you, the injured employee, as well as any witnesses you provide. It’s also likely that they will hear testimony from the medical professionals who treated your injury.
Once all the testimony is heard, the Deputy Commissioner will make a final decision, either deeming the claim compensable or not compensable.
The next steps in the claim process depend on whether either party decides to appeal the decision. If an appeal is made, the claim will continue in the legal process.