NC Workers' Comp Claim Denied - Why would an employer deny a legitimate claim?

Why Would an Employer Deny a Legitimate NC Workers Compensation Claim?
By Kimberly BishopOctober 17, 2017

One of the many issues faced by workers who are injured on the job in North Carolina and in many other states involves unreasonable denial of workers' compensation claims. The Bishop Law Firm represents injured workers in North Carolina and we do not get paid unless we win your case. Call us today for a free case review, (919) 615 -3095.

Workplace accidents can happen despite our best efforts to be safe. Employees can be hurt while performing their job duties even though they have routinely done so for years. You may fall, be struck by a heavy object, or perhaps because you were asked to lift a heavy object, your back “pops” and you can no longer stand or sit without pain.

You inform your employer of your injury and seek medical treatment as instructed for your workplace accident. As an injured employee, you expect your employer's workers' comp insurance will take care of your medical bills and lost wages while you recover. After complying with all requests from the insurance adjuster or nurse case manager, unfortunately, you receive a denial telling you that your workers' comp claim has been denied.

Why would an employer deny a legitimate workers' compensation claim?

Please remember that insurance companies make money off collecting premiums, not paying claims. The insurance adjuster will sift through your medical records and the facts of your accident to find reasons to deny your claim.

For unwitnessed injuries, the workers' compensation insurance company may claim that your accident did not happen or that you really hurt your back at home playing with your children or working around the house. Even if your workplace injury was witnessed by co-workers or your supervisor, your employer’s insurance company may deny your workers' compensation claim if your medical records show a history of health issues or do not fully explain your injury. If you refuse to give information to the adjuster/nurse case manager or do not give a recorded statement, your claim can also be denied.

While the insurance carrier may acknowledge your injury, they may also refuse to authorize the treatment necessary to help you recover. It seems that no one is on your side after your injury! So then, what’s the next step for an NC injured worker with a denied claim?

Steps After NC Workers' Comp Claim Denied

When a workplace injury claim is denied or “controverted” you need to act quickly. Here’s more about what it means when a work injury claim is controverted. Luckily, in North Carolina, like most other states, you have the right to a hearing to demand lost wage benefits as well as medical care, and you may be eligible for penalties if the insurance company is late in making payments as well.

In North Carolina an injured worker can take one of two courses of action after receiving a denial: (1) Either withdraw his/her claim, which means that the injured worker has 2 years from the date of injury to request a hearing to the NC Industrial Commission by filing a NCIC Form 33; or (2) Request a hearing immediately upon receipt of the employer’s denial by filing an NCIC Form 33 with the Industrial Commission.

After you request a hearing with the NCIC, if you are represented, your case will be scheduled for mediation. If your workers' comp claim does not settle at mediation, you case will proceed to hearing. This hearing will take place in front of a Deputy Commissioner with the North Carolina Industrial Commission (NCIC).

The hearing process will involve depositions, testimony and legal briefing. Hiring a NC workers compensation lawyer to represent you at this formal hearing prevents you from walking in alone without the documentation necessary to get your workers' comp benefits.

If your employer or their insurance company has denied your claim, is giving you the runaround, or nothing seems to be happening, you would be well served by seeking legal help from a NC workers’ compensation attorney.

The Bishop Law Firm represents injured workers with denied NC Workers' Comp claims in RaleighCaryFayettevilleDurhamRocky Mount, WilsonSmithfieldLouisburgChapel Hill, Roanoke Rapids, and surrounding areas in North Carolina. We do not get paid unless we win your case, (919) 615-3095. Call us today!

Also read Steps of a NC Worker’s Compensation Claim

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